akin to or greater than that of major natural disasters and to which the evolving discipline of public health responded. Epidemiologic and other public health skills and knowledge also have been advanced through lessons learned in such responses (Landesman et al., 2001).

The threat of bioterrorism has mobilized the engagement of many disciplines and government agencies both to prevent and to respond. The reemergence of infectious diseases in part related to demographic change and globalization has elevated interest in public health’s role as both a responder to and a preventer of epidemics and infectious disease outbreaks. Public health agencies have the ongoing responsibility to prevent disease outbreaks and other emergencies through measures such as immunization, sanitation, and community education. In cases where preventive measures are not successful, or there are barriers to their implementation, or an unexpected threat causes disease, public health becomes a responder, conducting surveillance, controlling the spread of disease, conducting mass immunization, etc. At the same time, public health agencies continue prevention to limit secondary public health problems. The current integration of public health preparedness efforts with those of more traditional “responder” disciplines is based on a growing acknowledgement of public health’s singular capabilities and importance in preparing for and responding to bioterrorism, as well as the health aspects of a range of disasters. These include deliberate attacks with nonbiological weapons, natural disasters that may result in the contamination of food or water supplies and lead to infectious diseases, and technological disasters that may endanger population health with radiation or chemical hazards.

Unique Role of Public Health in Disasters, and Primary Role in Response to Bioterrorism

Public health generally does not have a formal tradition of disaster preparedness and response. However, notable and instructive exceptions are found in the experience of the following types of public health agencies, some of which have developed varying levels of expertise in planning and exercising for disasters and in managing disasters (e.g., the experience of the state of Georgia described by Werner et al., 1998):

  • Public health agencies located in the vicinity of nuclear facilities and involved in federally mandated training and exercise programs;

  • Public health agencies located in areas with frequent natural disasters (hurricanes, floods, or tornadoes);

  • Public health agencies at sites of one-time or recurring major events or entertainment venues (e.g., auto racing, Olympics, amusement parks); and



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