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Outmoded policies may be undermining our ability to safeguard against infectious diseases

Biosecurity Dilemmas: Dreaded Diseases, Ethical Responses, and the Health of Nations

Christian Enemark
Georgetown University Press
225 pp.
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Before the Biological Weapons Convention (BWC) was signed in 1972, many terrible diseases—including tularemia, glanders, Q fever, and staphylococcal enterotoxins—were legally weaponized by national governments, including the United States, the United Kingdom, and Germany. Now, in 2017, the technical ability to make and create new bioweapons is exponentially greater. Biological techniques and equipment are available and inexpensive, pathogens are plentiful, and some can even be made de novo.

Although bioweapons have not been used in modern warfare, and bioterror events are rare, it’s an open question as to whether the norms that prohibit the use of biological weapons have an expiration date. Because of this uncertainty, and the considerable time and effort it takes to build defenses against such threats, nations need to prepare for intentionally released pathogens.

In his new book, Biosecurity Dilemmas, Christian Enemark describes the challenges that nations face in providing biosecurity. He explores ethical dilemmas that might arise, arguing, for example, that if a nation’s biodefense investments make their neighboring countries suspicious, such work could be considered offensive as opposed to defensive, and it may paradoxically lead to biological weapons proliferation. He also addresses how, in an effort to stop the spread of an infectious disease during an outbreak, nations may sacrifice the rights of individuals.


A worker departs an anthrax decontamination tent in Smailholm, Scotland, in 2007.

Enemark clearly describes how policies intended to reduce or prevent biological threats often borrow from nuclear security regimes—a practice that does not always translate appropriately. U.S. researchers working with regulated pathogens (so-called “select agents”) are required to count individual vials and estimate numbers of the pathogens stored in freezers, for example, even though microbes readily replicate (unlike enriched uranium). Because a small fleck of anthrax could be grown into tons, this sort of accounting procedure makes little sense.

Much of the book focuses on a country in which there is plentiful material to analyze: the United States. The United States, Enemark notes, has engaged in a conspicuous buildup of high-containment laboratories, has launched controversial biodefense threat-assessment programs, and has suffered a few high-profile biosafety lapses.

Although U.S. biodefense efforts are worthy of critical analysis, they are largely transparent. The book would have benefited from more critical attention to a nation that is not nearly as open and that has a long history of flouting biosecurity norms: Russia. During the Soviet era, despite signing the BWC, the Russians had a massive, covert bioweapons program employing an estimated 40,000 to 60,000 scientists, technicians, and support staff, which produced quantities in the tons of anthrax, smallpox, and dozens of other pathogens (1).

The transgressive behavior of the Russian government with regard to bioweaponry continues today, as evidenced by President Vladimir Putin’s 2012 announcement of the country’s intention to develop genetic weapons (a pronouncement that was subsequently removed from the official transcript); the continued existence of biological laboratories that remain off limits to international observers; and the fact that Russia now flatly denies that it ever had an illegal biological weapons program, despite overwhelming evidence.

In his discussion of Russian bioweaponry, Enemark makes several unfortunate missteps, most notably, referring to a 1979 accident at an illegal anthrax bioweapons plant in Sverdlovsk (now Yekaterinburg), Russia, as a biosafety incident and comparing it to nonlethal biosafety lapses in legitimate U.S. laboratories.

Biosecurity Dilemmas will be of interest to scholars engaged in debates about the “securitization” of global health. To the health practitioners who welcome the lifesaving effects of government aid programs, even if national interests drive the funding, debates about the pitfalls of securitization of health may seem beside the point. But Enemark acknowledges that political realities will not likely allow nations to apportion health resources solely based on projected health effects without regard to security concerns.

In future work, it would be good to see Enemark tackle ways that these dilemmas can be practically approached. Although not a panacea, a data-centric approach might help. If public health officials warn that closing borders and unduly curtailing individual rights are ineffective in stopping the spread of contagious disease and will disincentivize reporting, for example, no political theory can change the fact that fewer people will get sick if such evidence-based advice is heeded.

About the author

The reviewer is at the Center for Health Security, Johns Hopkins University, Baltimore, MD 21218, USA.