Threat and protection: Boundary-making, categorization and identification in pandemic preparedness and response

In April 2009, the World Health Organization (WHO) declared influenza A H1N1 a public-health emergency of international concern. This event was especially significant for marking the first pandemic outbreak to fall under 2005’s new International Health Regulations, an ambitious binding agreement to regulate international health. Since then, other communicable diseases have provoked similar international responses, with Ebola and Zika among the latest examples. Each of them has occasioned scrutiny of the ability of national and international health organisations – the WHO among them – to handle health threats and emergencies situated at global level. Among the issues recurrently rearing their head amid controversy are uniformity in enforcement of international regulations across contexts, promotion of specific lines of research, rapid development of new drugs, the management of local and international health-care workers’ activities, and engagement with local populations. One of the main ways in which health organisations respond to the uncertainty generally associated with pandemic threats is through biopreparedness policies – policies that articulate response and resource management mechanisms before a pandemic event is declared or even before its characteristics are known. The thesis examines the discourses and practices of institutional and scientific actors, for greater understanding of how knowledge is constructed and later carried into implementation in such conditions of uncertainty.

The focus is placed on processes of boundary-making, categorisation, and identification. The analysis of how health and scientific institutions identify, categorise, and describe the various human and nonhuman actors involved in pandemic events employs theoretical tools from science and technology studies, Foucauldian approaches, and understandings of the more-than-human in the social sciences. These shed light on the boundaries, categories, and identities at play during pandemic processes as shared among the many humans, animals, and molecular forms of life involved in pandemic events. The approach of assemblage ethnography is engaged with as an aid to navigating digital and material networks of public health from an empirical perspective. Public documents, interviews with public-health professionals, and field visits linked with diverse international organisations are used in combination with items of scientific news and articles from various journals to illuminate how pandemic threats and emergencies unfold.

The empirical work suggests that knowledge-making in institutional and scientific settings always involves notions of threat and protection. In the material analysed, there is a tendency to identify and categorise a given actor as threatening, vulnerable (in need of protection), or expert (able to protect). This argument is unfolded in tandem with discussion of three, interconnected areas of focus in pandemic preparedness and response wherein boundaries are made: 1) the establishment of governmental stand-by networks, 2) knowledge-making and knowledge distribution practices, and 3) the conceptualisation and governance of threatening life.

Each of these areas connects with one of the three main lines of analytically grounded argument. Firstly, institutional boundaries are challenged in efforts to construct more prepared governmental networks that are able to protect societies from pandemic threats and emergencies. As these networks emerge mostly in a context of uncertain and virtual threats, they impose a need for threats’ identification and characterisation. Secondly, practices of making and distributing knowledge are productive in that they determine the boundaries between expert, vulnerable, and threatening assemblages, creating differentiated communities by regulating who can produce knowledge and who may access it. The third main area of discussion involves how, from a governmental perspective, certain life forms (both human and nonhuman) come to be identified as hybrid threats because of its sociotechnical interactions. Such hybridity is a key element for the design of pandemic governance and response measures. Accordingly, the way in which actors are categorised in terms of threat, vulnerability, and expertise is defined with regard to their engagement with elements such as space, technology, nationality, and gender.

The thesis concludes with discussion of three ways in which boundary-making, categorisation, and identification processes interact with pandemic preparedness and response: 1) by shedding light on the establishment of more-than-human modes of pandemic governance; 2) by drawing attention to the need for portable, permeable, and flexible boundaries between threat and protection; and 3) by considering how boundary-making reinforces intersectional inequalities in international health. These conclusions point to a need to incorporate, from both an academic and a policy perspective, alternative pandemic narratives that pay heed to the intersectional, changing, and situated definitions of threat and protection.