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