The Shield and Sword of Biosecurity: Balancing the Ethics of Public Safety and Global Preparedness

This article refers to:

COVID in NYC: What We Could Do Better

Positive Public Health Ethics: Toward Flourishing and Resilient Communities and Individuals

As Jennifer Prah Ruger (2020), and Tia Powell and Elizabeth Chuang (2020) assert in their respective target articles, the COVID-19 crisis has brought into view the inadequacies of public health and safety programs of biothreat preparedness and response. Despite a number of governmental preparedness exercises and discussions, problems have arisen that have made biosecurity and public health responses challenging. We believe that some of these challenges are intrinsically tied to human elements of biosecurity readiness and response, and to the underuse of emerging technologies and techniques which have not been fully addressed by extant ethico-legal frameworks.

Any biosecurity risk and threat, regardless of size or scope, requires surveillance and tracking to assess if and how core components of response policies and practices are articulated to contain spread. During COVID-19, the lack of an available vaccine required employment of social distancing, and requests—followed by requirements—to shelter in place. These were paired with contract tracing, which engaged current technological advancements such as geo-spatial tracking via electronic devices and video surveillance of public spaces to assess movement of the populace that may be correlated to outbreak “hotspots.” Many in society however, perceived these methods as invasions of privacy and suppression of individual freedoms/liberties. Subsequent—and ongoing—discussions raise question of if, when and how certain individuals could “safely” emerge from lockdowns, and restrictions of social and economic activities could be lessened and/or lifted.

These discussions foster, and entail ethico-legal and social issues and concerns. In the main, these can be regarded as focal to and generated by (1) the relative novelty of the techniques and technologies considered; and (2) implications and effects of the use, and/or misuse of these approaches and the information they provide (Giordano 2017). For example, it is evident that testing can provide a primary disease surveillance tool to enable assessment of individuals who may be infected, recovered (and perhaps immune), and as yet uninfected and therefore vulnerable. While some nations’ testing programs were efficient, others’ provisions for widespread, effective testing were inapt. However, even thorough implementation of testing procedures did not afford information about individuals’ and populations’ relative risk or resistance to the disease, and this informational gap has prompted calls for increased use of advanced biotechnological tools that bridge such gaps by providing genomic analyses of (groups of) patients to identify aspects of genetic vulnerabilities and resilience.

But this too reveals—and further incurs—the ethically problematic nature of forging and yielding the “shield and sword of biosecurity,” as both are two-sided. To be sure, an axiomatic goal of any biosecurity program is to shield individuals and the public from risks and threats to health and safety through systems of analyses, and preparedness. Effective shielding must take into accord the risk/threat as well as the agent(s) being threatened. The former requires assessment and surveillance of extant and potential pathogens (and other detriments to public safety and health), while the latter necessitates evaluation of individual and group vulnerabilities on a variety of levels and scales that range from the cellular to the psychosocial, and from the personal to the political. Should the shield be too small, it will not meaningfully thwart the threats against which it is intended; whereas creating and maintaining shielding that is too broad can demand and expend undue—and unsustainable—effort, resources, and services. Similarly, too small a shield will fail to take into accord—and thereby leave accessible—the weaknesses of those it is designed to protect; and an over-weighted or—extensive shield can be unwieldy, and in this way impractical, burdensome, and/or inefficient.

However, shielding, while necessary, is often insufficient. There are times when a proverbial sword must be employed to actively defeat a threatening entity. But its utility and effectiveness bring into sharp relief critical considerations about the two sides of its blade. To be useful, the blade must be forged of substance and sharpened to meet the task at hand. Yet, to do so requires knowledge of that which the blade is to strike and cut, and iterative testing of “the mettle of its metal.”

These are not mutually exclusive; rather, we believe, that they are reciprocal in their intent and effects (DiEuliis and Giordano 2017). Shields and swords must be assessed in and across a range of conditions that an adversary may assume under circumstances that are known heretofore, as well as those that are possible in the future. To develop and use these implements defensively requires assertive engagement and evaluation of their capabilities to reveal their strengths, weaknesses, and what can be done to overcome limitations in their viability and value. Herein lies a conundrum: How can—and should—the limits of function be evaluated without (1) risking those doing the testing; and (2) implicitly or explicitly expanding and/or advancing what destructive forces are possible, if not probable, given tendencies toward some construct of the technologic imperative?

In its contribution to the safety and health of the polis, biosecurity (as a biomedical process, discipline, and systems of articulation) arguably serves a defined public good. As such, and to uphold community trust, programs of biosecurity must be genuine (i.e.—actually do what they claim will be done) and non-wasteful (i.e., not misuse resources) in their focus, scope and practices (May 2003). It is equally important to recognize that publics differ, and the cultural histories, needs, values, philosophies and ethics that define various nations’ community identity, ideologies—and the relative “good(s)” that these instantiate, must be at least acknowledged, if not responsibly and respectfully addressed.

What lessons for strengthening the shield and sharpening the sword of biosecurity can, and should be drawn from both the COVID crisis, and an appreciation for the ecological, scientific, technological, and geo-political realities of our time? We have advocated the use of an operational risk assessment and mitigation paradigm to appraise the capabilities, limitations, consequences and contingencies of developing and employing new biomedical techniques and technologies (Giordano 2017); and herein advocate its potential merit in the biosecurity milieu. A component of this method entails insight and appropriated regard for cultural and circumstantial contexts of use, and in this light, we have endorsed a cosmopolitan ethical palette from which to obtain or develop precepts that could be broadly multi-nationally applicable, and from which more “locally contextual” sets of principles may be taken for use in specific (inter-)cultural engagements (Shook and Giordano 2014). To put these into practice, we suggest consideration of discursive approach, taken with some form of equilibrium and application of a mini-max/maxi-min valuation of variables.¹

Easy enough to state, but certainly not simple in development or execution. Particularly given the dual-use potential of any proactive stance to biosecurity that is positioned to identify and address both naturally-occurring and man-made threats (that have become ever more interactive, and possible given newly available methods in gene-editing and synthetic biology; DiEuliis and Giordano 2017). Any realistic appraisal of the dual-use validity and value of biosecurity preparedness, readiness and response prompts the question of which ethical system(s) would provide the most authentic consideration of the multi-dimensional variables entailed, and most effective guidance and governance of benefits, burdens, risks and harms (Giordano and Evers 2018). Such ethical approach(es) must fully recognize and seek to navigate the often-fuzzy boundary of a nation’s public health and safety, and its stance(s) of security, and defense (Tennison et al. 2017).

Perhaps the multi-national impact of the COVID crisis will enable a more granular, and clearer lens through which to examine current and near-term vulnerabilities that are shared by humanity that is nested within local and global ecologies. Indeed, Owen Flanagan has claimed that ethics is most accurately regarded as “human ecology” (Flanagan 2016); and we applaud this view with recognition that ecologies are comprised of multiple niches, that contribute to, and are affected by environment(s) writ-large. Human technologic capability has enabled modification of natural environments and their products, and these activities bear a cost.

Benefits must be weighed with burdens and risks, and harms of commission and omission must be evaluated in terms of idiosyncratic as well as systemic effects. The ethical toolkits to guide and govern these decisions and actions may require revisiting. Certain existing positions, precepts, and postures may need revision, and/or might require development of new views and methods of engaging multi-national issues, questions, and problems that can—and likely will—arise given the scientific, technological, and political capabilities at hand, as well as those that are lacking (Lanzilao et al. 2013). We have called for a whole-of-nation approach to addressing emerging threats to biosecurity (DeFranco et al. 2019). But this alone will be ineffectual, as this is neither the time nor the circumstances for nationalistic isolationism. Rather, international fora are needed to exchange local needs and values desiderata, toward creation of globally relevant and respectful solutions. Our group remains hopeful for, and dedicated to such discourse and enterprise.

DISCLAIMER

The views and opinions presented in this work are those of the authors and do not necessarily reflect those of the US Department of Defense, and/or those institutions and organizations supporting the authors’ work.

Additional information

Funding

This work was supported in part by the Henry M. Jackson Foundation for Military Medicine (JG); Leadership Initiatives (JG); and federal funds UL1TR001409 from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through the Clinical and Translational Science Awards Program (CTSA), a trademark of the Department of Health and Human Services, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.” (JG).

Notes

1 For example, the discursive approach proposed by Jurgen Habermas; and a method of deliberation, for example, using an equilibrium-based orientation as proposed by John Rawls, in combination with particular consequentialist techniques and aims, such as those offered by Paul Thagard.