Correspondence

Bioterrorism and Civil Liberties

N Engl J Med 2002; 347:856-857September 12, 2002

Article

To the Editor:

On the basis of service as a senior public health official in four states, I believe that Annas (April 25 issue)1 is incorrect in his conclusion that bioterrorism is primarily a federal issue. Historically and legally, state and local public health agencies in this country have had the lead role in responding to outbreaks or suspected outbreaks of communicable disease within their jurisdictions. State and local public health agencies have performed in this capacity for over 100 years. During those years, state health officials have repeatedly demonstrated their ability to use “police powers” with proper restraint. Federal health agencies can and do play a valuable part in support of state and local public health agencies that are dealing with communicable diseases.

As a state health official, I have often requested and welcomed the assistance of federal health agencies. However, I do not believe a federal takeover of the public health response to bioterrorism would be in the public's best interest. By virtue of their relationships with their communities and expertise cultivated through years of dealing with outbreaks of communicable diseases, state and local public health agencies are better able to lead the public health response to bioterrorism within their jurisdictions.

I agree that actions to prevent and respond to bioterrorism should be a federal priority. The National Pharmaceutical Stockpile Program is an excellent example of a federal response to bioterrorism that properly integrates the public health responsibility and authority of state and federal governments. I look forward to further such development of the federal–state partnership for preparedness for bioterrorism.

Michael Moser, M.D., M.P.H.
Kansas Department of Health and Environment, Topeka, KS 66612
mmoser@kdhe.state.ks.us

1 References

1
Annas GJ. Bioterrorism, public health, and civil liberties. N Engl J Med 2002;346:1337-1342
Full Text | Web of Science | Medline

To the Editor:

Annas is correct that the model statutes proposed by the Centers for Disease Control and Prevention (CDC) would threaten the trust that Americans usually have in public health officials — trust that is essential for effective protection of our population. As a state health officer in Vermont and Colorado, I found the most common threat to trust to be the desire of elected officials to have public health officials reassure the public. In truth, the public is comforted only by knowing that its public health officials are more concerned about and more alert to threats to public health than are individual citizens. Public health officials are never trusted if they are perceived as offering reassurance rather than vigilance. Sadly, U.S. postal workers understand this lesson because, confronted with the peril of anthrax, a few of my public health colleagues forgot it.

Anthony Robbins, M.D.
Tufts University School of Medicine, Boston, MA 02111
anthony.robbins@tufts.edu

To the Editor:

Annas's review of the proposed model legislation to combat bioterrorism presents a truly horrible scenario. The price we might pay in the loss of precious liberties for a very uncertain protection makes me wonder what is worse for the nation: the loss of life or the loss of our civilized society. Is it worthwhile to live in a society in which constitutional protections can be summarily suspended by a politician, bypassing the courts, leaving civil liberties at the discretion of ill-prepared, low-level officials, the self-appointed guardians of the common well-being?

Sergio C. Stone, M.D.
11 Estates Dr., Villa Park, CA 92861
scstone@pacbell.net

Author/Editor Response

Professor Annas replies:

To the Editor: Dr. Moser uses the term “lead role” in a way that invites multiple interpretations. He is correct that state and local agencies have been (and will remain) the first to respond to local outbreaks of communicable diseases. He is incorrect, however, if he believes that September 11 and the anthrax attacks did not change the jurisdictional identity of the lead agencies in trying to prevent and respond to bioterrorism. The lead agencies will be federal agencies because, as I noted, bioterrorism is inherently a matter of national security, even if the attack is confined to a single state. The precise roles of both federal and state agencies in combating bioterrorism remain to be worked out (and are complex, since the vast majority of public health problems do not involve bioterrorism).1 Nonetheless, federal agencies such as the CDC, the Federal Bureau of Investigation, and the new Department of Homeland Security will have to take the lead in trying to prevent or mitigate a bioterrorist attack.

Of course, effective responses to a bioterrorist attack will require joint planning and close cooperation among local, state, and federal public health officials. In this regard, Dr. Robbins rightly emphasizes that public health officials must provide the public with honest and frank assessments of risk, not paternalistic reassurances. Unaccountable and untrustworthy public health agencies are not only ineffective, they can, as Dr. Stone understands, destroy both life and civil liberties.

George J. Annas, J.D., M.P.H.
Boston University Schools of Medicine and Public Health, Boston, MA 02118
annasgj@bu.edu

1 References