By Hylke Dijkstra and Anniek de Ruijter

It has long been recognized that public health may affect security and vice versa. The use of chemical and biological weapons by terrorists and enemy states presents a serious security threat, which can put public health infrastructures under pressure. Pandemics and epidemics – from the 1918 Influenza to HIV/AIDS and Ebola – can disrupt societies, undermine development and cause conflict.

Inter- and intra-state wars can cause displacements, which in turn affect the provisions of humanitarian assistance and public health. Pandemics are more likely to emerge in conflict zones where institutions are weak. The human security paradigm and the notion of “freedom from want” dedicate a central role to health security.

Traditionally, the EU has been a strong supporter of multilateral policies that address security and public health concerns. Yet relevant policies have largely developed in parallel. In recent years, however, we have witnessed an emerging nexus between public health and security policy.

Following the 9/11 terrorist attacks, the EU has adopted a series of sectoral policy strategies that recognise the interaction between public health and security. On the basis of the Lisbon Treaty, the EU adopted a Decision on Serious Cross-Border Threats to Health in 2013 to “bridge the policy fields of health and security”. And The EU Global Strategy of 2016 calls for a truly “integrated approach” spanning across policy areas and overcoming the internal-external dichotomy.

In a recent special issue of the European Journal of Risk Regulation, we try to make sense of these developments. We describe the increasing interaction between public health and security policies in the EU and we discuss the drivers behind this development. We also call for a research agenda on this topic.

Throughout the articles in the special issue, we notice that the integrated approach is often presented in terms of effectiveness. It is generally assumed that coordination and collaboration results in a more coherent EU approach to contemporary problems. Yet a key question for effectiveness remains whether there is any more to the integrated approach than solely coordination between the actors in the field of public health and security.

A truly integrated approach involves a reallocation of competences, the breaking down of barriers, and adequate resourcing. One also wonders whether this is desirable. For instance, the dichotomy between external and internal security in Europe exists for very good reasons and we may not want to break down the existing constitutional and legal order. If an integrated approach does not go further than coordination, we question whether it does not raise unrealistic expectations.

One can also ask questions as to what implications a security-health nexus has for the assignment of resources. For instance, the focus on possible health security threats may lead to a more short-term focus on policy, particular also with regard to external-development public health priorities, and take attention off ongoing and more durable public health prevention programmes that that may be more deserving in terms of morbidity and mortality.

Apart from questions over effectiveness, we see a number of possible trade-offs with respect to legitimacy. In the field of public health there is a long-standing discussion about balancing public health and individual rights. Indeed, choices regarding quarantines or mandatory vaccinations have long been part and parcel of public health. The HIV/AIDS pandemic showed that when disease becomes part of a different paradigm – in the late 1980s HIV/AIDS discussions revolved around the criminalisation of disease carriers as different members (criminals) of society – the effects can lead to serious fundamental right infringements.

Another possible trade-off concerns the central role of civil society in public health versus the state-run monopoly on security matters and the use of force. These may be difficult to reconcile with all the significant consequences. For instance, while openness and transparency are relevant in public health, security matters are often covered by a cloak of secrecy.

Finding middle ground, in such respects, will likely be sub-optimal from both perspectives. These fundamental trade-offs both in terms of effectiveness and legitimacy currently receive insufficient attention in all the talk and increasing practice of an integrated approach. This makes further academic research on the emerging health-security nexus and the EU all the more relevant.

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