A New Role for Public Health in Bioterrorism Deterrence

When this commentary was submitted in April 2014, only a handful of scholars and policy-makers in the defense and security communities were following the Ebola outbreak in West Africa, which was over 4 months old at that time. Now that thousands of people have died, cases have spread to the US and Europe, and thousands of US uniformed military are being deployed on humanitarian assistance/disaster relief missions, attention and interest are significantly heightened. The events of the last few months demonstrate the criticality for interdisciplinary thinking, which is more challenging due to different historical contexts, knowledge bases, interests, lexicon, and perspectives. This commentary will explore the creation of new relationships between deterrence, infectious disease, and public health to reduce the threat of biological terrorism and increase international security. Examining the global spread of re-emerging infectious disease, such as the re-emergence of polio from northern Nigeria, offers a novel case study for thinking about how to deter potential bioterrorists who seek to use infectious disease. Polio outbreaks have more directly affected the developing world compared to the US or other nations with robust public health sectors. This example suggests that a bioterrorist attack would also be more devastating for developing countries in low-resource settings compared to the western world. Credibly, communicating this may offer a new approach to deterring bioterrorism by foreign actors. Although a robust public health sector has long been noted to reduce the vulnerability to a bioterrorism attack, actively promoting the strength of US public health can also serve as a powerful deterrent in its own right. The issue of terrorist groups utilizing biological weapons against other states is a mounting concern, yet little deterrence research in the field of political science addresses methods of dealing with the threat of bioterrorism. Thus, creating new conversations among the life sciences, public health, and political science can lead to new perspectives on deterring bioterrorism. The issue of bioterrorism deterrence, if addressed, has been often added or subsumed under the auspices of deterrence strategies associated with nuclear weapons. In the second half of the twentieth century, nuclear deterrence dominated geopolitics and national security strategies. At its height, the threat of mutually assured destruction (MAD) existed in which both superpowers possessed arsenals with second-strike capabilities, i.e., the ability to respond to a first nuclear strike on land via use of nearly undetectable submarine-launched ballistic missiles with nuclear warheads. These historical approaches, however, undermine and oversimplify the distinct challenges of deterring bioterrorism. One such method attempted is focusing on pathogen security, or securing and denying access to the materials necessary to develop biological weapons (i.e., deterrence by denial). Based on the nuclear non-proliferation model, pathogen security strives to control the materials, equipment, and personnel involved with production and use of biological agents. With nuclear weapons, controlling fissile materials proved successful because of key characteristics of the critical materials: fissile material is man-made and can be tracked. Those same characteristics that make nuclear weapons easier to track are those that make biological weapons material difficult to monitor. These characteristics include the presence of biological agents in nature, lower production costs, increased diversity of materials that could be used in bioweapons attacks, and multiple legitimate uses for biological materials. These differing features have not always been fully considered by policy-makers (1). Rather than focusing solely on securing biological materials and laboratories from misuse, other recommendations and strategies that the US has pursued include prevention measures such as biosurveillance, global laboratory and research cooperation, research and development of diagnostics and countermeasures, international stockpiles of effective medical countermeasures, and increased response and mitigation capabilities (2–6). These approaches aim to reduce consequences of an attack, afford earlier detection, and reduce vulnerability; they do not address the challenge of deterring use and reducing motivation directly, however. To date, discussions about public health and deterrence have focused on measures such as regular vaccinations; access to timely medical care to treat infected, isolate suspected infected, and mitigate the spread of disease; confidence in the professional nature of health providers, etc. These are largely passive, defensive deterrence measures, in that they demonstrate credible capacity by a state to respond and mitigate the consequences of an attack (post-exposure) or reduce vulnerability to an attack by making it ineffective (preexposure) (7–9). Both approaches mentioned thus far, pathogen security and a defensive approach to terrorism, which