system is needed to accurately assess the burden of infectious diseases in developing countries, detect the emergence of new microbial threats, and direct prevention and control efforts. To this end, CDC should enhance its regional infectious disease surveillance; DOD should expand and increase in number its Global Emerging Infections Surveillance (GEIS) overseas program sites; and NIH should increase its global surveillance research. In addition, CDC, DOD, and NIH should increase efforts to develop and arrange for the distribution of laboratory diagnostic reagents needed for global surveillance, transferring technology to other nations where feasible to ensure self-sufficiency and sustainable surveillance capacity. The overseas disease surveillance activities of the relevant U.S. agencies (e.g., CDC, DOD, NIH, USAID, USDA) should be coordinated by a single federal agency, such as CDC. Sustainable progress and ultimate success in these efforts will require health agencies to broaden partnerships to include nonhealth agencies and institutions, such as the World Bank.

REBUILDING DOMESTIC PUBLIC HEALTH CAPACITY

The U.S. capacity to respond to microbial threats to health is contingent on a public health infrastructure that has suffered years of neglect. Upgrading current public health capacities will require considerably increased investments across differing levels of government. Most important, this support will have to be sustained over time. Such an investment will have lasting and measurable benefits for all humankind. With recent increased funding for bioterrorism preparedness, the United States has an opportunity to develop programs and policies that will both protect against acts of bioterrorism and improve the U.S. public health response to all microbial threats. However, it is alarming that some of these funds have been diverted from multipurpose infrastructure building to single-agent preparedness.

The threat of bioterrorism is intimately related to that of naturally occurring infectious diseases. The response to bioterrorism is much like the response to any microbial threat to health, and the necessary resources for building the public health infrastructure are, in essence, the same as those needed to respond to bioterrorism. It would be counterproductive to develop an ancillary system for bioterrorist threats. Rather, such efforts must be integrated with those addressing the continuum of infectious disease concerns and potential disasters to which public health agencies are already charged to respond. While preparedness for bioterrorist-inflicted outbreaks will require certain specialized program elements and policies (related, e.g., to law enforcement, evidence collection), the human health aspects of this



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