Public prophylaxis: Pandemic influenza, pharmaceutical prevention and participatory governance

In this article, I explore recent discussions among American public health professionals over how to protect the health of the nation in a state of emergency. My focus is specifically on questions of preventative strategy and population management, examining intensive debates around the prioritization of protective vaccine for pandemic influenza. Drawing on ethnographic research, I show how the mode of circulation, distribution and allocation of pandemic vaccine was gradually refashioned in the United States over the past 2 years. When government officials launched public engagement meetings reformulating in ethical terms the crucial question of how to dispense a scarce pharmaceutical resource in a public health emergency, a distinctive set of priorities emerged. My aim, in this article, is to examine this ethical refashioning and to interrogate the curious logics of public-ness that are increasingly embedded in a growing number of approaches of public health professionals. How are populations gathered into the fold of pharmaceutical prevention today?