Senses of Security: Probing the Logics and Effects of Hepatitis C’s ‘Regime of Cure’
The formidable promises of global public health security in the 21st century are couched in (im)probability calculations, uncertainties, and anxious anticipation. Securing against yet-unknown pandemic outbreaks has – for many countries and decades – meant reorganizing public health infrastructures along the lines of “preemptive biopreparedness” (Fee & Brown 2001; Collier & Lakoff 2015; Mason 2016). Almost counter to such tendencies and organizing principles, Hepatitis C proved an epidemic “solved” on impact. The Hepatitis C Virus (HCV) entered soundly into public consciousness the moment it could be cured by pharmaceutical means, by “magic bullets” called Direct-Acting Antivirals. In the six years since the introduction of Direct-Acting Antivirals, a “regime of cure” has calcified for the treatment of HCV. Qualitatively and ontologically different from a regime of chronic disease management, which had dominated patient care in decades prior, this novel regime has become ever more secure, certain, and indisputable. Using material and experiences collected over fifteen months of ethnographic research in patient organizations, addiction care centers, hospitals, government meetings and health conferences in Austria, I want to engage the example of this shift in HCV management and care to probe different enactments and connotations of “security” on the ground level: How are security and certainty produced, enacted, and maintained? Who is made to feel secure? And, what kind(s) of security are we talking about? Employing specific examples from the pharmaco-scientific framing of Direct-Acting-Antivirals, from large-scale HCV testing drives as well as federal public health initiatives (or lack thereof), I will sketch key underpinnings of HCV’s “regime of cure”: a fixed bio-exclusive interpretation of viral infection, a “logic of care” oriented at numbers and quantitative impact, as well as the production of particular “risky subjects.” I do so in a directed attempt to unsettle the arguably secure regime of HCV care itself and to ask what the cost of such security might be. Specifically, I will consider the constraints and elisions embedded in this regime, that is, its limited “response-ability” (Barad 2010) to outliers, alternatives, and certain patient needs.