Over-exploitation, on the other hand, is the stress in Africa, for example, in governments coping with the avalanche of initiatives, interventions and projects on HIV/AIDS from different set of actors. It is to under and over-exploitation we turn in seeking understanding of conflictual responses in global health governance such as when Indonesia withdrew from avian influenza sample sharing in 2007 on the ground that more powerful actors were using information from those samples to produce drugs which countries like Indonesia cannot afford. Indonesia sent a message to global power. South Africa equally did the same on patent, even got former President Clinton on its side and won. Interestingly, Indonesia and South Africa are all from the Southern hemisphere.

Bill Gates:
“The first element of this new anarchy is the rise of new actors in the activism of those like Bill Gates Foundation, pharmaceutical conglomerates, powerful international non-governmental organisations like Medicines Sans Frontieres, (MSF), individuals like Bono, the Iris entertainer and public-private partnerships like the Global Fund to Fight AIDS/TB.”

Notwithstanding the new anarchy so well elaborated, Fidler says the message embedded in the rise of health in international politics is that it has gone beyond “the House that WHO built”, (p.6). For him, this is for good reasons because the problem is somewhere, what he calls the ‘hardware’ problem – the very bare level of infrastructural foundation in majority of the countries and how this creates a gulf between the domestic level and the flurry of activities going on at the global level in relation to quality health care delivery. Fidler calls this the “plurality of incapacity” at the national level.

So, although the globalisation of diseases compels a global response, global response is constrained by a sea change in which the new anarchy and the ‘hardware’ crisis are key. The outcome is failure everywhere, be it in fighting tuberculosis, malaria, rising mortality and morbidity in NCDs. He makes three major analyses: the impossibility of building adequate public health infrastructure generally everywhere because “despite the globalisation of public health, the political and financial responsibility for public health infrastructure and capacity falls on governments”, (p.15) and, in fact, building better public health infrastructure is far more difficult in the post-Westphalian anarchy.

Adagbo Onoja :
“Something about the ‘new anarchy’ should draw attention to what might be called its domestic versions in many countries: mobile medicine sellers proclaiming via powerful loudspeakers herbal and related concoctions that they pose as cure for all sorts of imaginable ailments. For all we know, their claims might be completely true but are they licensed, supervised, authorised and monitored? There is also a reportedly thriving new medical culture in which Non-Governmental Individuals are operating hospitals where medicine are not allowed but only prayers.”

The challenge of Fidler’s position is how accommodation could be negotiated out of the new anarchy. New wealthy actors have entered global heath security with lots of money but which they spend in their own way, not the way any big brother like WHO will superintend. So, in spite of this in-flow of much larger resources, both the infrastructural foundation relatively across the world as well as some areas of global public health are neglected. What is to be done? Fidler thinks very poorly of the option of a global treaty on health as a way out. He says the history of grand summits on global crises does not make that option attractive.

It remains unclear why Fiddler wouldn’t call the dominant ‘normative source code’ by its real name. The closest he comes to calling it neoliberal globalisation is where he stated that: “Behind unstructured plurality are political attitudes that complicates and constrain building organised unity through governance architecture”, (p.8). Whatever the deficits of his intervention, he has given us his own picture of the problem in global health. What is our own Ministry of Health, global health intellectuals, political parties, NGOs, the medical sector, among others, thinking on the subject? And are we publishing our own views? Are those who talk of public-private partnership, networking and such stuff as if these are innocent concepts taking note?

Something about the ‘new anarchy’ should draw attention to what might be called its domestic versions in many countries: mobile medicine sellers proclaiming via powerful loudspeakers herbal and related concoctions that they pose as cure for all sorts of imaginable ailments. For all we know, their claims might be completely true but are they licensed, supervised, authorised and monitored? There is also a reportedly thriving new medical culture in which Non-Governmental Individuals are operating hospitals where medicine are not allowed but only prayers. There might be no one single meaning of what is medical but until we change the law to reflect that, we should have seen, in Nigeria, the police, the SSS, the early warning establishment and, above all, the media in possibly a joint operation on this.

That would have been national security at its best, striped of mystification to put human beings as its core. Public health as the cornerstone of national security can be seen in how the language of health is assuming the language of security in the literature, best exemplified in how Global Health Governance becomes Global Health Security, for example.

The fact that some of the above examples of the ‘new anarchy’ at the domestic level persist might be taken as evidence that the contested concept of state failure is not only when central authority has collapsed and everyone is running helter-skelter. It is also when the state is Away without Official Leave (AWOL), to borrow that lexicon. Too many actors in Africa might have gone on AWOL in terms of governing in many such realms. So, when Peter Piot says an epidemic in Africa is an automatic humanitarian catastrophe, he has a point.

This cannot continue like that. As Fidler further claims, the 21st century began with infectious diseases as the fulcrum of global security strategies. It began with HIV/AIDS which was considered to be capable of bringing about collapse of many armed forces and, by implication, their nations, including the US. The fear of weaponization of pathogens by those the US called the ‘axis of evil’, became the basis of grand strategy too. He even adds how responses to the SARS epidemic led to loss of power by some incumbents. So the new anarchy is a problem both at the domestic and the global level. The 2003 SARS, the 2009 (H1NI) influenza virus and the 2014 Ebola epidemic might actually have domestic health foundations even as they might have been globalised by movement of population, animals and food items.

It’s been two months of activism in global health governance. The United Nations system adopted the Sustainable Development Goals, the successor to the Millennium Development Goals, (MDGs), a huge chunk of it touching on health one way or the other. Outside the UN system, researchers at Chatham House, London: Marco Schaferhoff, Elina Suzuki, Philip Angelides and Steven Hoffman released a 54 page Research paper “Rethinking the Global Health System” last September. In August, another set also at Chatham released “Analysing Proposals for Reform of the Global Health Architecture”. The African specificity of global health challenges compel journalistic attention to these developments and publications in terms of whatever new value they bring to the table.