decline in the U.S. public health system is the result of its systematic dismantling over time by Congress and the executive branch. In fact, the response of the Centers for Disease Control and Prevention (CDC) to the anthrax attacks was admirable given its limited resources and outdated communications system. CDC, together with state and local health departments, has provided this nation with an outstanding cadre of people who understand how to perform surveillance, prevention, and detection of infectious agents, whether they are endemic, emerging, or a result of bioterrorism. These agencies must be supplied with the tools and resources taken away from them in the past. Restoring the public health system of the United States should be the first order of business in the efforts to defend the nation against bioterrorism.

The Need for Approaches with Multiple Benefits

Bioterrorism poses a unique challenge to the security of the U.S. population. A state-sponsored enterprise, or just a few individuals with specialized scientific skills and access to a laboratory, could easily and inexpensively produce a panoply of lethal biological weapons, although it is no trivial matter to disseminate or disperse such agents across large populations. Such operations may be difficult to detect because, in contrast to nuclear weapons, biological agents can be manufactured with ordinary pieces of equipment that are listed in commercial catalogues and are legitimately purchased for producing such things as chemicals, pharmaceuticals, or even beer.

Fortunately, investments made to protect the country against bioterrorism will help protect the public’s health and the U.S. food supply from naturally occurring threats as well. Although it may be difficult to distinguish an introduced infectious disease from a naturally occurring one, the strategies to protect against either—requiring preparation and new scientific and technological approaches to surveillance, prevention, response, recovery, decontamination, and forensics—must be the same. Similarly, investments made to protect the country’s food supply against bioterrorism have the potential, and are even necessary, to protect it from more routine threats as well. Because the most likely break-throughs will come from the study of both pathogenic and nonpathogenic bacteria and viruses, they should be studied together—indeed, the study of bioterrorism agents alone is likely to give a low return on investment.

There are also indirect benefits associated with investments in protecting ourselves from bioterrorism. Money spent on research to develop new types of sensitive detectors and related monitors for biowarfare agents will almost certainly carry over to the public health sector in the form of rapid, improved diagnostics for disease. Money spent on coordinating and developing emergency response teams at the federal, state, and local levels will also bring better mechanisms for dealing with natural outbreaks of emerging diseases. Money spent on innovative surveillance approaches for detecting biowarfare attacks should improve



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