immediate health crisis is rendered far more difficult, and the resilience of affected communities is diminished.

Increasing emphasis on enhanced public communication is a positive development within biodefense, and public health preparedness and response more broadly. Nonetheless, this development must be supplemented with robust discussion among leaders, and between authorities and the larger population, as to what an optimal response looks like, and from whose point of view.


The Working Group on Governance Dilemmas in Bioterrorism Response and the research focus groups—the findings of which are presented here—were convened by the Center for Biosecurity of the University of Pittsburgh Medical Center in collaboration with the Johns Hopkins University and supported under award MIPT-2003J-A-019 from the Oklahoma City Memorial Institute for the Prevention of Terrorism (MIPT) and the Office for Domestic Preparedness, Department of Homeland Security, and award 2000-10-7 from The Alfred P. Sloan Foundation. Points of view expressed in this document do not necessarily represent the official position of MIPT, the U.S. Department of Homeland Security, or the Sloan Foundation.


Lawrence O. Gostin9

Georgetown University

Severe Acute Respiratory Syndrome (SARS) garnered a great deal of public attention because it was novel and its potential for spread was unknown. However, the SARS coronavirus is significantly less virulent than pandemic influenza viral infections. Influenza pandemics have occurred roughly two to three times per century, causing untold morbidity and mortality (Kolata, 1997). The Spanish influenza pandemic of 1918 caused more


Lawrence O. Gostin is the John Carroll Research Professor of Law, Georgetown University; Professor of Public Health, the Johns Hopkins University; Director, Center for Law & the Public’s Health (CDC Collaborating Center).

Disclaimer: Professor Gostin was a member of WHO’s consultation on influenza preparedness and is working with WHO on the revision of the International Health Regulations. The views in this chapter do not necessarily reflect those of WHO. A shorter version of this chapter appears in the Hastings Ctr Rpt 2004;34:10–11.

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