Preparedness Act of 2001 is an attempt to fill those gaps. The leadership in Congress and the President of the United States are both committed to addressing bioterrorism in an appropriate, mature, and sophisticated way. However, it is imperative that experts in the field continue to emphasize to political leaders that the problem is much more complex than simply stockpiling. We must communicate in a way that is educational but not alarmist.

In order to better prepare, we must evaluate our financial support for this effort. There is not nearly enough money to strengthen across-the-board basic public health services. However, it is possible to strengthen certain components of the public health infrastructure. Thus, we need to prioritize what can and should be done.

Although the military has done an extraordinarily good job over the decades of preparing and planning for biowarfare, biowarfare is very different from bioterrorism. The issue is much more complex for the civilian population. For example, the civilian population is more diverse in terms of age and health which poses unique challenges in terms of which vaccines and antibiotics are most appropriate for different populations (i.e., children, immunocompromised individuals, geriatric patients, etc.). In fact, it was suggested that we may even need to pursue an antiviral approach to treating smallpox, given the risk of vaccinia in such a diverse civilian population.

In our effort to build up our biodefense arsenal, we must decide whether it is wiser to develop vaccines and therapeutics that target specific agents or a much broader spectrum of antivirals and antibiotics that can be used more generally. Unfortunately, we do not know enough about the immune system response to develop broad-spectrum agents. Does this mean that, given the increasing accessibility of the technology and knowledge needed for bioengineering drug- and vaccine-resistant microbial strains, we must continually develop more and more specific antiterrorist agents? One option is to continue research on broad-based agents, while in the meantime continuing to develop target-specific agents.

It was suggested that the very small fraction of the National Institutes of Health’s (NIH) total budget that is spent on bioterrorism be reevaluated. Some of the ground-breaking scientific findings that were presented during this workshop, for example on the mechanisms of the pathogenesis of anthrax, is testament to the long-term benefits that can result from basic research.

Because of limited national capabilities, especially with regard to containment conditions required for efficacy studies with aerosolized pathogens, research questions must be prioritized. We must lay out a clear research agenda and invest appropriately to pursue that agenda in order to build the knowledge base that is necessary for developing better drugs and vaccines. The scientific community must mobilize to help reduce real risks in a way that will not be overly cumbersome to legitimate science.



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