UCSF

This dissertation examines the emergence of biological threats and public health preparedness in the United States. The principal aims of this research revolved around tracking the ways in which pathogens and diseases have come to be understood as dangerous both to populations and to the state, as well as how responses to these dangers have been rendered thinkable and "actionable."

There were three research sites, including: 1) the US Congress, where biological threats were articulated largely within the Congressional committee hearing setting; 2) the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices, which collectively contributed to thinking about a specific biological threat, smallpox, around the turn of the century, feeding into the ill-fated Smallpox Vaccination Program; and 3) public health departments in five counties in California, where preparedness strategies and efforts have been put into practice.

Data sources for this study included 30 interviews with experts at federal, state and local levels; direct- and participant-observation of several preparedness exercises, meetings, clinics, etc.; and a wide array of documents from the various research sites and elsewhere. Several modes of analysis were employed, including policy narrative analysis, genealogical tracings of specific practices and logics, and grounded theory techniques.

Three sets of findings are presented. First, legislators and experts testifying at committee hearings employed a number of narrative techniques which successfully rendered ambiguous information, past and present events, and other uncertainties into dangers requiring imminent intervention. Second, techniques such as the risk- or cost-benefit analysis seem highly ineffective as a method to organize and structure difficult-to-grasp objects such as extremely unlikely (low probability) events. Moreover, the Smallpox Vaccination Program appears not to have been an instance of an emergent preparedness rationality, but rather a traditional public health program ill-suited to the demands of a national or homeland security program. Third, local public health preparedness efforts appear to lack structures and mechanisms to help sustain them in the long run, which in some sense also violates the logic of a preparedness rationality.