More than two years after Chinese public health officials and doctors began warning about a mysterious rise in cases of “pneumonia of unknown etiology,” does anyone feel secure these days? The COVID-19 pandemic has, as many scholars and practitioners across disciplines have described, exposed the cracks in our fragile construction of modern life. Traditional approaches to global health security have, with frightening efficiency, failed at offering either health or security. The timing seems apt for a reconsideration of our approach to these issues.

Clare Wenham offers a timely opportunity for such reflection in her new book, Feminist Global Health Security. The book is divided into seven chapters: the first two introduce the question “Where are the women?” and offer a robust literature review on the theoretical framework underpinning feminist health security. Primarily using the 2015–17 outbreak of the Zika virus as her case study, Wenham spends the next few chapters assessing how global health security failed those most affected by Zika—women. She explores how structural violence, gender-based violence, and climate change interact with global health security, and in an epilogue added after the book was submitted in late 2019, she addresses “the big one”: COVID-19.

Global health security is focused on preventing, detecting, and responding to infectious disease threats of international concern. Although Zika did not affect the entire world as COVID-19 has, it offers a perfect glimpse into the weaknesses of global health security as currently practiced and an inroad into discussing the need for a feminist approach. Wenham starts the book with an anecdote about her attendance at a “Women in Global Health Security Breakfast,” where she noted “the complete lack of recognition of how our collective work in global health security policy impacts women worldwide beyond the self-reflexive corridors of global health security influence” (p. 1). This anecdote thus presents one of the major tensions in even the most well-intentioned efforts: the increased (and long overdue) recognition and representation of senior women in global health along with still underestimating, or even overlooking, the impacts of global health security on the women most affected by negative outcomes. Although gender disparities exist in all sectors, mostly privileging men in terms of position and salary, the field of global health seems particularly ripe for a reckoning. The World Health Organization estimates that women make up 70% of the global health and social care workforce, whereas men hold 75% of health leadership roles. The gender pay gap is higher than in most other sectors, at 25%. Many organizations and efforts exist to attempt to narrow these unacceptable gaps in the health workforce. Yet there is less attention paid to how global health itself is practiced, especially as it relates to the world’s most marginalized groups, which in many contexts include women.

Because Zika was an infectious disease with complications that were most notably expressed in women, especially pregnant women, the virus presents a unique opportunity for a gendered analysis. Some babies born to a mother infected with Zika during her pregnancy were afflicted with microcephaly, an immediately noticeable condition in which a baby is born with a small head or a head that stops growing; thus, a rapid and observable increase in such births was an immediate cause for alarm for countries affected by Zika, like Brazil. Zika is primarily transferred through mosquito bites, and the conditions that attract mosquitos (like standing water or poor sanitation) are concentrated in poor, urban areas. It was also found to spread through sexual transmission. These characteristics provide interesting opportunities for analysis across socioeconomic and demographic lines that build on previous global health security work done with other infectious diseases like HIV/AIDS, measles, and malaria.

The book has several strengths that make it a welcome contribution to the global health literature. Wenham successfully presents her theoretical argument by using Zika as her case study of how women are marginalized in global health security. Zika was widely recognized as a risk to global health security, but across Latin America, where disease incidence was highest, much of the advice to residents about how to handle the virus was highly gendered: “clean your house and don’t get pregnant,” as described in the title of chapter 5. Wenham notes, “The women that were seen amid the crisis, those who were plastered on the front page at the global and national level were not recognized or conceptualized as women, but as mothers” (pp. 82–83). This framing of women as primarily filling the role of “mother” (including by some women themselves) is commonly seen across emergency settings, but the underlying assumptions and what they say about society are rarely questioned. Wenham does so in a clarifying and engaging manner.

Further, this motherhood framing allows for one of the strongest sections of the book, which is about the broader manifestation and implications of women’s “invisibility” in international relations. The response to Zika was heavily paternalistic and securitized (including with respect to military deployment), even though, as Wenham emphasizes throughout the book, Zika and many infectious diseases often disproportionately affect women, both as patients and caregivers. Although Zika precipitated the inclusion of women as research subjects and as the target audience of outreach efforts, it marginalized their efforts in most other aspects and at all levels. The clinical observations of the local, primarily female, clinicians who first identified microcephaly as it related to Zika were sidelined in favor of the conclusions eventually made in western journals. Domestically, women were largely ignored in terms of policy development regarding Zika, and at the global level, “the global health security regime systematically ignored women’s particular needs” (p. 82). This evoked broader calls for a more feminist approach to international relations—when women and women’s issues are left out of the policy conversation, the needs of women are often ignored, or they are flattened to those of mothers or women as “referent objects” (p. 173).

The minor weaknesses of the book come where more elaboration would have bolstered the arguments. For example, the concept of intersectionality, which acknowledges that “women are not identical, and gender intersects with other drivers of inequalities and social determinants of health” (p. 93), was only addressed briefly. As a core focus of the current fourth wave of feminism, however, it might have been more explicitly woven throughout the book. Further, as a global health scholar, I was intrigued by a too-brief discussion of rubella as it related to global health security in chapter 4. The gendered aspects of this nearly forgotten epidemic are rarely discussed in the global health literature, and it complemented the Zika discussion in several important ways.

In a way, the timing of this book could not be better. With so much of the current global health literature and discourse focused on COVID-19, it is refreshing to read a book on this topic using a case study of an entirely different, but still quite recent, global health security threat. The characteristics of Zika and the gendered response to it provide an optimal opportunity to argue for a feminist approach to global health security, and Wenham does so ably. This book would be beneficial reading to any scholar in political science, gender studies, or public health.