Conclusion

The complex linkages between public health and conceptualizations of power and security are ancient. They constitute an important historical tradition of republican political thought, having originated during the halcyon days of the Athenian Empire and having enjoyed their heyday from 1348 until the development of antibiotics in the early decades of the twentieth century.1 Thus, contemporary debates regarding the supposedly recent "securitization" of health issues ignore such historical context.2 This ignorance of the role of health as a central material-contextual factor obfuscates the relationship between disease, its impacts on society, and the evolution of the sovereign states of Europe. These polities clearly perceived pathogens as profound threats to their material interests, their power, and often their survival.

In view of the profound importance of material-contextual factors in republican thought, I propose a "broadening" of the modern conceptualizations of national security to include non-anthropocentric threats such as environmental destruction, migration, and naturally occurring epidemic disease. Thus, I argue for an analytical focus on "threats" as opposed to "enemies." Such threats may manifest in the form of either temporally constrained events (e.g., the SARS epidemic) or attenuated processes (e.g., the HIV/AIDS pandemic). This distinction is crucial because humans exhibit a psychological tendency to focus on the former, and to ignore the latter, despite the fact that processes may generate powerful long-term negative outcomes for human societies.

Pathogens may constitute a threat to national security through direct and/or indirect impacts on the material interests and the apparatus of the state, which may be moderated to a significant degree by societal and/or contextual factors. The threat presented by contagion is often pathogen-specific, as different pathogenic agents will present variable levels of threat depending on the immunity of the population, the vectors of transmission, and the adaptive capacity of the specific polity involved. Thus, rather than asking whether HIV/AIDS represents a threat to national security, one should ask "Under what specific conditions (viral clade, seroprevalence rate, degree of state capacity, degree of social capital) might HIV/AIDS represent a national security threat to a specific polity (such as Zambia)?" Indeed, I argue specifically that an entire range of infectious diseases, primarily those that kill and debilitate the very young and the very old, are not threats to national security per se, although they would certainly constitute issues of human rights and threaten human security. Measles may be a profound issue of human rights, and of economic development, but it does not typically generate mechanisms (demographic, economic, psychological) that undermine the security of the state.3 Excessively broad categorizations wherein all pathogens are designated as threats to national security must be eschewed because they obfuscate coherent analysis, and because they undermine the credibility of the argument.

What, then, of our original hypotheses about the relations between contagion, the dynamics of state-society interaction, and effects on international governance? The balance of evidence suggests that the following preliminary conclusions may be drawn at this time, as per the domain specified below.

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