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LETTER |
Kathryn C. Dowling is a member of the Union of Concerned Scientists, Berkeley, Calif. Robert I. Lipton is with the Prevention Research Center, Berkeley, Calif.
Correspondence: Requests for reprints should be sent to Robert I. Lipton, PhD, MPH, Prevention Research Center, 1995 University Ave, Suite 450, Berkeley, CA 94704 (e-mail: rlipton{at}prev.org).
The exchange of letters in the March issue regarding Cohen and colleagues’ October 2004 article1 did not sufficiently quantify the national public health impact of misdirecting precious dollars to bioterrorism preparedness. For fiscal years 2002–2005 and 2006 (projected), the Centers for Disease Control and Prevention’s (CDC’s) terrorism preparedness funding has varied from $1.4 billion to $1.7 billion, averaging 22% of the CDC’s entire annual budget.2,3 The anthrax incident of 2001, which caused 5 deaths, prompted an ill-conceived smallpox vaccination campaign that was implicated in the deaths of 3 health workers4 and cost an additional $0.6 billion in 2002 and 2003.2
It is difficult to accept the efficacy of dual-use prevention given the tragic failures during Hurricane Katrina.5 Thousands of the most vulnerable and helpless were left to die in the streets from dehydration, exposure, and lack of medical attention.6 Still, for the sake of argument, suppose that dual use (which Cohen et al. strongly discount) might prevent all of the estimated 36000 influenza-related deaths that occur each year.7 Even in this most optimistic of scenarios, the expenditure per fatality prevented would amount to more than $40000.
In comparison, the CDC’s Chronic Disease Control and Health Promotion branch has a budget of $0.9 billion3 with which to combat an array of extremely important diseases and public health matters, ranging from diabetes to heart disease, from tobacco use to physical inactivity. These problems adversely affect millions of people each year. The United States is currently facing one of the worst epidemics of its history—overweight and obesity, which now affects 2 of 3 adults and is responsible for an estimated 300000 premature deaths annually.8 The CDC currently funds only 5 states for basic implementation and 23 states for capacity-building to counter this rapidly mounting problem.9 The CDC’s 2005 budget for nutrition, physical activity, and obesity is $42 million,3 which equates to roughly $200 per death related to obesity or overweight or 20 cents per affected individual.
There is something seriously amiss when the CDC dedicates orders of magnitude more funding to preparedness for emergency events with a low probability of occurrence than to preventing a condition that affects the majority of our population, causing hundreds of preventable deaths every day. Considering that obesity and overweight are only two of the numerous pressing health concerns in this country, it is clear that the current massive misfunding of terrorism preparedness over public health has real-world implications for mortality and morbidity.
References
1. Cohen HW, Gould RM, Sidel VM. The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences. Am J Public Health. 2004;94:1667–1671.
2. Centers for Disease Control and Prevention. FY 2004 budget request—detail of increases/decreases. Available at: http://www.cdc.gov/fmo/FY2004BudgetRequestDetails.pdf. Accessed April 26, 2005.
3. Centers for Disease Control and Prevention. FY 2006 CDC functional table reflecting new budget structure. February 11, 2005. Available at: http://www.cdc.gov/fmo/PDFs/FY06funcnewbudgtstruct.pdf. Accessed April 26, 2005.
4. Frieden T, Mostashari F, Schwartz SP, et al. Cardiac deaths after a mass smallpox vaccination campaign—New York City, 1947. MMWR Morb Mortal Wkly Rep. 2003;52:933–936.[Medline]
5. Shane S, Lipton E. Government saw flood risk but not levee failure. New York Times. September 2, 2005. Available at: http://www.nytimes.com/2005/09/02/national/nationalspecial/02response.html. Accessed September 2, 2005.
6. McFadden RD. New Orleans begins a search for its dead; violence persists. New York Times. September 5, 2005. Available at: http://www.nytimes.com/2005/09/05/national/natioanlspecial/05storm.html. Accessed September 5, 2005.
7. Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289: 179–186.
8. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282:1530–1538.
9. National Center for Chronic Disease Prevention and Health Promotion. CDC’s state-based nutrition and physical activity program to prevent obesity and other chronic diseases. October 6, 2004. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm. Accessed July 26, 2005.
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