Understanding of biological agents as threats to human, livestock, and crop health, as well as to the U.S. economy, must be improved. Special emphasis might be placed on an urgent short list of recognized agents, including Bacillus anthracis (the agent responsible for anthrax), variola virus (which causes smallpox), and a few others, for obvious reasons; but much of the preparation should target a broader list and effectively prepare the nation for the unknown.
Appropriate government agencies and scientific organizations must evaluate emerging viruses and the genetic modification of existing viruses. Similarly, they need to consider the impact of genetic manipulations of pathogenic bacteria that enhance their virulence, particularly manipulations that render them resistant to the available antibiotics.
Although there are gaps in the scientific understanding of many potentially deadly biological agents and in the technological advances needed to anticipate and respond to their release, reliance on purely scientific or technological solutions is misguided. A much more inclusive effort is needed to build a seamless system of preparedness and response—one that can exercise the best available tools to counter biological threats.
This task depends first and foremost on rebuilding the public health infrastructure of the United States, which has been allowed to decay as the nation conquered some of the more common infectious and other disease challenges of the past century. The terrorist events of September and October 2001 should serve as a wake-up call to those in the position of setting science and health policies in the United States. Many of the scientific goals described in this chapter cannot be achieved in the absence of trained and well-equipped public
health officers, educated and prepared first responders, and clear communication among leaders, the medical community, and the public.
HHS, CDC, and other federal agencies, along with state departments of health, have begun to consider the best ways to educate health care professionals for effectively responding to bioterrorism. This country’s public health schools and professional societies have a major role to play both in training individuals and in researching ways to build a more responsive public health system. Various entities with some knowledge of bioterrorism, such as medical associations, have already prepared educational materials. The American Medical Association, for example, has produced an excellent primer to help physicians recognize and treat diseases likely to be caused by acts of bioterrorism. Regular updating of physicians and other health care professionals, perhaps through mandatory continuing education courses on the agents that pose the greatest threats, would be prudent. Meanwhile, training in this area should be part of the basic curricula for all aspiring health care professionals. Agencies and other institutions also face a major challenge in training first responders, such as firefighters and police, as well as in educating leaders and influential nonhealth professionals, such as teachers, on the realistic threats of bioterrorism and the ways in which they can be empowered to protect themselves and their communities.
But countering terrorism is not the only incentive for such actions. In 1992, the Institute of Medicine published a groundbreaking report, Emerging Infections: Microbial Threats to Health in the United States (IOM, 1992). It pointed out that “pathogenic microbes can be resilient, dangerous foes. Although it is impossible to predict their individual emergence in time and place, we can be confident that new microbial diseases will emerge” (p. 32). Thus, preparedness is essential not only for countering bioterrorism but also for facing the constantly evolving threat of infectious diseases, particularly the widespread escalation of bacterial pathogens resistant to all known antibiotics.
In reality, humans and the livestock and crops that sustain them are in a perpetual contest with microorganisms and the diseases that they cause—a contest that requires an armamentarium of knowledge gained from research, surveillance, and improved health practices. Humans and animals are not immune to the threat of infectious diseases just because they have been immunized or eat food and drink water that is regulated and evaluated for their safety. Serious, sometimes deadly, outbreaks of infectious diseases continue to occur naturally around the world. Even when they are treatable, these diseases take their toll in pain and suffering, inconvenience, disability, lost time from work and lost wages, and cost to the health-care system and the economy.
But preparing for the once unthinkable—a biological attack—should also prepare the U.S. population for the inevitable: the natural occurrence (or recurrence) of diseases that can affect all living things. Efforts that protect humans, animals, and plants from bioterrorism will also help us prevail in that never-ending contest with natural threats.
The reader is referred to Box 5.1 for Web sites with additional information on bioterrorism.