Correspondence

Preparedness for Bioterrorism?

N Engl J Med 2001; 345:1423-1424November 8, 2001

Article

To the Editor:

Drs. Khan and Ashford, in their editorial (July 26 issue),1 argue that the case of glanders in a microbiologist working in a military laboratory, reported by Srinivasan et al. in the same issue,2 suggests the need for expanded preparedness for bioterrorism. We disagree. The lesson should instead be a warning that current “preparedness programs” are actually dangerous diversions of resources and that there is a need for primary prevention of all uses of biologic weapons. The microbiologist was not a victim of terrorism. He was an accidental casualty of the growing, multibillion-dollar preparedness programs and of failure to include restrictions on hazardous research in the Biological Weapons Convention.

The deplorable lack of funding for public health programs increases the vulnerability of the United States and the world to outbreaks of infectious diseases, whatever their origin. But instead of making public health the priority, proponents of preparedness have embraced the idea of a “dual benefit” — a trickle-down theory suggesting that public health programs will gain from the allocation of billions of dollars for terrorism-preparedness programs dominated by military and police agencies. Drs. Khan and Ashford correctly distance themselves from the assertion of “intelligence sources” that a serious bioterrorism incident in the United States is inevitable. Even including the current anthrax scare, as of October 18, 2001, there had been one death and one hospitalization from the use of biologic weapons by terrorists, and there had been only a single incident of such use of chemical weapons. Nonetheless, the editorialists endorse preparedness programs without any evidence of their efficacy. Bioterrorism drills and stockpiles, and even the word “preparedness,” have been recycled from an earlier era of discredited “duck-and-cover” civil-defense drills and fallout shelters that were sold to a frightened public more than 40 years ago as preparedness for nuclear war.3 Unlike bioterrorism, nuclear war and even biologic war may pose major risks, but secondary-prevention preparedness programs are ineffective responses that could also do considerable harm.

There are opportunity costs entailed in spending so many health dollars preparing for highly improbable events while real, natural epidemics threaten to overwhelm the world's health resources.4 Research on bioterrorism, such as the military research on glanders, may be interpreted by other nations as offensive-weapons development that could trigger a new arms race involving toxins and pathogens in the same way that attempted national missile-defense systems may cause renewed proliferation of nuclear missiles and warheads. Some former U.S. arms-control officials believe that recently revealed secret tests of a germ bomb by the Central Intelligence Agency and genetic engineering of more potent anthrax organisms by the Pentagon may violate the existing treaty on biologic warfare.5 Subordinating health programs to military and police methods and priorities may also subvert public health.

Focusing on the treatment of casualties is also a problem, because it diverts attention from primary prevention. The same week that the article and editorial on glanders appeared in the Journal, an international agreement to strengthen the 1972 treaty banning biologic weapons was scuttled by the Bush administration “in order to protect military and trade secrets.”6

Preparedness for bioterrorism would neither have prevented the despicable terrorist attack on September 11, 2001, nor have reduced the terrible toll in deaths and destruction. It is a contradiction of good public health practice to spend billions of dollars for dubious and dangerous preparedness while blocking international efforts directed at the primary prevention of war and terrorism.

Hillel W. Cohen, Dr.P.H.
Albert Einstein College of Medicine, Bronx, NY 10461
hicohen@aecom.yu.edu

Victor W. Sidel, M.D.
Montefiore Medical Center, Bronx, NY 10467

Robert M. Gould, M.D.
Santa Teresa Community Hospital, San Jose, CA 95119

6 References

1. 1

   Khan AS, Ashford DA. Ready or not -- preparedness for bioterrorism. N Engl J Med 2001;345:287-289
   Full Text | Web of Science | Medline

2. 2

   Srinivasan A, Kraus CN, DeShazer D, et al. Glanders in a military research microbiologist. N Engl J Med 2001;345:256-258
   Full Text | Web of Science | Medline

3. 3

   Geiger HJ. Terrorism, biological weapons, and bonanzas: assessing the real threat to public health. Am J Public Health 2001;91:708-709
   CrossRef | Web of Science | Medline

4. 4

   Sidel VW, Cohen HW, Gould RM. Good intentions and the road to bioterrorism preparedness. Am J Public Health 2001;91:710-716
   CrossRef | Web of Science | Medline

5. 5

   Miller J. When is bomb not a bomb? Germ experts confront U.S. New York Times. September 5, 2001:A5.
   

6. 6

   Gordon MR. Germ warfare talks open in London; U.S. is the pariah. New York Times. July 24, 2001:A11.