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Michel Foucault refers to biopolitics as “the processes by which human life, at the level of the population, emerged as a distinct political problem in Western societies”. Yet for Foucault, ‘biopower’ – power over human life at the population level – remains a force strictly wielded via individuals. This neglects the global biopower wielded by biology itself. Given the sheer influence of disease on global politics, we must move to considering ‘international biorelations’: a study that recognises diseases as significant non-state ‘actors’ shaping geopolitical landscapes and giving rise to critical, yet often neglected, transstate dynamics. Doing so would help us capture the co-constitution of global health forces and international structures, reveal the limitations of state-centric IR scholarship, and better understand the international system itself.

Man, the State, and Disease

The history of IR scholarship paints a picture in which global health is a nascent afterthought. While war is oft-situated as a by-product of the human condition – the continuation of politics by other means” – health is generally perceived as a domestic issue. Realists trace the origins of IR to Thucydides’ 5th century BC History of the Peloponnesian War, while conceptual histories of transnational or ‘global’ health are claimed to begin with European colonialism or the scientific developments of the nineteenth century. As a discipline, IR gained traction in the 1930s with Carr’s The Twenty Years Crisis, yet the link between securitization and health only began to take hold in the 1990s with the UNDP’s notion of ‘human security’ and the seminal 1997 text: Security: A New Framework for Analysis.

Something is a little perverse about this framing, given that infectious disease is the largest killer of humans throughout history. In the 20th century, smallpox alone killed 300-500 million individuals. The history of international relations is thus not solely one of war of all against all”, but also one of war of all against disease – in which humans have been the clear loser.

The sheer deadliness of disease has been critical to shaping political and economic outcomes. The Black Death is arguably the “largest demographic shock in European history”. Disease was responsible for killing up to 90% of the indigenous Native American population after the arrival of European settlers.  In Africa, the spread of AIDS is crucial to explaining variation among states’ governance systems and political outcomes. For example, AIDS posed a significant challenge to African neoliberalism in the 1990s, while magnifying the North-South divide. We are still experiencing the political and economic after-effects of the COVID-19 pandemic, which made it blatantly clear that the war against disease is ongoing. Crucially, given the amplifying forces of globalisation, industrialisation, and climate change, we should note that pandemics will become more frequent over time.

It should go without saying that disease knows no borders and domestic interventions are insufficient. For this reason, disease prevention represents one of the earliest forms of international cooperation and policy diffusion. A proto example of policy diffusion is the spread of quarantine practices in Europe during the 14th century. Following the widespread consensus on Germ Theory, the first international sanitary meetings took place in 1830 and 1866 in response to Cholera epidemics.

In the same way that realists frame anarchy – the absence of a sovereign power to control the behaviour of states – as a force that arises from the human desire for security which then constraints the actions of states, transnational health is a force that arises out of the human desire for security which then demands transstate cooperation. COVID-19 brought significant attention to the importance of global health cooperation, but its recency means that not much attention has been paid to how its emergence, transmission dynamics, and the resultant global shocks were caused by – and continue to shape – the structure of the international system itself. Ultimately, we need to move towards a more rigorous study of the co-constitution of global health forces and the international system: the study of international biorelations.

The True Promise of Non-State Institutions

To explore the co-constitution of health issues, health cooperation, and the structure of the international system itself, we can begin by looking at a key example of international biorelations with substantially more history than the COVID-19 pandemic: the structural features of public health that give rise to the primacy of non-state actors, such as philanthropic foundations in the international system.

One dominant account of why the state is the central unit of organisation in the international system is the inherent efficacy of the state as an organising compared to other polities, a case famously argued by Charles Tilly. For example, centralised states have a clear comparative advantage over city-states or fractures empires in organising a military. But what about states against diseases?

Disease knows no borders; hence effective mitigation requires bilateral or multilateral cooperation at the very least. Mitigating diseases is also served by on-the-ground development, information-sharing, and implementing technical solutions on top of enforcing appropriate legislation. Not only can institutions such as philanthropic foundations play a key role in such multilateral efforts; they are often unique in their ability to flexibly raise funds, and removal from the machinations of international politics.

It should not surprise us, then, that philanthropy underpinned some of the earliest forms of global health cooperation. The Rockefeller Foundation was founded in 1913 to promotepublic sanitation and the spread of the knowledge of scientific medicine, notably before the establishment of the League of Nations Health Organisation in 1920. We should not be surprised that 65% of international financing for malaria programs occurs through the privately launched Global Fund. Non-state actors such as philanthropic foundations are uniquely well-placed to deal with the structural features of disease – namely, the global impact of disease and the necessity for transstate countermeasures. However, this amplifies power dynamics within both the international system and national health systems, as philanthropic foundations themselves accrue power. It is precisely because of their structural role in responding to transnational threats such as disease that philanthropic foundations are able to exert an undue influence on foreign policy and even cultural hegemony through the sponsorship of civil society institutions.  This could have serious consequences for predictions on the future of health cooperation and the future role of philanthropic foundations more broadly.

Biotechnology Among Nations: The Confounder of Power and Peace

The inherently transstate nature of pathogens has significant implications for their weaponisation. Advances in biotechnologies mean that bioweapons are potentially extremely deadly, increasingly accessible, and well within the scope of known malicious actors. Additionally, the risk of lab leaks represents an increasing threat to international security. This raises a key question: what can, and should, transstate cooperation to limit the impact of biotechnologies look like?

Biotechnology cooperation initiatives such as the Biological Weapons Convention – designed to regulate and prevent bioweapon proliferation by states – are less-staffed, less-funded, and less able to verify compliance than its counterparts such as the Chemical Weapons Convention or International Atomic Energy Agency. We might be tempted to think that biological weapons are simply less of a threat than chemical and nuclear weapons. Yet, a closer examination of the properties of bioweapons highlights that (i) the dual-use nature of biotechnologies makes verification exceptionally difficult; (ii) biological substances are easier to access than chemical and nuclear weapons, particularly by non-state actors, and (iii) many of the most concerning advances in biotechnology are very recent. Additionally, (iv) bioweapons are exceptionally difficult to control and can lead to catastrophic outcomes, though this has not stopped organisations from tryingand succeeding – to deploy them.

The above factors combine to make bioweapons a uniquely heavy-tailed threat: one in which unlikely, hard-to-mitigate outcomes driven by non-state actors represent a disproportionate share of the threat landscape. Although this type of heavy-tailed threat has received attention in the context of cybersecurity, the rationalist logics of international security give us little theoretical understanding of the most likely – let alone the most effective – forms of cooperation for threats of this nature. It may be the case we should expect the failure of pre-emptive cooperation over such heavy-tailed threats, and we should note that bioweapons are not unique in this sense. From worst-case-scenario climate change to threats from novel technologies such as artificial intelligence, we observe heavy-tailed dynamics elsewhere. Studying international biorelations may provide us with insights into these dynamics and highlights how interplays between disease and security can give rise to complex patterns and dynamics we are almost certainly neglecting.

Towards a Theory of International Biorelations

International biorelations illuminates how global health gives rise to structural patterns of cooperation, reveals the importance of non-state actors and transstate dynamics in the international system (such as global philanthropy), and illuminates neglected dynamics in the international system such as cooperation over heavy-tailed threats – and this a mere starting point. Given the immense role disease continues to play in shaping the course of human history and the importance of effective global health cooperation, IR scholarship owes it to the world to move beyond state-centrism and closely examine the complex interdependencies between humanity and disease.


Note: This article reflects the views of the author and not the position of the DPIR or the University of Oxford.



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