As societies modernise, the landscape of risk becomes ever more complex. What were once thought of as low-probability/high-impact events like nuclear war, biological terrorism, environmental catastrophe or pandemic disease merge with more localised perceptions of social instability, criminal disorder and cultural decline, compounded by the daily pressures of increasingly precarious economic subsistence, eventually forming a framework whose actuarial probabilities are incalculable to the individual. Our growing demand for security becomes, in the end, rooted in the sense of being permanently insecure; our appetite for safety progressively rationalising the surrender of individual agency, ceding local autonomy in favour of top-down, statecentralised protection (Beck, 1992; Ekberg, 2007; Furedi, 2008; Kaldor, 2018).

The evolution of health security focuses, similarly, on the defensive control of diseases by enhancing centralised capacity to monitor and manage the interaction between population and pathogen; investing in hard enforcement capacity to exercise disciplinary control over citizens rather than engaging with communities to leverage the power of social cohesion and collective public action on which sustainable security is based (Cialdini and Goldstein, 2004).

The Global Health Security Index (GHSI), launched in 2019, is designed to assess countries’ pandemic preparedness. Its metrics, though, privilege technical functions – of surveillance, detection and biomedical response – over softer dimensions of the citizen-state relationship such as trust in government, density of civil society, or quality of health communication networks (Mahajan, 2021). Measures relating to ‘biosecurity and safety’ weight the index in favour of high-income countries. Emphasis on institutional capability – in surveillance and laboratory systems, epidemiological and clinical workforce, as well as wider conditions of poverty and political instability – skew ranking in favour of more developed regions, offering false comfort to higher-scoring high-income countries and a greater latitude for enforcement in lower-scoring poorer states (Abbey et al, 2020; Razavi et al, 2020). In 2019, the US and UK topped the GHSI league table of pandemic readiness.

In the event, though, GHSI ranking had little to do with how COVID was managed. In an analysis of 100 countries with complete data for the first wave of the COVID pandemic, a higher GHSI score was associated with greater rates of infection; and no correlation was found between GHSI position and rate of population testing (Aitken et al, 2020).