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Electronic Letters to:
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eLetters: Electronic letters published:
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![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Do Bioterrorism Expenditures Compromise Public Health?
- Kathryn C Dowling, Robert I Lipton (3 May 2005)
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Do Bioterrorism Expenditures Compromise Public Health?
- Kathryn C. Dowling, Robert I. Lipton (23 December 2004)
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Kathryn C Dowling , Robert I Lipton
Send letter to journal:
kathryndowling{at}yahoo.com Kathryn C Dowling, et al.
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The recent exchange of letters in the March issue, responding to Cohen et al. [1], did not sufficiently quantify the national public health impact of misdirecting precious dollars to bioterrorism. For fiscal years 2002-2005, and 2006 (projected), CDC terrorism funding has varied from $1.4 to 1.7 billion, averaging 22% of its entire annual budget [2,3]. The anthrax incident of 2001 caused five deaths. One of the results was an ill-conceived smallpox vaccination campaign implicated in the deaths of three health workers [4] at an additional cost of at least $0.6 billion (2002-2003) [2]. Even if we accept the efficacy of dual-use prevention in strengthening response to natural disasters and novel infectious disease outbreaks, in 2004--a year notable for hurricanes and the spread of West Nile—less than 300 such deaths occurred [5,6]. Indeed, for the sake of argument (and to the point of fantasy) let us assume that dual use might prevent all of the estimated 36,000 annual influenza deaths [7]. Even in this most sanguine of scenarios, the expenditure per fatality amounts to over $40,000. In comparison, with $0.9 billion [3], the CDC Chronic Disease Control and Health Promotion branch is responsible for addressing an array of extremely important diseases and public health issues, from diabetes to heart disease and from tobacco use to physical inactivity. These problems adversely affect millions of people each year. In this regard, the United States is currently facing one of the worst epidemics of its history: that of overweight and obesity, which now affects two out of three adults and is responsible for an estimated 300,000 premature deaths annually [8]. The CDC currently funds only 28 states for capacity-building to address this rapidly mounting problem [9]. The 2005 CDC budget for nutrition/physical activity/obesity is $42 million [3], which equates to roughly $200 per obesity/overweight death or 20 cents per affected individual. There is something seriously amiss when CDC dedicates orders of magnitude more funding to rare emergency events with low recurrence probabilities, rather than a disease that affects the majority of our population, causing hundreds of preventable deaths every day. Considering that obesity/overweight is only one of numerous major health issues in this country, it is clear that current massive U.S. mis-funding of terrorism over public health has real world implications for mortality and morbidity. 1. Cohen HW, Gould RM, Sidel VM. The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences. Am J Public Health. 2004;94:1667-1671. 2. Financial Management Office, Centers for Disease Control and Prevention. FY 2004 Budget Request—Detail of Increases/Decreases, http://www.cdc.gov/fmo/FY2004BudgetRequestDetails.pdf 3. Financial Management Office, Centers for Disease Control and Prevention. FY 2006 CDC Functional Table Reflecting New Budget Structure. Feb. 11, 2005. http://www.cdc.gov/fmo/PDFs/FY06funcnewbudgtstruct.pdf 4. Frieden T, Mostashari F, Schwartz SP, Thorpe LE, Karpati AM, Marx MA, Manning SE. Cardiac Deaths After a Mass Smallpox Vaccination Campaign -- New York City, 1947; MMWR 2003;52:933-936. 5. National Climatic Data Center, National Oceanic and Atmospheric Administration. Billion Dollar U.S. Weather Disasters, 1980-2003. Feb. 3, 2004. http://www.ncdc.noaa.gov/oa/reports/billionz.html 6. National Center for Infectious Diseases, Centers for Disease Control and Prevention. 2004 West Nile Virus Activity in the United States. Jan. 11, 2005. http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount04_detailed.htm 7. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. J Amer Med Assoc. 2003;289:179-186. 8. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributed to obesity in the United States. J Amer Med Assoc. 1999;282:1530-1538. 9. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. CDC’s State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases. Oct. 6, 2004. http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm |
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Kathryn C. Dowling , Robert I. Lipton
Send letter to journal:
kathryndowling{at}yahoo.com Kathryn C. Dowling, et al.
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In their cogent argument in the October issue [1], Cohen and colleagues do not fully characterize the national public health impact of squandering precious dollars on bioterrorism. For fiscal years 2002-2004, and 2005 (projected), CDC terrorism preparedness/emergency response funding ($1.1-1.2 billion) has represented roughly 17% of its entire annual budget [2,3]. Although we subscribe to the authors’ view that "dual use" of bioterrorism funding to shore up public health preparedness is illusory, for the sake of argument let us assume some efficacy in strengthening response to natural disasters and novel infectious disease outbreaks. Thus, to the five anthrax deaths that occurred in 2001, we could add 1998’s unusual wave of weather disasters that accounted for at least 400 deaths [4]. West Nile virus killed 246 in 2003 [5]; SARS and avian flu have not caused any U.S. fatalities. Assuming that all such deaths occurred in a single year, and were preventable, equates to a cost of roughly $1.7 million per death. If we are even more inclusive (to the point of fantasy) on what might constitute dual use prevention, we could consider the estimated 36,000 annual influenza deaths [6] as preventable, dropping the total spent to about $30,000 per fatality. In comparison, with $0.9 billion [2], CDC Chronic Disease Control and Health Promotion addresses diseases from diabetes to heart disease and health problems from tobacco use to physical inactivity, which, with absolute certainty, adversely affect millions of people each year. The United States is currently facing one of the worst epidemics of its history: that of overweight and obesity, which now affects two out of three adults and is responsible for an estimated 300,000 premature deaths annually [7]. The CDC currently funds only 28 states for capacity- building to address this rapidly mounting problem [8]. The 2004 CDC budget for nutrition/physical activity/obesity was $45 million [9], which equates to roughly $150 per obesity/overweight death or roughly 20 cents per affected individual. There is something seriously amiss when CDC dedicates 200 – 10,000 times more funding to extremely rare emergency events with low recurrence probabilities, rather than a disease that affects the majority of our population, causing thousands of preventable deaths every day. Considering that obesity/overweight is only one of numerous major health issues in this country, it is clear that current massive U.S. misfunding of terrorism over public health has real world results. The implications for mortality and morbidity are sobering. 1. Cohen HW, Gould RM, Sidel VM. The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences. Am J Public Health. 2004;94:1667-1671. 2. Financial Management Office, Centers for Disease Control and Prevention. FY 2004 Budget Request—Detail of Increases/Decreases, http://www.cdc.gov/fmo/FY2004BudgetRequestDetails.pdf 3. Financial Management Office, Centers for Disease Control and Prevention. FY 2005 CDC Budget Request—Detail of Increases/Decreases. Feb. 2, 2004. http://www.cdc.gov/FMO/PDFs/FY05budincrea-decrestab.pdf 4. National Climatic Data Center, National Oceanic and Atmospheric Administration. Billion Dollar U.S. Weather Disasters, 1980-2003. Feb. 3, 2004. http://www.ncdc.noaa.gov/oa/reports/billionz.html 5. National Center for Infectious Diseases, Centers for Disease Control and Prevention. 2003 West Nile Virus Activity in the United States. May 21, 2004. http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount03_detailed.htm 6. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. J Amer Med Assoc. 2003;289:179-186. 7. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributed to obesity in the United States. J Amer Med Assoc. 1999;282:1530-1538. 8. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. CDC’s State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases. Oct. 6, 2004. http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm 9. Financial Management Office, Centers for Disease Control and Prevention. FY 2005 CDC Budget Request—Funding by Disease. February 2, 2004. http://www.cdc.gov/FMO/PDFs/FY05budgfunddiseasetab.pdf |
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