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The pods of the tropical plant cacao, Theobroma cacao, are the source of chocolate. This crop is afflicted by a multitude of fungal diseases, including witches’ broom, frosty pod rot, and black pod. Until the mid-1990s, Brazil was second only to Côte d’Ivoire in cacao production. But then, the witches’ broom fungus, Crinipellis perniciosa, arrived, devastated the cacao plantations in Bahia, and Brazil dropped to fifth place among the cacao producing nations. The story of cacao diseases involves intriguing twists and turns, both scientific and geopolitical, including contemporary concern about the deliberate introduction of plant pathogens as acts of bioterrorism.

This chapter provides an overview of the legal issues relating to public health surveillance. It discusses the general legal authorities for public health surveillance set forth in constitutional, statutory, and regulatory laws; legal milestones in the evolution of public health surveillance and disease control in the United States; and legal issues related to the collection, analysis, and dissemination of surveillance data for public health practice and research activities. In addition, the chapter presents information about new surveillance challenges beyond traditional infectious disease models, including the influence of bioterrorism preparedness on surveillance activities.

This chapter describes biological weapons, including the history of their proliferation and use, outbreaks of anthrax and salmonellosis, international control of biological weapons, and specific bioterrorist weapons and their adverse health effects. It concludes with a discussion of what health professionals can do to address biological weapons.

This chapter describes the public health response to the anthrax epidemic in 2001. It discusses historical background, epidemiology of anthrax, terrorist use of anthrax, and evaluation of the public health response to the anthrax outbreak in 2001. It concludes that the public health response to the anthrax bioterrorist event in 2001 was rapid and comprehensive, and it may have prevented the further spread of anthrax.

This chapter narrates a meeting in Geneva in December 2011, where former U.S. secretary of state Hillary Clinton warned of a potential bioterrorism threat. She said that “a crude, but effective, terrorist weapon can be made by using a small sample of any number of widely available pathogens, inexpensive equipment, and college level chemistry and biology.” Her statement reiterates a common belief: scientific knowledge is cumulative, is easy to acquire and use, and does not depreciate over time. However, academic and practical evidence suggests that such knowledge is difficult to acquire, use, or transfer because much of it is tacit, local, and collective in nature. Thus, the chapter explores how different types of knowledge are acquired and transferred.

In the foregoing chapters, we have focused on the intersection of war and infectious disease over the 140-year period from 1850. We have examined long-term trends in disease activity in civil, military, and displaced populations (Chs. 3–5), outlined some of the analytical approaches used to describe the spread of war epidemics (Ch. 6), and we have explored in a regional context recurring themes at the interface of war and infectious disease (Chs. 7–12). In this concluding chapter, we examine the epidemiological consequences of wars and war-like events in the years since 1990.We begin in Section 13.2 by reviewing the empirical evidence for the spread of diseases in association with three recent conflicts: the Gulf War (1990–1); the Bosnian Civil War (1992–5); and Afghanistan and the ‘War on Terrorism’ (2001–). In Section 13.3, we examine the role of war both as an obstacle to disease eradication and to disease-control strategies while, in Section 13.4, we focus on biological weapons as one of the foremost threats to global security in the modern world. Finally, in Section 13.5, we isolate a series of further war-related issues (militarism; economic sanctions; international peacekeeping; disease re-emergence; and post-combat syndromes) that—given the balance of probabilities—are likely to be of continuing epidemiological significance in the current century. As we enter a new millennium, there is an undercurrent of academic thought that nuclear weaponary and the end of the Cold War have rendered war obsolete; that war is, and will be, increasingly supplanted by economic competition between states and regions (see e.g. Black, 2000).Yet it is clear from Figure 13.1 that wars—of greater or lesser intensity—have continued to increase, rather than decrease, in number over the last few decades. This increase has remained largely focused in the less developed regions of the world (van der Wusten, 1985; Brogan, 1992; Arnold, 1995). By way of illustration, Figure 13.2 delimits the global pattern of conflict in the year 2000. As the map shows, levels of conflict intensity were highest in some of the poorest of the world’s regions—in Sub-Saharan Africa, Central and South Asia (Murray et al., 2002).

Following the September 11^th terrorist attacks and anthrax attacks shortly after, the need was recognized for public health departments to partner with law enforcement and federal security agencies to enhance early detection capabilities and response to threats of terrorism. Building collaborative relationships with these agencies to facilitate effective information sharing, and conducting joint-investigations requires public health departments to develop mechanisms for routinely communicating and jointly assessing threat information with law enforcement and other intelligence agencies. This chapter describes the infrastructure established within the Los Angeles County Department of Public Health which allows for such information sharing and provides examples of several joint-investigations conducted by the Department with its law enforcement partners.

You wouldn’t see the asteroid, even though it was several miles in diameter, because it would be hurtling toward you at 15 to 25 miles a second. At that speed, the column of air between the asteroid and the earth’s surface would be compressed with such force that the column’s temperature would soar to several times that of the sun, incinerating everything in its path. When the asteroid struck, it would penetrate deep into the ground and explode, creating an enormous crater and ejecting burning rocks and dense clouds of soot into the atmosphere, wrapping the globe in a mantle of fiery debris that would raise surface temperatures by as much as 100 degrees Fahrenheit and shut down photosynthesis for years. The shock waves from the collision would have precipitated earthquakes and volcanic eruptions, gargantuan tidal waves, and huge forest fires. A quarter of the earth’s human population might be dead within 24 hours of the strike, and the rest soon after. But there might no longer be an earth for an asteroid to strike. In a high-energy particle accelerator, physicists bent on re-creating conditions at the birth of the universe collide the nuclei of heavy atoms, containing large numbers of protons and neutrons, at speeds near that of light, shattering these particles into their constituent quarks. Because some of these quarks, called strange quarks, are hyperdense, here is what might happen: A shower of strange quarks clumps, forming a tiny bit of strange matter that has a negative electric charge. Because of its charge, the strange matter attracts the nuclei in the vicinity (nuclei have a positive charge), fusing with them to form a larger mass of strange matter that expands exponentially. Within a fraction of a second the earth is compressed to a hyperdense sphere 100 meters in diameter, explodes in the manner of a supernova, and vanishes. By then, however, the earth might have been made uninhabitable for human beings and most other creatures by abrupt climate changes.

The number of extreme catastrophes that have a more than negligible probability of occurring in this century is alarmingly great, and their variety startling. I want to describe them and in doing so make clear the importance of understanding what science is doing and can do and where it is leading us. I begin with the natural catastrophes and move from there to the man-made ones, which I divide into three groups: scientific accidents, other unintended man-made catastrophes, and intentional catastrophes. The 1918–1919 flu pandemic is a reminder that nature may yet do us in. The disease agent was an unexpectedly lethal variant of the commonplace flu virus. Despite its lethality, it spread far and wide because most of its victims did not immediately fall seriously ill and die, so they were not isolated from the healthy population but instead circulated among the healthy, spreading the disease. No one knows why the 1918–1919 pandemic was so lethal, although it may have been due to a combination of certain features of the virus’s structure with the crowding of troops in the trenches and hospitals on the Western Front (where the pandemic appears to have originated near the end of World War I), facilitating the spread of the disease. The possibility cannot be excluded that an even more lethal flu virus than that of the 1918–1919 pandemic will appear someday and kill many more people. There is still no cure for flu, and vaccines may be ineffective against a new mutant strain—and the flu virus is notable for its high rate of mutations. Another great twentieth-century pandemic, AIDS, which has already killed more than 20 million people, illustrates the importance to the spread of a disease of the length of the infectious incubation period. The longer a person is infected and infectious yet either asymptomatic or insufficiently ill to be isolated from the healthy population, the farther the disease will spread before effective measures, such as quarantining, are taken.

Bioterrorism has emerged as a prominent fear of the modern age, alongside revolutions in biological science and changing practices of warfare. Bioterrorism is also an important, and often overlooked, site for studying the cultural politics of nature. Nature is at the center of contemporary concerns as never before, but its forms are no longer recognizable in a traditional sense. Massive expenditures on disease control over the last century have been a central site for the production of nature. Institutions of health, war, and science built around modern natures, are setting new terms for biological citizenship and environmental futures for the 21^st century. The introduction overviews key histories of bioterrorism and theoretical underpinnings for a critical study of biosecurity.

Following 9/11 and the subsequent anthrax attacks, the U.S. government enlisted the public health industry in homeland security and defense, bringing weapons like disease surveillance and life science research to the war against terrorism. As Congress poured out funding for bioterrorism preparedness, agencies like the Centers for Disease Control and Prevention rearranged themselves around new logics of biosecurity. In the decade after 9/11, CDC brought its surveillance, science, and communication practices to bear on questions of national security, and became a federal organizing agency for emergency response and pharmaceutical stockpile stewardship. The political transformations at the CDC exemplify how bioterrorism changed the role of government in disease management, along with the specific work of the nation’s largest public health agency.

Because no large-scale bioterrorist attack has happened in the modern age, planning for bioterrorism requires imagination. Simulations, ranging from computer-generated models to large-scale role-playing events involving thousands of actors, have gained credibility as a scientific tool for calculating the outcomes of violent events. Expanding use of simulation raises questions about how modeling and scenario planning gain tenacity in the current political climate, used by planners and policymakers to generate knowledge of the future. In bioterrorism preparedness, simulations and scenarios matter because they rationalize political actions that manage human life, individually and collectively, in the present moment. A case study of a terrorism training center in Playas, New Mexico, demonstrates the material and political effects of scenarios and simulation.

Fears of bioterrorism persist more than a decade after 9/11, continuing to shape public health practice and scientific research. The conclusion revisits two themes of the book: that the materiality of microbes matters, and that by changing what it means to be human and a biological citizen, microbes create new systems of governance for a world full of unspecified risks. Whether there exists a biological threat or not, the work to prepare the nation is shaping citizens’ lives. I draw attention to the outcomes of bioterrorism preparedness not because they are inevitable consequences of the search for national security, but because we have the ability to make different choices to create the biological future in which we want to live.

The decade and a half since the last review article on political geography by Reynolds and Knight (1989) in Geography In America has been one of extraordinary geopolitical transformation and change. Not only did the Cold War come to an end with the fall of the Berlin Wall and the dissolution of the Soviet Union but the spectacular terrorist attacks of September 2001 brought the “post-Cold War peace” to an end also. In the early 1990s the threat of superpower nuclear war faded as an omnipresent nightmare in international relations. Yet new threats and dangers quickly emerged to take the place of those imagined during the Cold War. Concern grew about “rogue states,” genocidal ethnonationalism, global warming, and the dangers of nuclear proliferation (Halberstam 2001; Klare 1995; Odom 1998). Fears about terrorism also grew with a series of bombings, from Paris, London, and Moscow to Oklahoma City, New York, and Atlanta. United States troops and embassies in Saudi Arabia, Tanzania, Kenya, and Yemen were the targets of terrorist attacks. But it was only after the disruption, shock, and panic of the devastating terrorist attacks of 11 September 2001 and subsequent incidents of bioterrorism that world politics was given new definition and clarity by the world’s most powerful state. The new metanarrative of geopolitics is the “war against terror.” Beyond the high dramas of geopolitics, already existing trends in everyday economic and political life deepened in the last decade and a half. New social movements have forced questions concerning the politics of identity and lifestyles onto the political agenda. The globalization of financial markets, telecommunication systems, and the Internet further rearranged governing notions of “here” and “there,” “inside” and “outside,” “near” and “far.” With global media networks broadcasting news twenty-four hours a day and the Internet spreading a world wide web, the “real” geographies of everyday life were becoming strikingly virtual as well as actual (Wark 1994; Mulgan 1997). Informationalization, and the relentless pace of techno-scientific modernity were transforming everyday life and education in the United States’ colleges and universities. Celebrated by the culture of transnational corporate capitalism, these tendencies brought enormous wealth to some, further polarizing income inequalities across the planet while also introducing unprecedented vulnerabilities and uncertainties into what was becoming “global everyday life.”

One can conceive of at least three potentially catastrophic events involving the energy of the atom: a nuclear accident in which massive quantities of radiation inadvertently are released into the environment including inadvertent nuclear missile launches; nuclear war among nation-states; and nuclear violence inflicted by non-state actors. This chapter focuses on the last of these threats – the dangers posed by nuclear terrorism, a phenomenon that lies at the nexus between what are widely considered to be two of the primary security threats of the modern era. Non-state actors have essentially four mechanisms by which they can exploit civilian and military nuclear assets intentionally to serve their terrorist1 goals: • the dispersal of radioactive material by conventional explosives or other means; • attacks against or sabotage of nuclear facilities, in particular nuclear power plants and fuel storage sites, causing the release of radioactivity; • the theft, purchase, or receipt of fissile material leading to the fabrication and detonation of a crude nuclear explosive, usually referred to as an improvised nuclear device (IND); and • the theft, purchase, or receipt and detonation of an intact nuclear weapon. All of these nuclear threats are real; all merit the attention of the international community; and all require the expenditure of significant resources to reduce their likelihood and potential impact. The threats, however, are different and vary widely in their probability of occurrence, in consequences for human and financial loss, and in the ease with which intervention might reduce destructive outcomes (for a detailed analysis, see Ferguson and Potter, 2005). Nuclear terrorism experts generally agree that the nuclear terror scenarios withthehighestconsequences–thoseinvolvingnuclearexplosives–aretheleast likely to occur because they are the most difficult to accomplish. Conversely, the scenarios with the least damaging consequences – those involving the release of radioactivity but no nuclear explosion – are the most likely to occur because they are the easiest to carry out. Constructing and detonating an IND, for example, is far more challenging than building and setting off a radiological dispersal device (RDD), because the former weapon is far more complex technologically and because the necessary materials are far more difficult to obtain.

This concluding chapter explains that as viruses like human immunodeficiency virus, severe acute respiratory syndrome, Zika, and West Nile evolve and emerge, humans are faced with new challenges. Simultaneously, perceptions about new infections and new plagues continue to change. What can and should be done? One must now consider the possible return of smallpox and its use as a weapon of bioterrorism. Meanwhile, even as the march to contain measles and poliomyelitis viruses continues at an impressive pace, bumps and setbacks have been encountered along the way, especially with measles having recurred in 2019 at the time of writing this book. Ultimately, the history of viruses, plagues, and people is an account of the world and the events that shape it. In the end, the splendor of human history is not in wars won, dynasties formed, or financial empires built but in improvement of the human condition. The obliteration of diseases that impinge on people’s health is a regal yardstick of civilization’s success, and those who accomplish that task will be among the true navigators of a brave new world.