Plan of the Book

In chapter 1, I offer a historical exploration of relations between state and society in the context of contagion, ranging from Thucydides' observations to relatively recent times. The purpose here is to expose the reader to the utility of the historical record as a means to inform modern inquiries in the social sciences. Disease has historically generated negative effects on various societies, ranging from economic and social destabili-zation to rampant stigmatization and inter-ethnic violence, prompting draconian reactions by the state against its own people to enforce order. In that chapter I also illustrate the principle that infectious disease has long been perceived as a distinct threat to stability, to prosperity, to the material interests of elite factions, and therefore to the security of the state. This serves to place the current debate as to whether disease should be "securitized" in its proper historical perspective.

In chapter 2, I analyze the effects of the influenza pandemic of 191819 on various affected societies. In the domain of demography, the chapter illustrates the differential mortality generated by the waves of contagion that swept the planet. The chapter then examines the possibility that the pandemic affected the various combatants in World War I in different fashions, based on the statistical data presented herein. Previously unpublished data from German and Austrian archives reveal the malign effects of the virus on the military forces and the people of the Central Powers during this period. Analysis of the data suggests that the epidemic eroded the Central Powers' capacity to continue the conflict, and that it may have accelerated their capitulation and/or disintegration. The data presented herein also raise the possibility that the first serious episode of influenza-induced mortality occurred in Austria in the spring of 1917, not in the United States in the spring of 1918. Finally, the chapter briefly addresses the Swine Flu affair and the shortcomings of the United States' preparedness for another lethal pandemic.

Chapter 3 constitutes an analysis of the deleterious effects of HIV/ AIDS on intra-societal relations, the capacity of state institutions, and the relations of the state to society in the context of the contagion. In that chapter I examine the worst-case scenario of Zimbabwe and juxtapose it against the scenario of Botswana, where, despite similarly high levels of contagion, state-society relations remain benign and the state retains its cohesion. The chapter examines the demographic implications of HIV/AIDS, and in particular the issue of AIDS orphans and their potential for radicalization. Using a human-capital approach, I then analyze the effects of HIV/AIDS on economic productivity (at the micro, sectoral, and macro levels) and the virus' possible effects on foreign investment. Subsequently, I examine the effects of the pathogen on the domain of governance, articulating the direct negative effects of HIV/ AIDS on the institutions of the state, such as the military, police forces, and the bureaucracy. Finally, I chronicle the Zimbabwe government's draconian response and abuses of power, which have coincided with the epidemic, and collectively undermined societal prosperity and cohesion.

Chapter 4 is an investigation into the effects of a prion-induced contagion, bovine spongiform encephalopathy (BSE), and its human variant, Creutzfeld-Jakob disease. In both Europe and North America, the BSE affair is associated with questions about the efficacy and legitimacy of the scientific community and about the government institutions that are entrusted with safeguarding the public interest. In this chapter I also analyze the economic impact of these cases and explore how the North American cases generated externalities that continue to undermine the United States' relations with Japan and South Korea. I highlight problems of miscalculation of risk, question assumptions of rationality by individuals and states, and note the significant role of emotion (fear and anxiety). Further, I examine the role of BSE in generating rapid institutional change at both the domestic and the international level, and I analyze BSE's effects on cooperation between sovereign states.

In chapter 5 I deal with the SARS contagion of 2002-03, which resulted from the emergence of a novel coronavirus in southern China late in the year 2002. I detail the peculiar etiology of the virus and its subsequent demographic impact. I also note the central role of fear and anxiety in undermining social cohesion, international markets, and the irrational behavior of many sovereign states in the face of a new pathogen. I then examine the effects of SARS on governance in China and Canada, and on regional governance in Pacific Rim countries. Finally, I examine the claim that we have entered a "post-Westphalian" era of global health governance.

In chapter 6, I analyze violent conflict and war as "disease amplifiers." I examine the mechanisms by which inter-state and intra-state conflict contribute to the dissemination of existing pathogens and to the emergence of novel microbial agents. I then examine the interaction between conflict and individual pathogens as documented in the historical record. I utilize data regarding the incidence of multiple pathogens and their effects on mortality and morbidity culled from US, German, and Austrian government archives for the period of World War I (1914-1918), and the role of civil wars in the propagation of disease.

In chapter 7, I briefly examine the proposition that health contributes to economic productivity, which then bolsters the power of the state and facilitates the projection of power (martial and ideological). I chronicle the nascent debate on health security and critique the existing literature. I then argue that significant pathogenic threats to health constitute both a direct and an indirect threat to national security. Further, I argue that the existing "health and security" debate is excessively myopic, insofar as most of the current discourse focuses exclusively on HIV/AIDS, and that as a result the discourse is profoundly anti-historical. Moreover, this debate in political science reveals a truncated understanding of the history of public health, and of health's effects on state-society relations. Finally, I suggest a mechanism by which security theorists may assess the threat that a specific pathogen presents to a specific state.

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