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LETTER |
Victor W. Sidel is with Montefiore Medical Center, Bronx, NY. Hillel W. Cohen is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. Robert Gould is with Kaiser Hospital, San Jose, Calif.
Correspondence: Requests for reprints should be sent to Hillel W. Cohen, MPH, DrPH, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Room 1006, Belfer Bldg, 1300 Morris Park Ave, Bronx, NY 10461 (e-mail: hicohen{at}aecom.yu.edu).
We are grateful to Dowling and Lipton for their letter and to the Journal for providing an opportunity to continue this important discussion. Dowling and Lipton provide additional data that underscore the absurdly distorted priorities of bioterrorism preparedness spending relative to spending for real public health needs in the United States. Outside the United States, the United Nations has estimated that about US$10 billion invested annually in safe water supplies could reduce by one third the 4 billion annual cases of diarrhea that result in 2.2 million deaths.1 Bioterrorism preparedness spending thus diverts resources not only from US public health needs but also from urgent international public health work.
In addition, overstated concern with bioterrorism has led to a climate of fear that is inimical to public health and that incites constraints on civil rights and human rights. The Model State Emergency Health Powers Act, elements of which had been adopted by states, and the USA Patriot Act and the Homeland Security Act, which have been adopted by the US Congress, are examples of such constraints.2,3 The potential for misuse and abuse of emergency powers is great in a climate in which even a rumor of a bioterrorist threat can evoke panic.4
The overall climate of fear to which an exaggerated fear of bioterrorism contributes has led to domestic and foreign policies that are antihealth, such as the disastrous "preemptive" war in Iraq that has killed and injured many military personnel and civilians and has diverted funds from health, education, and social services. The now discredited campaign for the war on Iraq followed a well-known pattern. Nazi leader Herman Goering, interviewed during the Nuremberg Trial in 1945, said, "The people can always be brought to the bidding of the leaders. That is easy. All you have to do is to tell them they are being attacked, and denounce the pacifists for lack of patriotism and exposing the country to danger. It works the same in any country."5(pp278–279)
While it may be hard to convince the people of the United States that fears of bioterrorism are being overstated for political reasons and that the health of the people of the United States and the world requires action for peace and justice and the denunciation of war, this is nonetheless an urgent priority for public health workers.6
References
1. Price of safe water for all: $10 billion and the will to provide it. New York Times. November 23, 2000:A10.
2. Geiger HJ. Protecting civil liberties. In: Levy BS, Sidel VW, eds. Terrorism and Public Health: A Balanced Approach to Strengthening Systems and Protecting People. New York, NY: Oxford University Press; 2002:322–334.
3. Sidel M. More Secure, Less Free? Antiterrorism Policy and Civil Liberties After September 11. Ann Arbor: University of Michigan Press; 2004.
4. Levy BS, Sidel VW. Challenges that terrorism poses to public health. In: Levy BS, Sidel VW, eds.
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