How Can We Prepare?
Responding to the Threat of Bioterrorism

Featured Article

Hamburg MA. Bioterrorism: A Challenge to Public Health and Medicine. Public Health Management Practice. 2000; 6(4): 28-44.
This article explains why bioterrorism must be the main focus of the public health system. Using examples, the author demonstrates how a bioterrorist attack could quickly overwhelm the existing health care system at the local level. Pointing out lessons learned, as well as the key role of public health and medicine, the article highlights key issues-i.e., the importance and limitations of laboratory diagnostic capability, the role of public and health care provided education, and the complexity and costs associated with large-scale infectious disease control programs.

Other Articles

Garrett L. Betrayal of Trust: The Collapse of Global Public Health. New York: Hyperion. 2000.
Is our collective health in a state of decline? If yes, how severe is this crisis and has the public health system itself contributed it? The author tackles these questions in full detail and provides a standard definition of public health. "The basic factors essential to a population's health are ancient and non-technological: clear water; plentiful, nutritious, uncontaminated food; decent housing; appropriate water and waste disposal; correct social and medical control of epidemics, widespread or universal; access to maternal and child health care; clean air; knowledge of personal health needs administered to a population sufficiently educated to be able to comprehend and use the information in their daily lives; and a health care system that follows the primary maxim of medicine-do no harm." Traveling across the globe, from Zaire to Chernobyl to India, the author makes clear that no part of the planet is too remote, too exotic, or too forbidding for travelers or business development. All are linked to one another-diseases know no boundaries. For public health this presents a real challenge: "its membership is six billion human beings, more than five billion of whom live in the global equivalent of New York City's 1890s tenements." Chapter five of this book, "Threatening Biological Terrorism and Public Health" focuses on bioterrorism.

Garrett L. The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York: Farra, Straus and Giroux. 1994.
The author examines the reemergence of infectious diseases. Describing a number of outbreaks, ranging from isolated epidemics to the global spread of influenza and maleria, Garrett takes the reader from remote missionary posts in Africa to international AIDS conferences. She explains the tricks bacteria use to elude antibiotics and traces the genetic clues that hint at how the AIDS virus emerged. The author notes that newly emerging diseases must be spotted by someone who has the courage to sound the alarm and conduct a thorough investigation.

Miller J, Engelberg S, Broad W. Germs: America's Secret War Against Biological Weapons. New York: Simon & Schuster. 2001.
Is the threat of germ weapons real or exaggerated? The book provides a narrative of cutting-edge science and spycraft, highlighting the use of germ weapons by the Rajneeshees-a religious cult in Oregon in the 1980s-to a detailed history of germ weapon research. The authors note that the use of such weapons will be driven by both scientific discoveries and political upheavals. The authors advocate for nations to enact tougher laws. "The weight of international laws should be brought to bear on those who traffic in biological weapons."

Osterholm MT. Living Terrors: What America Needs to Know to Survive the Coming Bio-Terrorist Catastrophe. New York: Delacorte Press. 2000.
In very clear terms, this book explains what the consequences are when bioterrorism strikes and what this county must do in order to protect itself. Using scenarios, the author demonstrates what the public health system-and society---will have to contend with in the event of bioterrorism.

For Further Reference

Alibek K, Handelman S. Biohazard: The Chilling Story of the Largest Covert Biological Weapons Program in the World, Told from the Inside by the Man Who Ran It. New York: Random House. 1999.

Barbera J, Macintyre A, Gostin L, Inglesby T, O'Toole T, DeAtley C, Tonat K, and Layton M. Large-Scale Quarantine Following Biological Terrorism in the United States: Scientific Examination, Logistic and Legal Limits, and Possible Consequences. JAMA. 2001 December 5; (21)286: 2711-2717.

Orent W. The Return of Smallpox. The American Prospect. 2001 December 3: 21-23.

United States General Accounting Office. Testimony before the House Committee on Energy and Commerce. Bioterrorism: The Centers for Disease Control and Prevention's Role in Public Health Protection. Statement of Janet Heinrich, Director, Health Care-Public Health Issues. 2001 November 15. Washington, DC: U.S. GAO. Available at www.gao.gov/new.items/do2235t.pdf.

United States General Accounting Office. Report to Congressional Committees. Bioterrorism: Federal Research and Preparedness Activities. 2001 September 28. Washington, DC: U.S. GAO. Available at www.gao.gov/new.items/d01915.pdf.

United States General Accounting Office. Testimony before the House Subcommittee on Government Efficiency, Financial Management, and Intergovernmental Relations, Committee on Government Reform. Bioterrorism: Coordination and Preparedness. Statement of Janet Heinrich, Director, Health Care-Public Health Issues. 2001 October 5. Washington, DC: U.S. GAO. Available at www.gao.gov/new.items/d02129t.pdf.

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