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Anatomy of a Crisis 5 within a very short time frame. In her book How Everything Became War and the Military Became Everything, Rosa Brooks quotes retired general Dave Barno, who says that the U.S. military has become “like a Super Walmart with everything under one roof.”8 The list of military activities other than war stretches far: leading WMD interdiction operations, procuring equip- ment for U.S. allies, overseeing urban renewal projects, providing disaster response to both domestic and international events (e.g., Katrina, Fuku- shima, and West Africa), patrolling U.S. borders, housing and judging Gitmo prisoners, leading global biological threat reduction and biosur- veillance programs, and producing medical countermeasures for domestic use. The military is first on call for all dangers associated with an external threat, even when there are more appropriate government agencies that should be utilized. We need to reexamine this concept of health security and assess how U.S. government policy addresses this issue. HOW DID WE GET HERE? Before covering a brief history of U.S. administrations’ actions on this topic, we should understand the differences between the terms “disease outbreak,” “epidemic,” and “pandemic.” A disease outbreak is when a particular illness unexpectedly arises within a particular community. It can last days or years (becoming endemic) and could be a new disease remaining in one particular area. An epidemic occurs when an infectious disease spreads quickly over a region or in a community and affects more individuals than is historically normal. A pandemic is a disease outbreak that has spread rapidly over several countries or continents, affecting a very large number of people.9 Not all disease outbreaks are national secu- rity issues, although pandemic outbreaks certainly have significant secu- rity implications. These terms will be helpful in the following discussion about how presidential administrations have categorized and acted on biological threats. The following narrative is not to provide an exhaustive description of all of the actions taken by government agencies that were tasked with addressing biological threats but rather to note some of the major events that policy makers have addressed. The human immunodeficiency virus (HIV) that causes acquired immu- nodeficiency virus syndrome (AIDS) began as a disease outbreak in sub- Saharan Africa in the 1970s and evolved into an epidemic outbreak in East Africa in the early 1980s. It quickly overwhelmed African nations that did not have the health infrastructure to manage this contagious dis- ease. Health authorities in the United States started to grapple with the disease in 1981 after the CDC described cases of a rare lung infection in five young gay men in Los Angeles.10 Although the spread of HIV/AIDS had crossed continents, the World Health Organization described this dis- ease as a “global epidemic,” while others described it as a pandemic. The