Biosecurity Interventions: Global Health and Security in Question
Edited by Andrew Lakoff and Stephen J. Collier
Columbia University Press, 2008
US$ 27.50 (Hardcover)
Reviewed by Alexandria Reid, Wayne State University
The field of biosecurity remains mired in uncertainty and confusion. There is little agreement among experts as to what constitutes a biosecurity threat, what it means to secure health, and who is responsible for doing so. The essays in Biosecurity Interventions offer a map to this confusion, providing not definite conclusions, but rather, “starting points for inquiry,” which can be used to make sense of a still-developing field (280). In the introduction, Lakoff and Collier list four general areas in which biosecurity concerns have coalesced: emerging infectious disease, bioterrorism, the cutting-edge life sciences, and food safety (9). Each of the eleven essays in the volume, then, introduces a topic in biosecurity that relates to one of these areas. The essays address a range of topics including tuberculosis in post-Soviet Georgia, government responses to avian flu, biodefense, and many others. The breadth of topics highlights both the diversity of areas falling under the heading “biosecurity,” and the struggles to establish expertise in such a diverse field.
Throughout the book there is never a real definition of “biosecurity,” and no real declaration of what constitutes a biosecurity threat. This, however, points to a central theme of the volume: there is no consensus on either of these points. The essays examine what “experts” have declared to be biosecurity threats (for example, the perceived threat of smallpox, biomedical science research in general, and raising poultry in one’s backyard). Each of these is threatening for a different reason. Smallpox, even though it has been eradicated, is a potential biological weapon, threatening both to the populace and popular imagination because no one knows who could use it to launch an attack, or when (89). Biomedical research is a biosecurity threat because when scientists publish in journals, they are providing a framework to replicate their experiments—very dangerous in the wrong hands (258-259). As for raising poultry, that’s a biosecurity risk because it creates prime conditions for the propagation of avian influenza (180). Each of these have become constructed as threats for various reasons, though many, such as smallpox and biomedical research, seem to straddle issues of real and perceived vulnerability. For example, as Lakoff describes in his essay, “From Population to Vital Systems,” an exercise called “Operation Dark Winter” illustrated that the US health infrastructure was not capable of handling a smallpox epidemic: it pointed out vulnerability in the system (100).
When trying to define what constitutes a biosecurity threat, however, other more basic questions emerge: “what, exactly, does it mean to secure health?” The essays in the volume provide several points of view. One particularly interesting contribution, Peter Redfield’s essay on Médecins Sans Frontiers (MSF/Doctors without Borders) looks at the issue of biosecurity not as a concern of national defense, but rather as a humanitarian effort (147-48). The volunteers of MSF intervene in areas in crisis; for example, when there is a cholera outbreak, they provide healthcare and well as essential supplies, such as clean drinking water. On the other hand, securing health might mean culling all possible carriers of avian influenza (see Bingham and Hinchliffe’s essay, “Mapping the Multiplicities of Biosecurity, 180-181) or censoring scientific papers to keep the “methods” section out (see Carlo Caduff’s “Anticipations of Biosecurity,” 259), or even designing a vaccination program for a disease that does not exist outside of laboratories, (as in Dale Rose’s, “How did the Smallpox Vaccination Program Come About”, 89). What it means to secure health, then, remains somewhat ambiguous and fraught with questions: securing health for whom? And against what threat to health?
And how? Several essays in this volume address the problem of instituting a universally-applicable procedures for securing health. For example, Erin Koch’s essay describes the issue of treating tuberculosis in post-Soviet Georgia using the directly observed therapy (DOTS) program. The DOTS program is meant to work under all circumstances, but Koch argues that it cannot, because it presupposes a level of health infrastructure that simply does not exists everywhere (131). When speaking of the Egyptian response to avian influenza, Nick Bingham and Steve Hinchliffe note that biosecurity is problematic because there is always more at work than simply a spreading microbe—biosecurity efforts are tied in with the whole of culture (199). Thus, securing health involves considering more than protection from microbes, but also requires considering who is to be protected, from what, and the range of other factors that play into the equation.
When trying to determine what it means to secure health, and how it is to be done, the question arises of who is best able, and who is responsible, to do so. It would be easy to simply say, “the government,” but that raises its own problems—specifically, who or what part of a government? Again, the volume provides several different views. Frédéric Keck’s essay on avian flu in France provides an interesting look at the clash between doctors who saw avian flu as a possible human pandemic, and veterinarians who were trying to deal with the disease strictly as an animal disease (220). These opposing views prompted vastly different responses—though both factions saw this as an issue of “health.” When biosecurity becomes an issue of defense, then there is an entirely different response, as seen in Carlo Caduff’s essay. Instead of becoming about preventing an actual infectious agent, biosecurity becomes about a search for “unintended meaning” in biomedical research, and it becomes the responsibility of scientists consider the “ethical, legal, and social issues” of their work (259, 260).
Concerns about biosecurity are not a new development. Rather, the debate over what constitutes biosecurity and who can lay claim to biosecurity expertise gives biosecurity an aura of newness. While the essays in this volume emphasize—rightly—the continuing debate, at times this emphasis obscures the fact that biosecurity has an extensive history under various nomenclatures in the history of science and public health. Despite this, Biosecurity Interventions is a thought-provoking volume that provides an important look into how far-reaching biosecurity is, while illustrating the ambiguities that still remain. Overall, the volume is not concerned with concrete answers, but rather, as Paul Rabinow states in the volume’s final chapter, provides “starting points for inquiry” into a complicated topic (280).