How global is global health security? Subaltern agency in international regimes of infectious disease control

Recent outbreaks of Ebola, Zika, and COVID-19 have transformed global health security into a critical area of international relations. Yet the rise of global health security in the twenty-first century has also been a source of tension, principally with respect to a widespread and enduring perception that it fundamentally prioritises the interests of Western actors, further entrenching the marginalization of the global South in world politics. This thesis mobilises growing interest in post-colonial, and decolonization, theories to advance a post-colonial analysis of global health security. Adopting, and adapting, the concept of fragments, originally described by Edward Said as central to the methodology employed to construct the Orient, this thesis examines three foundational domains of global health security (GHS) through a post-colonial heuristic. These domains are: 1) the discursive securitization of health, 2) the governance regime of global health security, and 3) the political economy for developing medical countermeasures. This thesis reveals the existence of colonialities of power, knowledge, and being, and concurrent expressions of subaltern agency within the GHS regime. The thesis shows that subalternity is gradated, the degree and way in which actors in the global South exert agency in a GHS context being influenced by a range of factors. Expressions of subaltern agency through GHS discursive processes may be increased in local and regional settings, notably with respect to public health priority setting and knowledge production. At an international level, subaltern agency and influence has been increased, facilitated by the equalising effects of global GHS institutions. Finally, when possessed of sufficient leverage, subaltern actors have sought to directly challenge entrenched power asymmetries and inequities that permeate GHS. Through the identification and examination of these expressions of agency this thesis finds, more broadly, that subaltern actors have significantly shaped the knowledge, strategies, and practices of contemporary GHS.