The global governance regime to address the vast dangers of intentionally inflicted disease is ineffectively adaptive to meet emerging challenges. Scientific advances pertaining to manipulation of disease offer profound benefits but also open ominous new capacities for violence. Weaponized disease can transform a few malevolent actors wholly lacking in power from purveyors of localized death into architects of existential crises endangering international security. The historically inexorable relationship between political-economic power and technology for mass violence is shifting – a paradigm shift called the democratization of mass violence. The 7th Review Conference of the Biological Weapons Convention in December could set markers for how the world should address this paradigm shift. Three sets of global policies could reduce dangers of intentionally inflicted disease and promote bioscience’s advance while elevating global attention to public health: (1) worldwide implementation of harmonized measures to secure and account for especially dangerous pathogens and to enable interruption of intentional biothreats; (2) strengthened national reporting obligations and international investigations of suspicious behavior in order to build mutual confidence about national biodefense programs; and (3) implementation of harmonized measures to improve disease surveillance, strengthen resilience to bio-attacks and stanch an attack’s transnational spread.