| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
LETTER |
The author is with the Department of Continuing Education, Brigham Young University.
Correspondence: Requests for reprints should be sent to John B. Amadio, PhD, MPH, 2103 S Mountain Vista Lane, Provo, UT 84606 (e-mail: jramadio1{at}juno.com).
I disagree strongly with the contentions of Cohen et al. in the October issue of the Journal. In their commentary "Pitfalls of Bioterrorism Preparedness," based on the anthrax and smallpox vaccination experiences, the authors argue that the present expansion of bioterrorism preparedness programs squanders health resources and that "the ‘dual use’ rationale is illusory."1(p1667) This view is too narrowly focused as to the possible threats and shows a serious lack of knowledge of what is happening at the grassroots local health level as a result of the emphasis on bioterrorism preparedness. I have been involved in public health for 40 years and have always found it to be underfunded. Today’s shortfalls in public health funding cannot be blamed on the emphasis on bioterrorism preparedness.
Bioterrorism preparedness money is some of the first real new money that has come to public health in many years, and it has been a real boon for many local health departments. In my state, epidemiological expertise has been greatly enhanced by bioterrorism preparedness funds. Surveillance of communicable disease in general has improved to where it should have been years ago. Communications between local public health officials, emergency personnel, law enforcement, health care providers, and health facilities has been developed in a serious way never before achieved. Public health is now seen as a key player in emergency preparedness, whereas previously we were just an afterthought. Before the emphasis on bioterrorism preparedness most local providers in my state took an average of 24 days to report communicable diseases to the local health department. In 2003 that time was reduced to 7 days. We are working to get it to less than 3 days.
The examples of the anthrax and smallpox vaccination programs Cohen et al. used, while real, are not a true measure of the successes of the bioterrorism preparedness program. It would take only a small amount of a highly communicable deadly disease to deliberately infect 19 suicide volunteers (similar to the 19 hijackers of September 11th) who would then board crowded international flights traveling to 19 US cities to trigger widely spread epidemics that could overwhelm our health system. Even if it never happens, which is what Cohen et al. seem to think, we cannot afford to be unprepared for the unthinkable. Surely 9/11 taught us that much.
The prompt international response to SARS is an example of the impact of improved communication between agencies on an international level. Major overhauls of national, state, and local electronic communication systems are currently under way throughout the entire communicable disease prevention and response community with the assistance of bioterrorism preparedness funding. It may take 2 more years to really see the impact of the communications improvements, but by then they will be noticeable. It is not my experience that "preparedness priorities have weakened rather than strengthened public health."1(p1669)
References
1. Cohen HW, Gould RM, Sidel VW. The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences. Am J Public Health.2004;94:1667–1671.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
