Book Excerpt: Bioterror

This point is related to the third item, but goes further and deeper. Along with helping the people who will treat patients on the front lines, we have to strengthen the broader public health system that supports their efforts. The first major phase of the nation's new infectious disease detection program, a nine site network of monitoring and diagnostic centers (now receiving only $12 million of annual funding), must grow. The $41 million for the CDC's first grants to 53 state and local public health programs must also grow quickly. Current levels provide only very limited resources for any one state or large city, given the potential need. With our public health infrastructure in its current shape, trying to detect and respond to a bioterrorism attack is comparable to running O'Hare Airport's air traffic control system with tin cans and string.

Like the proposed buildup in surge capacity, strengthening our public health system is "dual use" in the best sense of the phrase. The improvements will be felt by the entire nation as we find ourselves better able to detect and combat natural outbreaks like foodborne pathogens, influenza, and the next West Nile virus scare. They will also help us fix problems of our own making such as the rise in antibiotic resistant strains of bacteria; there's no risk that we'll be spending money just to have a lot of people sitting around idle.

It is this reinforced public health infrastructure that will be able to respond to outbreaksnatural and manmadeby mobilizing the necessary antibiotics and vaccines and getting them to the people that need them. Building an adequate stockpile of vaccines and antibiotics won't mean much if the cache is locked in a vault in Atlanta and nobody can get it to the citizens who need it. Having to scramble to get antibiotics and vaccines to a large population isn't as rare as you might think it is. Remember the meningitis outbreak I discussed earlier, where our team was stretched to the breaking point with a need to distribute vaccine and antibiotics to only 30,000 people. It occurred under the watch of one of the best health departments in the country and it stretched us to the very limits of our ability. Now imagine needing to vaccinate millions of people!

5. Clear Up the Roles of Federal, State, and Local Governments.

Just as we need to define the roles of the various agencies across the federal government, we need to drill down through the layers of bureaucracy and clarify the roles and responsibilities on the state and local levels. Our efforts to turn around the lagging preparedness issues at the top don't automatically ensure that the same problems will be resolved at the other levels. Local police and medical teams don't have any better understanding of each other than the federal Departments of Justice and HHS do, but the federal government can help by setting a better example. Heads of federal agencies, too, can improve matters by treating the funding for biological terrorism as less of an opportunity for porkbarrel grantsmanship and more of an opportunity to help the nation head off catastrophe.

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