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The New Counterterrorism: Strengthening Health Care and Public HealthAbout two years ago, while working at a foundation in Washington D.C. that is concerned with immunization and vaccine R&D, I interviewed D.A. Henderson, director of the Center for Civilian Biodefense Studies at Johns Hopkins University and recently named as the first director of the new federal Office of Public Health Preparedness. I was writing about the development of vaccines to combat the threat of biological warfare (BW). And speaking to the man who led the World Health Organization's Smallpox Eradication Campaign in the 1960s and 1970s confirmed my worries. In a Monday-morning-quarterback kind of way, I recently read through the article I wrote and those I had studied to prepare for interviewing Henderson. I also reviewed the 1999 book Biological Weapons: Limiting the Threat (MIT Press), edited by Nobel laureate Joshua Lederberg. I could not help but think that all the warning signs have been there, and we seem not to have taken them seriously. Or perhaps not seriously enough. New NetworksIn Lederberg's monograph, the need for close coordination among federal, state, and local agencies, which rarely interact, is presaged. Observing that "health authorities will need to negotiate with the military, law enforcement, with environmental managers," Lederberg describes the complex organizational structure needed to effectively address the threat of a biological attack. Each day brings to bear the importance of close coordination between the Centers for Disease Control, state and local health authorities, the FBI, CIA, Department of Justice, U.S. Postal Service, and the EPA, to name a few of the diverse players. Lederberg's observations seem to ring particularly true in our current situation of anthrax attacks on the U.S., whose fallout seems to spread weekly: "The transcendence of BW over medicine and public health, private criminal acts, terrorism, interstate warfare, and international law directed at the elimination of BW makes this one of the most intricate topics of discourse, poses very difficult security problems, and opens some novel challenges in the ethical domain."Henderson has been addressing these intricate topics for many years, most recently from his post at Hopkins. When I spoke with him in June 1999, we discussed the strategy of stockpiling vaccine, specifically for smallpox, to be distributed in case of attack. He expressed some doubt over whether mass vaccination would even be feasible. "In general," he told me, "preventive measures are adopted with great difficulty." Logistics of a NightmareAs recently as Sept. 5 of this year, less than a week before the terrorist attacks on New York and Washington D.C., Henderson was speaking before the U.S. Senate Foreign Relations Committee in a hearing on the threat of bioterrorism. Testifying to a committee that has recently gained even more prominence in the wake of Sept. 11, Henderson warned that "nothing in the realm of natural catastrophes or man-made disasters rivals the complex problems of response that would follow a bioweapons attack against a civilian population."It is clear that the public health infrastructure--along with our military preparedness, diplomacy skills, law enforcement skill, and collective emotional strength--is being tested. Yet hearing David Satcher on National Public Radio the other day commenting on how health officials were doing their best to take the necessary precautions against an attack with anthrax or smallpox, I was again struck by something that has kept me confident in our country's ability to deal with the current situation and has kept a creeping, debilitating sense of fear, anger, and frustration at bay: if there is any nation in the world able to effectively mount a response to the terror attack of Sept. 11, it is the United States. It is this confidence that allows me to maintain some composure while jogging past firehouses in New York City during a fall afternoon run and visiting my brother a few blocks from Ground Zero. Henderson's Sept. 5 testimony is prescient: "If we do nothing more than strengthen the public health and medical care systems, we can significantly decrease the suffering and death that would follow a bioweapons attack. By being able to mitigate the consequences of such an attack, we can make ourselves less attractive targets.... As important, we could improve the everyday functioning of the health care and the public health system for the general good." --Erica Seiguer, a third-year MD-PhD student at HMS Erica Seiguer Photo by Graham Ramsay |
