The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

The concept of ?health security? has been increasingly apparent in recent years in both academic and policy discourses on transborder infectious disease threats. Yet it has been noted that there are a range of conceptualisations of ?health security? in circulation and that confusion over the concept is creating international tensions with some states (particularly from the Global South) fearing that ?health security? in reality means securing the West. This article examines these tensions but puts forward an alternative explanation for them. It begins by looking at the different ?health securities? that characterise the contemporary global health discourse, arguing that there is in fact a good deal more consensus than we are often led to believe. In particular there is a high level of agreement evident over what the major threats to ?health security? are and what should be done about them. These are a particular set of health risks which are primarily seen as major threats by Western developed nations, and contemporary global responses ? often couched in the language of global health security ? have a tendency to focus on containment rather than prevention. The article makes the case that to resolve the tensions around (global) health security there is the need for a more explicit recognition of the primary beneficiaries of the current system, and of who is bearing the costs. Only following such a recognition can meaningful debates be carried out about the appropriate prioritisation of global health security in relation to other global health governance priorities.preprintPeer reviewe

This article uses an analysis of the securitization of HIV/AIDS as a basis for proposing three contributions to securitization theory. Beginning with an examination of some of the key debates which have taken place between the Copenhagen School and its critics, the article goes on to argue that the process of securitizing HIV/AIDS was in fact significantly more complex than has been generally recognized and, crucially, that a more nuanced reading of this case highlights a number of issues that are not well captured by the existing securitization theory literature. The first is that securitization can be a multi-level process, with distinct securitizing actors and audiences at each level. The second is that securitization can best be understood as a continuum rather than a binary condition, and that different members of an audience may place an issue at varying points along this spectrum. The third contribution we seek to make is an intervention in the debate over the role of empirical evidence in securitization, suggesting that claims about 'empirical reality' form a crucial part of securitizing speech acts, but that where doubts subsequently arise over the evidence for this 'reality', securitization can be undermined, a dynamic that we show in practice in the HIV/AIDS case.

The study of global health governance has developed rapidly over recent years. That literature has identified a range of factors which help explain the ?failure? of global health governance, but it has largely neglected the global public policy processes which perpetuate that failure. In this paper we argue that there is such a thing as ?global health policy? and set out a new framework for analyzing the processes through which it is made, highlighting the mixture of power and ideas, agency and structure, which impact upon the policy cycle. The framework rests upon four pillars: framing; paradigms; power; and the ?deep core? of neoliberalism. Through integrating insights from a range of literatures, in particular from the global health governance and public policy analysis fields, we seek to enrich the conceptual basis of current work on global health governance.preprintPeer reviewe

Research funded under ERC Ideas grant 230489 GHG Volume 7, Supplement 2, 2012 Special Issue: Framing Global Health GovernanceWith the emergence of global health comes governance challenges which are equally global in nature. This article identifies some of the initial limitations in analyses of global health governance (GHG) before discussing the focus of this special supplement: the framing of global health issues and the manner in which this impacts upon GHG. Whilst not denying the importance of material factors (such as resources and institutional competencies), the article identifies how issues can be framed in different ways, thereby creating particular pathways of response which in turn affect the potential for and nature of GHG. It also identifies and discusses the key frames operating in global health: evidence based medicine, human rights, security, economics and development.Peer reviewe

HIV/AIDS is one of the greatest single causes of death and suffering on the planet. Over the last decade the societal impact of HIV/AIDS has been widely discussed in terms of national and international security. This article assesses the securitizing move and suggests that HIV/AIDS was only partially securitized at best and both the political consensus and strength of evidence were overestimated. It argues for greater nuance in our understanding of the link between HIV/AIDS and security, and the effects of its securitization, suggesting that neither is straightforward, and both are subject to case sensitivities.

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It is often said that "diseases know no borders," but COVID-19 has once again shown that policy responses certainly do. Governments have implemented bordering practices in a variety of ways to ensure that their own citizens are protected, even when in direct contravention to the International Health Regulations (IHR) of 2005. The IHR and the World Health Organization (WHO) have a strong preference for borders to remain open. Yet, we argue here, non-compliance by WHO member states is not the only problem with the IHR's treatment of borders. Bringing insights from critical border studies and exploring the varied ways in which the response to the COVID-19 crisis has been "bordered," we argue that a much broader understanding of "borders" is required in the IHR and by the WHO, given that much of the exclusionary bordering we find takes place away from physical points of entry.