The concept of ‘health security’ has been increasingly apparent in recent years in both academic and policy discourses on transborder infectious disease threats. Yet it has been noted that there are a range of conceptualisations of ‘health security’ in circulation and that confusion over the concept is creating international tensions with some states (particularly from the Global South) fearing that ‘health security’ in reality means securing the West. This article examines these tensions but puts forward an alternative explanation for them. It begins by looking at the different ‘health securities’ that characterise the contemporary global health discourse, arguing that there is in fact a good deal more consensus than we are often led to believe. In particular there is a high level of agreement evident over what the major threats to ‘health security’ are and what should be done about them. These are a particular set of health risks which are primarily seen as major threats by Western developed nations, and contemporary global responses – often couched in the language of global health security – have a tendency to focus on containment rather than prevention. The article makes the case that to resolve the tensions around (global) health security there is the need for a more explicit recognition of the primary beneficiaries of the current system, and of who is bearing the costs. Only following such a recognition can meaningful debates be carried out about the appropriate prioritisation of global health security in relation to other global health governance priorities.