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

Dreaded Diseases, Ethical Responses, and the Health of Nations

Christian Enemark

Georgetown University Press / Washington, DC

2017 Georgetown University Press. All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.

Library of Congress Cataloging-in-Publication Data

Names: Enemark, Christian, author. Title: Biosecurity dilemmas : dreaded diseases, ethical responses, and the health of nations / Christian Enemark. Description: Washington, DC : Georgetown University Press, 2017. | Includes bibliographical references and index. Identifiers: LCCN 2016024115 (print) | LCCN 2016040083 (ebook) | ISBN 9781626164048 (pb : alk. paper) | ISBN 9781626164031 (hc : alk. paper) | ISBN 9781626164055 (eb) Subjects: LCSH: Biosecurity. | BiosecurityMoral and ethical aspects. | Bioterrorism Prevention. | Communicable diseases. | Biological arms control. | Public health Moral and ethical aspects. | National security. Classification: LCC JZ5865.B56 E54 2017 (print) | LCC JZ5865.B56 (ebook) | DDC 174.2/944dc23 LC record available at https://lccn.loc.gov/2016024115

This book is printed on acid-free paper meeting the requirements of the American National Standard for Permanence in Paper for Printed Library Materials.

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Printed in the United States of America

Cover design by N. Putens. Cover image Karayuschij | Dreamstime.com .

For Bree and Henry

THE EARLY STAGES OF RESEARCH for this book were conducted as part of a Discovery Project on Infectious Diseases, Security and Ethics (no. DP0987012) funded by the Australian Research Council. For their valuable advice and encouragement, I thank my colleagues Richard Beardsworth, Huw Bennett, Madeline Carr, Campbell Craig, Alan Dupont, Mike Foley, Jonathan Herington, Rebecca Hester, Suzanne Hindmarch, Adam Kamradt-Scott, Tom Kompas, Milja Kurki, Jenny Mathers, Colin McInnes, Amy Patterson, Anne Roemer-Mahler, Simon Rushton, Jan Ruzicka, Elke Schwartz, Kamila Stullerova, and Sridar Venkatapuram. Special thanks go to Stefan Elbe, Andrew Price-Smith, and Jeremy Youde for the inspiration they have provided over many years, and to Don Jacobs for his professionalism and many courtesies. Most of all I thank my wife and son, to whom this book is dedicated.

IN MARCH 2014 A DEADLY VIRUS was spreading across Guinea. It was the virus that causes Ebola, a form of hemorrhagic fever, and the epidemic it sparked soon became the worst of its kind on record. Within a year the disease had killed at least ten thousand people in West Africa, but this alone does not explain the enormous amount of attention that the Ebola outbreak attracted throughout the world. Death can come to a person in a variety of ways, but some ways can seem far worse than others, and the possibility of dying of Ebola was terrifying to many people. The humanitarian aid organization Mdecins Sans Frontires, which was deeply involved in responding to the Ebola outbreak, claimed in a 2015 report Ebola provokes an... almost universal fear that is unequalled by any other disease. Fear, as Daniel Deudney has observed, is the emotion most intimately linked to security. This book focuses on those dreaded diseases that governments have variously framed in security terms. These security diseases are often contagious but always infectious (caused by bacteria, viruses, or other microorganisms), and these two facts alone set them apart from diseases lacking a microbial cause (e.g., diabetes, stroke, and cancer). Although the latter are certainly serious health burdens in many places, the sudden outbreak of a deadly infectious disease has a greater tendency to excite the urgent attention of policymakers concerned about national security. As this book will show, however, the adoption of a security-oriented approach to preventing or responding to disease outbreaks is not necessarily a good thing.

In a 1952 article Arnold Wolfers argued that no policy... can escape becoming a subject for moral judgment... which calls for the sacrifice of other values, as any security policy is bound to do. He highlighted, as a matter of ethical concern, the way by which, for better or for worse, security can manifest as a political practice (as distinct from a desirable state of being). When conceived in this way, security is not something that is inherently good, and the matter for judgment becomes, Is activity X a good form of security practice? In the name of security, many a vital project has been funded and also much money has been wasted. Appealing to security concerns can be a device not only for raising public awareness but also for maintaining secrecy; a determination to pursue security can result in the achievement of good goals as well as the perpetration of injustices. It might also be the case, moreover, that policymakers seeking to do the right thing encounter deep uncertainty about whether the benefit to be derived from choosing to implement a particular security practice outweighs the harm that might result from it. That is, in some situations deemed to be of security concern, a policy dilemma can arise.

The aim of Biosecurity Dilemmas is to highlight and explain the tension between differing values and interests that are generated or exacerbated by the practice of biosecurity. Biosecurity is here defined as the safeguarding of populations within and among states against selected infectious disease risks. These risks include both the natural occurrence of deadly disease outbreaks and the deliberate dissemination of pathogenic microorganisms (that is, biological weapons). This book is founded on recognition of the close relationship that exists between these two areas of concern. In this way it differs from literature that addresses the security significance of only one or the other. Rather, the focus has more in common with the work of authors who advance their ideas based on a comprehensive definition of biosecurity. Gregory Koblentz, for example, has argued in favor of a broad definition because it helps make explicit what would otherwise be implicit trade-offs that reduce the risk of one type of biological threat while increasing the risk of another. Indeed, by highlighting these trade-offs, the processes of responding to the problem of biological weapons are potentially made more sensitive to the challenges posed by disease outbreaks of natural origin, and vice versa. And, when concerns about public health, national security, and scientific progress intersect, it is important for analysts and policymakers to be able to identify and address the tensions that erupt along the fault lines between secrecy and openness, restriction and freedom, population health and individual health, and so on. When confronting an infectious disease risk, each of these competing values will be worthy of consideration. But a biosecurity dilemma might arise over which values should be subordinated (at least temporarily) to others. In situations that seem to demand the protective effect of a particular biosecurity practice, the risk is that the practice taken will be more harmful than beneficial. For example, would preventing scientists from perpetrating biological attacks serve to reduce a populations overall vulnerability to infectious disease outbreaks, or would such efforts increase that vulnerability by impeding scientists ability to make lifesaving discoveries about the organisms that cause disease?