Book Excerpt: Bioterror

At the moment, hospitals, pharmaceutical companies, and insurers squeeze every excess penny out of health care, performing at the limits of their capacity. It's time to open the debate over how much we're going to let economics be the single compass for directing our medical system; we need, as a nation, to build a little more slack into the system. The added capacity would have the side benefit of better preparing our health care networks for natural disasters and the still possible pandemic of influenza like the one that carried off so many millions of people worldwide at the beginning of this century. It also will be expensive but then, so are fire departments at airports. When was the last time the fire department at your nearest metropolitan airport responded to a plane crash? Still, we would never operate those airports without fire fighters on duty 24 hours a day, every day of the year. History shows us that we pay for what we think we need, and when we understand how much we need this, I'm confident we will pay for it. If we don't, we'll really pay for it.

We desperately need doctors, particularly infectious disease experts, and nurses to participate in local and regional planning activities for bioterrorism. But they almost never show up. Why? In large part, they are so stretched in their capacities to provide more patient care with less resources, they have no "financial freedom" to spend time at an all-day meeting without some reimbursement to their hospital or managed care organization. Our failure to address this is pennywise and poundfoolish.

Part of our surge capacity process will involve assembling medical teams to supplement the staffs of local hospitals and treatment centers wherever outbreaks may occur. Prior to any attacks, these professionals, who would come from the ranks of trained medical personnel nationwide, would voluntarily receive the vaccinations they need to be able to go safely into the nation's new hot zones. Although I knew it would be their job to do so, my worst nightmare when I was at the Department of Health was the prospect of forcing my staff to investigate an outbreak of smallpox in my state. As most of them have little if any immunity against smallpox, I knew it would be a death sentence. Military leaders have become experts in the unhappy business of putting people in harm's way and suffering "acceptable losses," but public health officials have not and won't ever have to if we prepare these medical teams.

We'll also need to enlist the help of mental health professionals equipped to help counsel the survivors, which could include entire cities of people whose world and lives will have been shattered by the advent of the unthinkable.

4. Shore Up the Public Health Infrastructure to Be Ready for Quick Response to Outbreaks.

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