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© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.058685
LETTER |
Robert M. Gould is with the Department of Pathology, Kaiser Hospital, San Jose, Calif. Hillel W. Cohen is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. Victor W. Sidel is with the Montefiore Medical Center and Albert Einstein College of Medicine, Bronx.
Correspondence: Requests for reprints should be sent to Hillel W. Cohen, MPH, DrPH, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Room 1302, Belfer Bldg, 1300 Morris Park Ave, Bronx, NY 10461 (e-mail: hicohen{at}aecom.yu.edu).
We certainly share Amadio’s view that public health has been underfunded for decades. We believe this situation is attributable in part to our nation’s propensity for prioritizing colossal military budgets over vital domestic and global public and environmental health programs. Consider, for example, the possibilities denied public health by the United States’ expenditure of approximately $5.5 trillion (in constant 1996 dollars) for nuclear weapons programs from 1940 through the late 1990s.1
We also agree that bioterrorism preparedness funding "is some of the first real new money that has come to public health in many years." However, the impact of such appropriations, useful though they may be for limited improvements in communications and disease surveillance capacity, has been often constrained by strict restriction of their use to bioterrorism preparedness programs. These restrictions have left public health without adequate resources to meet fundamental needs. At the same time, public health has been stretched to the breaking point by ill-considered, dangerous programs such as the smallpox vaccination campaign, conducted in a climate of widespread state and local funding cuts.2 Reports heard at the 2004 annual meeting of the American Public Health Association3 and communications we have received from grassroots public health practitioners since our article appeared support this view.
The reality of the current crisis in public health underscores the deficiencies of a bioterrorism-oriented public health model, compared with a model oriented toward prophylaxis and primary prevention of all forms of emerging and reemerging infectious diseases. The latter model could provide surge capacity to deal with new challenges4; for example, it could ensure an adequate annual supply of influenza vaccine. Improved communication among public health and other agencies is useful, but we must strictly avoid breaches of privacy based on mere suspicion of bioterrorism.5 A full evaluation of bioterrorism preparedness programs must weigh the putative benefits against the risks and adverse impacts of these programs, which Amadio does not mention.
We would hope that any program oriented toward prevention of all potential biological threats would be comprehensive in scope and would address as a public health priority the potential threats posed by new developments in the biological sciences.6 A strong demand by public health leaders for development of the strongest and most stringent inspection and verification protocols for the Biological Weapons Convention, safeguards now spurned by the US government, would be a welcome change from the silence on this issue currently emanating from the Centers for Disease Control and Prevention. In this vein, all putative biodefense research programs must be made transparent and all potentially offensive programs halted as a bulwark against setting off a biological arms race that will seriously challenge any attempts at secondary or tertiary prevention.7,8 Thoughtful anticipation of future threats predicted to arise from global climate change9 should challenge us to move beyond heightened surveillance and vector eradication programs of the sort employed against West Nile virus to prevention strategies linked to the promotion of sustainable and renewable sources of energy.10
References
1. Schwartz S. Introduction. In: Schwartz S, ed. Atomic Audit. The Costs and Consequences of US Nuclear Weapons Since 1940. Washington, DC: Brookings Institution Press; 1998:3.
2. Elliott VS. Public health funding: feds giveth but the states taketh away. Amednews.com. October 28, 2002. Available at: http://www.ama-assn.org/sci-pubs/amnews/pick_02/hll21028.htm. Accessed August 31, 2003.
3. Allan S. How bioterrorism preparedness is changing the context of public health work at the local level. Paper presented at: Annual Meeting of the American Public Health Association; Terrorism and Public Health, Session 3218.0; November 8, 2004; Washington, DC.
4. Avery G. Bioterrorism, fear and public health reform: matching a policy solution to the wrong window. Public Admin Rev. 2004;64(3):275–288.[CrossRef]
5. Miller J. City and FBI reach agreement on bioterror investigations. New York Times. November 21, 2004:39.
6. Wheelis M. Will the new biology lead to new weapons? Arms Control Today. July/August 2004.
7. Wright S. Taking biodefense too far. Bull Atomic Sci.2004;60(6):58–66.
8. Sidel VW. Bioshield, biosword. Gene Watch. 2004;17(6/6):3–7,20.
9. Epstein P, Rogers C, eds. Inside the greenhouse. The impacts of CO2 and climate change on public health in the inner city. The Center for Health and the Global Environment. Harvard Medical School. April 2004. Available at: http://www.med.harvard.edu/chge/green.pdf (PDF file). Accessed November 28, 2004.
10. APHA Policy Statement 2004–6. Affirming the Necessity of a Secure, Sustainable, and Health-Protective Energy Policy. Passed by APHA Governing Council. November 9, 2004. Available at: http://www.apha.org/legislative/policy/policysearch/index.cfm?fuseaction=view&id=1289. Accessed December 30, 2004.
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