Biosecurity reconsidered: Calibrating biological threats and responses

International Security

Volumn 34, Issue 4, 2010, Pages 96-132

  Koblentz, Gregory D ^a  

^a GEORGE MASON UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 77954264908     PISSN: 01622889     EISSN: 15314804     Source Type: Journal    
DOI: 10.1162/isec.2010.34.4.96     Document Type: Article

References (203)

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9. George W. Bush, The National Security Strategy of the United States of America (Washington, D.C.: White House, 2006), p. 44.
10. The label "nature" is a misnomer, because even naturally occurring diseases are heavily influenced by human behavior. See Mark S. Smolinski, Margaret A. Hamburg, and Joshua Lederberg, eds., Microbial Threats to Health: Emergence, Detection, and Response (Washington, D.C.: National Academies Press, 2003), pp. 53-148.
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17. Barry Buzan, People, States, and Fear: The National Security Problem in International Relations (Brighton, U.K.: Harvester Wheatsheaf, 1983).
18. Jessica T. Matthews, "Power Shift," Foreign Affairs, Vol. 76, No. 1 (January/February 1997), pp. 50-66; and Michael E. Brown, "Security Problems and Security Policy in a Grave New World," in Brown, ed., Grave New World: Security Challenges in the 21st Century (Washington, D.C.: Georgetown University Press, 2003), pp. 305-327.
19. Michael E. Brown, "Security Problems and Security Policy in a Grave New World," in Brown, ed., Grave New World: Security Challenges in the 21st Century (Washington, D.C.: Georgetown University Press, 2003), pp. 305-327.
20. Buzan, People, States, and Fear
21. United Nations Development Programme (UNDP), Human Development Report, 1994 (New York: UNDP, 1994), pp. 22-40.
22. Buzan, People, States, and Fear.
23. Ullman, "Redefining Security".
24. Brown, "Security Problems and Security Policy in a Grave New World.".
25. Commission on Human Security, Human Security Now: Protecting and Empowering People (New York: United Nations, 2003), chap. 6.
26. Colin McInnes, "Health and Security Studies," in Alan Ingram, ed., Health, Foreign Policy, and Security: Towards a Conceptual Framework for Research and Policy (London: Nuffield Trust, 2004), p. 53.
27. Lincoln Chen, Jennifer Leaning, and Vasant Narasimhan, eds., Global Health Challenges for Human Security (Cambridge, Mass.: Harvard University Press, 2003).
28. Ingram, Health, Foreign Policy, and Security.
29. For a critique of the field, see William Aldis, "Health Security as a Public Health Concept: A Critical Analysis," Health Policy and Planning, Vol. 23, No. 6 (November 2008), pp. 369-375.
30. Robert Carlson, "The Pace and Proliferation of Biological Technologies," Biosecurity and Bioterrorism, Vol. 1, No. 3 (September 2003), pp. 1-12.
31. Jon Cohen, "Sequencing in a Flash," Technology Review, May/June 2007, p. 72.
32. Steven M. Block, "Living Nightmares: Biological Threats Enabled by Molecular Biology," in Sidney D. Drell, Abraham D. Sofaer, and George D. Wilson, eds., The New Terror: Facing the Threat of Biological and Chemical Weapons (Stanford, Calif.: Hoover Institution Press, 1999), pp. 39-75.
33. U.S. Department of Defense, Advances in Biotechnology and Genetic Engineering: Implications for the Development of New Biological Warfare Agents (Washington, D.C.: Department of Defense, June 1996).
34. National Research Council, Biotechnology Research in an Age of Terrorism (Washington, D.C.: National Academies Press, 2004).
35. Ronald J. Jackson et al., "Expression of Mouse Interleukin-4 by a Recombinant Ectromelia Virus Suppresses Cytolytic Lymphocyte Responses and Overcomes Genetic Resistance to Mousepox," Journal of Virology, Vol. 75, No. 3 (February 2001), pp. 1205-1210.
36. Jeronimo Cello, Aniko V. Paul, and Eckard Wimmer, "Chemical Synthesis of Poliovirus cDNA: Generation of Infectious Virus in the Absence of Natural Template," Science, August 9, 2002, pp. 1016-1018.
37. Gaymon Bennett et al., "From Synthetic Biology to Biohacking: Are We Prepared?" Nature Biotechnology, Vol. 27, No. 12 (December 2009), pp. 1109-1111.
38. NIC, The Global Infectious Disease Threat and Its Implications for the United States, p. 5.
39. Smolinski, Hamburg, and Lederberg, Microbial Threats to Health.
40. World Health Organization (WHO), SARS: How a Global Epidemic Was Stopped (Geneva: WHO, 2006).
41. World Health Organization, Avian Influenza: Assessing the Pandemic Threat (Geneva: WHO, 2005).
42. Elizabeth M. Prescott, "SARS: A Warning," Survival, Vol. 45, No. 3 (Autumn 2003), pp. 207-226.
43. In July 2009, the World Health Organization stopped requiring countries to test and report individual cases to the WHO; so the number of reported cases significantly understates the real number of cases.
44. World Health Organization, "Pandemic (H1N1) 2009: Update 76," November 27, 2009, http://www.who.int/csr/don/2009_11_27a/en/index.html.
45. National Intelligence Council, Mapping the Global Future: Report of the National Intelligence Council's 2020 Project, NIC 2004-13 (Washington, D.C.: NIC, December 2004), p. 10.
46. Institute of Medicine and National Research Council, Globalization, Biosecurity, and the Future of the Life Sciences (Washington, D.C.: National Academies Press, 2006), pp. 79-112.
47. Stanley Knobler, Adel Mahmoud, and Stanley Lemon, eds., The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities (Washington, D.C.: National Academies Press, 2006).
48. Ann Marie Kimball, Risky Trade: Infectious Disease in the Era of Global Trade (Aldershot, U.K.: Ashgate, 2006).
49. World Health Organization, "Summary of Probable SARS Cases with Onset of Illness from 1 November 2002 to 31 July 2003," April 21, 2004, http://www.who.int/csr/sars/country/table2003_09_23/en/.
50. World Health Organization, "Changes in Reporting Requirements for Pandemic (H1N1) 2009 Virus Infection," Pandemic (H1N1) 2009 Briefing Note 3 (Revised), July 16, 2009, http://www.who.int/csr/disease/swineflu/notes/h1n1_surveillance_20090710/en/index.html.
51. Between 1995 and 2005, 95 percent of armed conflicts took place within states. Human Security Centre, Human Security Report, 2005: War and Peace in the 21st Century (Oxford: Oxford University Press, 2005), p. 18.
52. Michael Moodie and William J. Taylor Jr., Contagion and Conflict: Health as a Global Security Challenge (Washington, D.C.: Chemical and Biological Arms Control Institute and Center for Strategic and International Studies, 2000), pp. 28-35.
53. Andrew T. Price-Smith, Contagion and Chaos: Disease, Ecology, and National Security in the Era of Globalization (Cambridge, Mass.: MIT Press, 2009), pp. 184-187.
54. Hazem Adam Ghobarah, Paul Huth, and Bruce Russett, "Civil Wars Kill and Maim People-Long after the Shooting Stops," American Political Science Review, Vol. 97, No. 2 (May 2003), pp. 189-202.
55. Michelle Gaye, Dominique Legros, Pierre Formenty, and Maire A. Connolly, "Conflict and Emerging Infectious Diseases," Emerging Infectious Diseases, Vol. 13, No. 11 (November 2007), pp. 1625-1631.
56. Richard A. Falkenrath, Robert D. Newman, and Bradley A. Thayer, America's Achilles' Heel: Nuclear, Biological, and Chemical Terrorism and Covert Attack (Cambridge, Mass.: MIT Press, 1998); and Jessica Stern, The Ultimate Terrorists (Cambridge, Mass.: Harvard University Press, 1999).
57. Gregory D. Koblentz, "Biological Terrorism: Understanding the Threat and America's Response," in Arnold M. Howitt and Robyn L. Pangi, eds., Countering Terrorism: Dimensions of Preparedness (Cambridge, Mass.: MIT Press, 2003), pp. 97-173.
58. David P. Fidler and Lawrence O. Gostin, Biosecurity in the Global Age: Biological Weapons, Public Health, and the Rule of Law (Stanford, Calif.: Stanford University Press, 2008), p. 6.
59. "Laboratory biosafety" is defined as measures to prevent the transmission of biological agents to researchers, the community, and the environment. A simple formulation that helps to distinguish between biosafety and biosecurity in the laboratory context is that biosafety protects people from germs, whereas biosecurity protects germs from people. In addition, for the community concerned with ecological and environmental protection, biosafety is associated with "the transboundary movements, transit, handling and use of all living modified organisms that may have adverse effects on the conservation and sustainable use of biological diversity, taking also into account risks to human health." " Cartagena Protocol on Biosafety to the Convention on Biological Diversity," January 29, 2000, http://www.cbd.int/biosafety/protocol.shtml. This issue is also included in the first definition of biosecurity described below.
60. Marc L. Ostfield, "Global Progress on Biosecurity: U.S. Vision and International Efforts," remarks to the Partnership for Global Security, Carnegie Endowment for International Peace, Washington, D.C., March 6, 2007, http://2001-2009.state.gov/g/oes/rls/rm/2007/81611.htm.
61. Laura A. Meyerson and Jamie K. Reaser, "Biosecurity: Moving toward a Comprehensive Approach," BioScience, Vol. 52, No. 7 (July 2002), pp. 593-594.
62. Food and Agriculture Organization Committee on Agriculture, "Biosecurity in Food and Agriculture," 17th sess., Rome, Italy, March 31-April 4, 2003, p. 1, ftp://ftp.fao.org/unfao/bodies/coag/coag17/Y8453e.doc.
63. Department of Health and Human Services (HHS), Biosafety in Microbiological and Biomedical Laboratories, (BMBL), 5th ed. (Washington, D.C.: Government Printing Office, 2007), sec. 6.
64. According to the World Health Organization, "laboratory biosecurity" refers to institutional and personal security measures designed to prevent the loss, theft, misuse, diversion, or intentional release of pathogens and toxins. World Health Organization, Laboratory Biosafety Manual, 3d ed. (Geneva: WHO, 2004), pp. 47-48.
65. The Organization for Economic Cooperation and Development (OECD) defines biosecurity as "institutional and personal security measures designed to prevent the loss, theft, misuse, diversion or intentional release of pathogens, or parts of them, toxin-producing organisms, as well as such toxins that are held, transferred and/or supplied by BRCs [Biological Resource Centers]." OECD, OECD Best Practice Guidelines on Biosecurity for BRCs (Paris: OECD, 2007), p. 8.
66. In the context of the BWC, the term "biosecurity" refers to "the protection, control and accountability measures implemented to prevent the unauthorized access, retention, loss, theft, misuse, transfer, diversion or intentional release of biological agents and toxins." Georgi Avramchev, "Synthesis of Considerations, Lessons, Perspectives, Recommendations, Conclusions, and Proposals Drawn from the Presentations, Statements, Working Papers, and Interventions on the Topics under Discussion at the Meeting of Experts," October 10, 2008, http://www.unog.ch/80256EDD006B8954/(httpAssets)/C0981350151BD96AC12574E30035A817/$file/Synthesis?Paper?distrib?10?Oct.pdf.
67. National Science Advisory Board for Biosecurity (NSABB), "Enhancing Personnel Reliability among Individuals with Access to Select Agents" (Bethesda, Md.: NSABB, May 2009), http://oba.od.nih.gov/biosecurity/meetings/200905T/NSABB%20Final%20Report%20on%20PR%205-29-09.pdf.
68. Secretary of Health and Human Services, "Charter of the National Science Advisory Board for Biosecurity" (Washington, D.C.: U.S. Department of Health and Human Services, March 16, 2006).
69. Institute of Medicine and National Research Council, Globalization, Biosecurity, and the Future of the Life Sciences.
70. Michele S. Garfinkel et al., Synthetic Genomics: Options for Governance (Rockville, Md., and Cambridge, Mass.: J. Craig Venter Institute, Center for Strategic and International Studies, and Massachusetts Institute of Technology, October 2007).
71. National Science Advisory Board for Biosecurity, "Proposed Framework for the Oversight of Dual Use Life Sciences Research: Strategies for Minimizing the Potential Misuse of Research Information" (Bethesda, Md.: NSABB, 2007).
72. Institute of Medicine and National Research Council, Globalization, Biosecurity, and the Future of the Life Sciences, p. 32.
73. See Christopher F. Chyba, "Towards Biological Security," Foreign Affairs, Vol. 81, No. 3 (May/June 2002), p. 122.
74. Andrew J. Grotto and Jonathan B. Tucker, Biosecurity: A Comprehensive Action Plan (Washington, D.C.: Center for American Progress, June 2006).
75. Fidler and Gostin, Biosecurity in the Global Age, p. 4.
76. Roland Paris, "Human Security: Paradigm Shift or Hot Air?" International Security, Vol. 26, No. 2 (Fall 2001), p. 88.
77. Price-Smith, Contagion and Chaos, p. 208.
78. Heather Owens and Barbara Arneil, "The Human Security Paradigm Shift: A New Lens on Canadian Foreign Policy? Report of the University of British Columbia Symposium on Human Security," Canadian Foreign Policy, Vol. 7, No. 1 (Fall 1999), p. 2.
79. For a similar argument about how to conceptualize human security, see Paris, "Human Security," pp. 96-97.
80. Marc A. Levy has identified a similar weakness in the environmental security literature. See Levy, "Is the Environment a National Security Issue?" International Security, Vol. 20, No. 2 (Fall 1995), pp. 36-37.
81. Barry Kellman, Bioviolence: Preventing Biological Terror and Crime (Cambridge: Cambridge University Press, 2007), p. 1.
82. Reynolds M. Salerno et al., "A BW Risk Assessment: Historical and Technical Perspectives," Nonproliferation Review, Vol. 11, No. 3 (Autumn 2004), pp. 25-55.
83. Kathryn Baker, "The Meaning and Practice of Biosecurity," International Journal of Risk Assessment and Management, Vol. 12, Nos. 2/3/4 (May 2009), p. 121.
84. This figure borrows from Roland Paris's conceptualization of how human security fits into the broader field of security studies and Michael Brown's framework for the new security landscape. See Paris, "Human Security," p. 98.
85. Brown, "Security Problems and Security Policy in a Grave New World," p. 312.
86. This categorization is similar to the one used in Christian Enemark, Disease and Security: Natural Plagues and Biological Weapons in East Asia (New York: Routledge, 2007).
87. Buzan, People, States, and Fear, p. 26.
88. Andrew T. Price-Smith, The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development (Cambridge, Mass.: MIT Press, 2002).
89. Stefan Elbe, Strategic Implications of HIV/AIDS, Adelphi Papers, No. 357 (Oxford: Oxford University Press, 2003).
90. Enemark, Disease and Security.
91. For a useful review of the literature on the nexus between disease and security, see Price-Smith, Contagion and Chaos, pp. 189-206.
92. Chen, Leaning, and Narasimhan, Global Health Challenges for Human Security.
93. Barry Buzan, Ole Waever, and Japp de Wilde, Security: A New Framework for Analysis (Boulder, Colo.: Lynne Rienner, 1997), pp. 23-24.
94. McInnes, "Health and Security Studies," pp. 53-54.
95. Enemark, Disease and Security, pp. 6-15.
96. Price-Smith would designate a disease as a security threat if it causes at least 1 percent annual gross domestic product loss per year, at least 1 percent annual mortality of the adult population, and/or severe debilitation of 10 percent of the adult population per year. Price-Smith, Contagion and Chaos, p. 206.
97. Susan Peterson, "Epidemic Disease and National Security," Security Studies, Vol. 12, No. 2 (Winter 2002/03), pp. 43-81.
98. HIV/AIDS and National Security
99. Gregory D. Koblentz, Living Weapons: Biological Warfare and International Security (Ithaca, N.Y.: Cornell University Press, 2009).
100. Anthony Rimmington, "The Soviet Union's Offensive Program: The Implications for Contemporary Arms Control," in Susan Wright, ed., Biological Warfare and Disarmament: New Problems/New Perspectives (Lanham, Md.: Rowman and Littlefield, 2002), pp. 103-150.
101. United Nations Monitoring, Verification, and Inspection Commission, Compendium of Iraq's Proscribed Weapons Programmes in the Chemical, Biological, and Missile Areas (New York: United Nations, 2007), pp. 765-1030.
102. U.S. Department of State, Adherence to and Compliance with Arms Control, Nonproliferation, and Disarmament Agreements and Commitments (Washington, D.C.: Bureau of Verification and Compliance, U.S. Department of State, 2005), pp. 17-31.
103. Koblentz, Living Weapons, pp. 48-51.
104. The only confirmed cases of such use are Germany's sabotage campaign aimed at draft animals bound for the Allies during World War I, and Japan's repeated biological attacks on military and civilian targets in the Republic of China between 1939 and 1942.
105. On the Rhodesia case, see Marléne Burger and Chandré Gould, Secrets and Lies: Wouter Basson and South Africa's Chemical and Biological Warfare Programme (Cape Town, S.A.: Zebra Press, 2002), pp. 15-16, 221-222.
106. Chandré Gould and Peter Folb, Project Coast: Apartheid's Chemical and Biological Warfare Programme (Geneva: United Nations, 2002), pp. 86-99, 103-104, 115-116, 159-167.
107. Shlomo Shpiro, "Poisoned Chalice: Intelligence Use of Chemical and Biological Weapons," International Journal of Intelligence and Counterintelligence, Vol. 22, No. 1 (March 2009), pp. 5-6.
108. Kofi Annan, Uniting against Terrorism: Report of the Secretary-General, A/60/825 (New York: United Nations, 2006), p. 11.
109. Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, World at Risk: The Report of the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism (New York: Vintage, 2008), p. xv.
110. The cult sickened 750 residents of a small town in Oregon by contaminating local salad bars with Salmonella Typhimurium, a common cause of food poisoning. Milton Leitenberg, Assessing the Biological Weapons and Bioterrorism Threat (Carlisle Barracks, Pa.: Strategic Studies Institute, U.S. Army War College, 2005), pp. 20-21.
111. Senior U.S. intelligence official, interview by author, Washington, D.C., May 2008.
112. Koblentz, Living Weapons, pp. 200-227.
113. Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, World at Risk, p. 11.
114. Thomas F. Dellafera, "Affidavit in Support of Search Warrant," Search Warrant 07-524-M-01, October 31, 2007, http://www.usdoj.gov/amerithrax.
115. U.S. General Accounting Office (GAO), High-Containment Laboratories: National Strategy for Oversight Is Needed, GAO-09-574 (Washington, D.C.: GAO, September 2009), pp. 20-21, 25-26, 29.
116. Ronald M. Atlas and Malcolm Dando, "The Dual-Use Dilemma for the Life Sciences: Perspectives, Conundrums, and Global Solutions," Biosecurity and Bioterrorism, Vol. 4, No. 3 (September 2006), pp. 276-286.
117. Institute of Medicine and National Research Council, Globalization, Biosecurity, and the Future of the Life Sciences.
118. James B. Petro, Theodore R. Plasse, and Jack A. Mcnulty, "Biotechnology: Impact on Biological Warfare and Biodefense," Biosecurity and Bioterrorism, Vol. 1, No. 3 (September 2003), pp. 161-168.
119. Christopher F. Chyba and Alexander L. Greninger, "Biotechnology and Bioterrorism: An Unprecedented World," Survival, Vol. 46, No. 2 (Summer 2004), pp. 143-162.
120. Terrence M. Tumpey et al., "Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus," Science, October 7, 2005, pp. 77-80.
121. Darwyn Kobasa et al., "Enhanced Virulence of Influenza A Viruses with the Haemagglutinin of the 1918 Pandemic Virus," Nature, October 7, 2004, pp. 703-707.
122. Jocelyn Kaiser, "1918 Flu Experiments Spark Concerns about Biosafety," Science, October 22, 2004, p. 591; and Kerri Smith, "Concern as Revived 1918 Flu Virus Kills Monkeys," Nature, January 18, 2007, p. 237.
123. Kerri Smith, "Concern as Revived 1918 Flu Virus Kills Monkeys," Nature, January 18, 2007, p. 237.
124. Jonathan B. Tucker and Raymond A. Zilinskas, "The Promise and Perils of Synthetic Biology," New Atlantis, No. 12 (Spring 2006), pp. 32-34.
125. Charles Allen, chief intelligence officer, Department of Homeland Security, in "Bioscience and the Intelligence Community," hearing before the House Committee on Homeland Security, 109th Cong., 1st and 2d sess., November 3, 2005, and May 4, 2006, p. 47.
126. Reports that Aum Shinrikyo conducted genetic engineering are apocryphal. Milton Leitenberg, "Aum Shinrikyo's Efforts to Produce Biological Weapons: A Case Study in the Serial Propagation of Misinformation," Terrorism and Political Violence, Vol. 11, No. 4 (Winter 1999), pp. 154-156.
127. Kathleen M. Vogel, "Framing Biosecurity: An Alternative to the Biotech Revolution Model?" Science and Public Policy, Vol. 35, No. 1 (February 2008), pp. 45-54.
128. Bruce Hoffman, Inside Terrorism (New York: Columbia University Press, 2006), p. 36.
129. W. Seth Carus, Bioterrorism and Biocrimes: The Illicit Use of Biological Agents since 1900 (Washington, D.C.: National Defense University, February 2001), pp. 7-8.
130. "Man Found with Deadly Puffer Fish Toxin Indicted on Charges of Plotting to Kill His Wife," Associated Press, June 16, 2009.
131. Carus, Bioterrorism and Biocrimes, pp. 17-20.
132. Tjeerd G. Kimman, Eric Smit, and Michèl R. Klein, "Evidence-Based Biosafety: A Review of the Principles and Effectiveness of Microbiological Containment Measures," Clinical Microbiology Reviews, Vol. 21, No. 3 (July 2008), pp. 403-425.
133. Jonathan B. Tucker and Raymond A. Zilinskas, eds., The 1971 Smallpox Epidemic in Aralsk, Kazakhstan, and the Soviet Biological Warfare Program, Occasional Paper, No. 9 (Monterey, Calif.: Center for Nonproliferation Studies, 2002).
134. Jeanne Guillemin, Anthrax: The Investigation of a Deadly Outbreak (Berkeley: University of California Press, 1999), pp. 233-237.
135. High biocontainment laboratories include those with biosafety levels (BSL) 3 and 4. Work in BSL-3 laboratories involves agents such as Francisella tularensis (tularemia), SARS coronavirus, and West Nile virus that may cause serious and potentially lethal infection although vaccines or effective treatments may be available.
136. Work in BSL-4 laboratories involves the most dangerous agents for which there are no effective vaccines or treatments available, such as Ebola, Marburg, and variola virus (smallpox). HHS, Biosafety in Microbiological and Biomedical Laboratories.
137. GAO, High-Containment Laboratories, pp. 20-21, 25-26.
138. Gigi Kwik Gronvall and Nidhi Bouri, "Biosafety Laboratories," Biosecurity and Bioterrorism, Vol. 6, No. 4 (December 2008), p. 300.
139. Filippa Lentzos, Preparing the Ground for the CBM Content Debate: A Study on the Exchange That Builds Confidence between States Parties to the Biological and Toxin Weapons Convention (BTWC) (London: BIOS Centre, London School of Economics, 2008), p. 11.
140. Karl M. Johnson, "Biosafety at BSL-4: More than 20 Years Experience at Three Major Facilities," in National Institutes of Health (NIH), Rocky Mountain Laboratory Integrated Research Facility Final Environmental Impact Statement (Washington, D.C.: NIH, 2004), pp. D-5 to D-11.
141. David L. Heymann, R. Bruce Aylward, and Christopher Wolff, "Dangerous Pathogens in the Laboratory: From Smallpox to Today's SARS Setbacks and Tomorrow's Polio-free World," Lancet, May 15, 2004, pp. 1566-1568.
142. Jocelyn Kaiser, "Accidents Spur a Closer Look at Risks at Biodefense Labs," Science, September 28, 2007, pp. 1852-1854.
143. Heymann, Aylward, and Wolff, "Dangerous Pathogens in the Laboratory," pp. 1566-1568.
144. T. Hugh Pennington, "Biosecurity 101: Pirbright's Lessons in Laboratory Security," BioSocieties, Vol. 2, No. 4 (December 2007), pp. 449-453.
145. Joint United Nations Program on HIV/AIDS (UNAIDS), 2008 Report on the Global AIDS Epidemic (Geneva: UNAIDS, 2008), pp. 32, 39.
146. This section is based on Elbe, Strategic Implications of HIV/AIDS.
147. Lee, and Preeti Patel, "The National Security Implications of HIV/AIDS," PLoS Medicine, Vol. 3, No. 6 (June 2006), pp. 775-777.
148. United Nations Development Programme, Human Development Report, 2005: International Cooperation at a Crossroads: Aid, Trade, and Security in an Unequal World (New York: UNDP, 2005), p. 3.
149. Laurie Garrett, "HIV and National Security: Where Are the Links? A Council on Foreign Relations Report" (New York: Council on Foreign Relations, 2005), pp. 25-29.
150. United Nations Department of Peacekeeping, "Monthly Summary of Contributors of Military and Civilian Police Personnel," http://www.un.org/Depts/dpko/dpko/contributors.
151. Harley Feldbaum, "U.S. Global Health and National Security Policy: A Report of the CSIS Global Health Policy Center" (Washington, D.C.: Center for Strategic and International Studies, 2009), p. 4.
152. Price-Smith attributes an important role to HIV/AIDS for the growing instability in Zimbabwe, but the multiplicity of factors at play makes it difficult to establish a causal link between the disease and that nation's destabilization. Price-Smith, Contagion and Chaos, pp. 89-116.
153. Stefan Elbe now believes that HIV/AIDS is better thought of as a threat to human security rather than to national or international security. Compare Elbe, Strategic Implications of HIV/AIDS.
154. Elbe, Virus Alert: Security, Governmentality, and the AIDS Pandemic (New York: Columbia University Press, 2009), pp. 27-58.
155. John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Viking, 2004), p. 5.
156. Michael T. Osterholm, "Preparing for the Next Pandemic," Foreign Affairs, Vol. 84, No. 4 (July/August 2005), pp. 24-37.
157. Laurie Garrett, "The Next Pandemic?" Foreign Affairs, Vol. 84, No. 4 (July/August 2005), pp. 3-23.
158. Michael T. Osterholm, "Unprepared for a Pandemic," Foreign Affairs, Vol. 86, No. 2 (March/April 2007), pp. 47-57.
159. Andrew Burns, Dominique van der Mensbrugghe, and Hans Timmer, "Evaluating the Economic Consequences of Avian Influenza" (Washington, D.C.: World Bank, updated September 2008).
160. Christian Enemark, "Is Pandemic Flu a Security Threat?" Survival, Vol. 51, No. 1 (February-March 2009), pp. 191-214.
161. David M. Morens, Jeffrey K. Taubenberger, and Anthony S. Fauci, "The Persistent Legacy of the 1918 Influenza Virus," New England Journal of Medicine, July 16, 2009, pp. 225-229.
162. Gerardo Chowell et al., "Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza," New England Journal of Medicine, August 13, 2009, pp. 674-679.
163. Margaret Chan, director-general, World Health Organization, "Concern Over Flu Pandemic Justified," address to Sixty-second World Health Assembly, May 18, 2009, http://www.who.int/dg/speeches/2009/62nd_assembly_address_20090518/en/index.html.
164. This section is based on Gregory D. Koblentz, "The Threat of Pandemic Influenza: Why Today Is Not 1918," World Medical and Health Policy, Vol. 1, No. 1 (November 2009), pp. 71-84.
165. In contrast, war and conflict accounted for only 0.3 percent of global deaths. World Health Organization, The Global Burden of Disease: 2004 Update (Geneva: WHO, 2008), pp. 72-74.
166. Yanzhong Huang, "The SARS Epidemic and Its Aftermath in China: A Political Perspective," in Stacey Knobler et al., eds., Learning from SARS: Preparing for the Next Disease Outbreak (Washington, D.C.: National Academies Press, 2004), p. 116.
167. Price-Smith, The Health of Nations, pp. 120-127.
168. Peterson, "Epidemic Disease and National Security".
169. Price-Smith, Contagion and Chaos, p. 200.
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