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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.

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.

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.

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.

The Introduction develops the context within which the federal government’s biodefense plans emerged and on which they were justified, including 9/11, the anthrax attacks, and the successive menace presented by West Nile virus, SARS, and avian influenza and most recently Ebola. After discussing the context and moral panic that ensued over terrorism, which were used to justify the new federal biodefense agenda, the Introduction then turns to local manifestations of those plans and responses to them–the community cases whose civic responses are comparatively explored in Community at Risk. The Introduction then develops key terms and concepts that are relied on to investigate and understand the community cases as well as the research strategy deployed to gather relevant data, analyze it, and draw conclusions. The Introduction ends with a brief summary of how the book is organized by chapter.

Broadly historical in its perspective, Laura Donohue tells a story of the blurring of categories. From the founding of the Republic through the end of the twentieth century, the legal authority to respond to the threat of pandemic disease dramatically shifted from the police powers of the states to those of the federal government. The events of 9/11, however, triggered a shift in thinking, as the threat posed by disease has more recently come to be seen through a “national security framework” and “through the lens of war.” Donohue worries that as categories continue to blur, the consequences will be difficult to foresee and control. Were a pandemic to strike the United States, the initial chaos would make it all but impossible to determine whether the outbreak was caused by natural factors or by a purposive act of biowarfare/terrorism. In either case, the response would require the coordinated efforts of institutions of civilian governance and the military.

This chapter studies civilian biodefense as a “natural experiment” to compare with research, development, acquisition, and doctrine in the military. Foreshadowed during the Korean War, the rise of civilian biodefense began in earnest during the 1990s when prominent scientists constructed a new relationship between bioterrorism and emerging infectious diseases. These ideas helped situate biological weapons inside the biomedical frame at the Department of Health and Human Services (HHS), enabling it to respond to increasing demands from the president and Congress. Unlike the military, the HHS lobbied hard to win funds money on the table for biodefense rather than let the funding go to the Department of Homeland Security after September 11 and the anthrax attacks of 2001. Moreover, the HHS did not rely on the military's inaccurate stereotypes.

This introductory chapter explains why the National Science Advisory Board for Biosecurity (NSABB) halted Erasmus Medical Center's plan to publish a major finding about the H5N1 bird flu. The Erasmus team, led by Ron Fouchier, had created a mutant strain of H5N1 that spread more easily among mammals. NSABB requested that scientific details be deleted before publication for fear that they might be used by terrorist groups. Based on this case, the book addresses the question: Does the threat of bioterrorism automatically increase with progress in science? It claims that the challenge in developing biological weapons is not the acquisition of scientific data and tools but in the use of the material and technologies required for the biological weapon development.

This chapter describes various biological hazards and their impact on workers and others. A major focus of the chapter is biological hazards in healthcare and laboratory settings, including exposure to bloodborne pathogens and prevention of diseases related to them. Sections deal with sharps injuries, HIV/AIDS, hepatitis B virus, hepatitis C virus, tuberculosis, and other infectious diseases that can be acquired in the work environment via direct contact, droplet or airborne spread, or fecal-oral transmission. In addition, infectious agents spread by animal contact or arthropod vectors in a broad range of settings will be addressed. Newly emerging infectious or re-emerging infections, such as those due to H5N1 and novel H1N1 influenza, Middle Eastern respiratory syndrome (MERS), and Ebola Virus Disease (EVD) as well as agents associated with bioterrorism are discussed.