First, there is the matter of how prepared the public health profession is for a biological attack. With the first Anthrax cases came the realization that public health authorities were woefully unprepared. According to A.D Henderson, now in charge of leading the preparedness of the Department of Health and Human Services (HHS), the deficiencies of our public health capacities are so vast that any biological attack would be overwhelming.
For instance, most public health buildings are in bad condition and only 10 percent of local and state health departments have access to e‑mail. That makes an effective transmission of the news about a biological attack unlikely. Also, a simulation exercise in June to test the government’s response to a biological attack with the smallpox virus ended with more than 1,000 people dead (simulated) and 15,000 reported smallpox cases — all in less than two weeks after 24 patients first showed signs of an undiagnosed illness.
The overwhelming inability of health authorities to face potential biological attacks is hard to understand considering the terrorist rumors that have circulated for years about Iran and Iraq. Both countries are listed by the United States as sponsors of international terrorism. And both countries reportedly obtained a virulent strain of smallpox in 1972 to make into a weaponized form of the virus.
Sally Satel, a fellow at the American Enterprise Institute, says that the American Public Health Association’s “Guiding Principles for a Public Health Response to Terrorism” shows that the health profession is not prepared. In fact, the document shows a deep confusion among health authorities regarding their responsibility to the public. One would think that biological attacks should be a top concern of health organizations. However, the facts show they are mainly preoccupied with broader national and international policy issues that are marginally related to public health. Unfortunately, that is consistent with the Centers for Disease Control activities of the last decade — making policy pronouncements about seat belts and gun control rather than smallpox and Anthrax.
The administration’s battle plan should an outbreak occur does not look much better than that of “public health” authorities. The government is buying doses of smallpox vaccine but will not make them available to the public. Rather, the government will stockpile them in the event of a terrorist attack. Finally, when an outbreak occurs, the government will take extremely cohesive measures against the population including forced-vaccination, quarantine and destruction of property.
That is a bad idea, to say the least. First, the government is rushing to adopt permanent command and control plans instead of proposing temporary measures to face a potential threat. Second, if mass vaccination is unacceptable, the government’s decision to sit on the vaccine is arguable too. The administration should make the smallpox vaccine available to the public immediately. After being apprised of the risk of vaccination, people should be allowed to decide for themselves whether they want to be inoculated with the vaccine.
Letting people decide before an outbreak occurs allows doctors and patients to evaluate the risk posed by vaccination on a patient-by-patient basis. Once the crisis is upon us, health authorities will be cranking out vaccinations without wondering who is likely to be killed by the vaccine (and you can’t sue the government for wrongful death). Furthermore, even a small portion of the population voluntarily vaccinated would create ‘community immunity,’ which would drastically lower the rate of transmission of the disease. Also, fewer people would need the vaccine during a crisis and a well-vaccinated population is probably unattractive to bio-terrorists.
Given the Sept. 11 terrorism and the Anthrax cases, there is the possibility of a biological attack. Public health authorities are unprepared but still request the right for more power and more money. They also want to decide who, where, and when individuals should be vaccinated. The right approach is to make the vaccine available to the public and let individuals and doctors, rather than public bureaucrats, decide who should be vaccinated. Hopefully, the probability of an attack will remain low and we will not have to rely on luck and “public health” authorities.
