The field of biosecurity is fairly new and for such a new field it is remarkable that so many scholarly works have appeared. I recently completed reading one such work, Biosecurity Dilemmas: Dreaded Diseases, Ethical Responses, and the Health of Nations by Christian Enemark. The theme of this book, published in 2017, is to “highlight and explain the tension between differing values and interests that are generated or exacerbated by the practice of ‘biosecurity’.”
For those that track the field, it comes as no surprise that tensions exist in the field and a constant risk-benefit calculus is always at play. Biosecurity Dilemmas accurately (but selectively) reflects the tension and is divided into four parts that highlight major debates in the field: “Protect or Proliferate,” “Secure or Stifle,” “Remedy or Overkill,” and “Attention or Neglect. Each of the eight chapters explores in detail important events to concretize the concepts being discussed.
My colleague, Gigi Gronvall, has already reviewed this book for Science and highlighted her concerns regarding the selective attention the book pays to arguable the largest biosecurity issue and the heightened attention given to American programs. As she writes:
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.
To not recapitulate her review, I want to focus on one specific aspect of Enemark’s analysis that I do not believe to be valid.
Biosecurity, in its original conception, addresses the threat of intentional infectious disease releas. As such, it must be viewed as a national security issue despite the fact that many actions involved may have substantial overlap with public health and ordinary healthcare activities (e.g. disease surveillance, vaccination, diagnostic testing). However, it is indisputable that gains in biosecurity positively impact and synergize with “ordinary” public health and medical activities, involve many of the same people, and have “all hazards” preparedness implications. What, in my analysis, has happened is that because of these synergies, it becomes easier for people to lose the distinctions and muddle the concepts.
Cashing in on this conflation, Enemark to advocate a “security sensitive” approach that attempts to create a middle way between what he characterizes as the “dispassionately evidence-based” and “people’s dread of being attacked.” This “security sensitive utilitarianism” underlies his call to require that all “civilian biodefense projects…afford protection against natural as well as as intentional infectious disease risks” as measured by a “dual-benefit” test.
What Enemark fails to realize is that government, properly understood, has specific roles that are delegated to it. These roles are limited to the protection of individual rights. Individual rights are violated through the use of physical force or fraud. When it comes to biosecurity this means government’s role is to protect individuals from being endangered by the use of microorganisms or their toxins, just as they do with bullets and bombs. Naturally occuring infectious diseases, outside of quarantine and related matters, are can not really be seen in the same manner. Biosecurity is a core function of government. As such, no “dual-benefit test” or calculation involving natural infections should be performed. Biodefense, whether civilian or military, is a policing function of the government and must be evaluated in that context, not in the context of seasonal influenza, HIV, and non-communicable diseases. While it is ideal when biosecurity is integrated with other overlapping domains, it is still distinct. To construct a false alternative obscures this fact.
Overall, despite my disagreements with the philosophical framework of the book, I believe that those wanting to deepen their understanding of aspects of the field of biosecurity would benefit from the book.