Infectious disease outbreaks primarily affect communities of individuals with little reference to the political borders which contain them; yet, the state is still the primary provider of public health capacity. This duality has profound effects for the way disease is framed as a security issue, and how international organisations, such as the World Health Organization, assist affected countries. The article seeks to explore the role that domestic political relationships play in mediating the treatment of diseases as security issues. Drawing upon an analysis of the securitisation of avian influenza in Vietnam and Indonesia, the article discusses the effect that legitimacy, competing referents and audiences have on the external and internal policy reactions of states to infectious diseases, specifically in their interpretation of disease as a security threat. In doing so, we extend upon existing debates on the Copenhagen School's securitisation framework, particularly on the impact of domestic political structures on securitisation processes in non-Western, non-democratic and transitional states.