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Vulnerability to Global Epidemics and Bioterrorism: Absence of Adequate Early Warning System

Problem:  Absence of early warning system for emergent global infectious disease.  In addition, in the U.S. the public health system has atrophied, thus increasing the nation's vulnerability to biological terrorism.

Source: Weiss and Nakashima, "Biological Attack Concerns Spur Warnings: Restoration of Broken Public Health System is Best Preparation, Experts Say," Washington Post, September 22, A4:

• "For decades before bioterrorism was on anyone's mind, [the nation's public health] system -- built around community hospitals and closely linked public health laboratories -- offered a sensitive mechanism for detecting emerging epidemics. Local public health departments, hospitals and clinics were the listening posts of disease detection . . . But a dramatic economic shift to privatized medicine and managed care -- and a mistaken belief among policymakers that infectious diseases had been beaten by antibiotics -- have together decimated that world-class early warning system, leaving the public vulnerable to naturally emerging problems such as West Nile fever and those perpetrated by terrorists." 

• Since the 1970s, "Federal and state legislators repeatedly cut spending on public health or shifted that support to flexible 'block grants' that states chose to spend on more politically visible priorities. But even as public health budgets shrank, the threat of disease was growing. Tuberculosis, which in the 1970s was well on its way to being vanquished, has returned with a vengeance -- and this time it is resistant to standard medicines.  Centralized food sources has led to widely dispersed and sometimes fatal outbreaks of food-borne diseases.  And ailments never before seen in this hemisphere, such as West Nile fever, are appearing and seem to be settling in for good."

• " . . . quick and accurate disease detection is especially important because some of the deadly diseases that might be unleashed by terrorists, such as anthrax and smallpox, could at first be mistaken as an ordinary cold or a flu."

Source: Raeburn, Paul, "Wanted: Early Warning for Global Epidemics," Business Week, November 1, 1999, p. 82. 

• "Public health officials have called for establishment of a global surveillance system that could quickly identify outbreaks [of  infectious disease] and prepare an emergency response. The only existing reporting system is a mostly volunteer effort called the Program for Monitoring Emerging Diseases, or ProMED, located at the Harvard School of Public Health. . . . But it has no resources to  actively search for outbreaks and no capacity to respond when they are discovered."

• "The World Health Organization and several other international health groups have proposed the creation of a network of regional centers equipped to recognize outbreaks and identify the microbes  responsible for them. When plague broke out in India in 1994, for example, ‘there was no laboratory in India capable of diagnosing it," [according to Barbara Hatch Rosenberg, a molecular biologist at the State University of New York at Purchase, one of the founders of ProMED].

• "The health groups are seeking $50 million over the next five years under a section of the international Biological Weapons Convention that provides for peaceful use of biological agents."

• "The next virus could be as deadly as AIDS—or worse.  And we are not ready for it."

Source: Associated Press & Reuters, "TB's Global Spread Affects U.S.," Washington Post, February 8, 2002, A21:

• "A global tuberculosis epidemic is fueling high rates of the disease among immigrants, refugees, and other foreign-born residents in the United States and threatening efforts to eradicate the disease , federal health officials reported yesterday.  The Centers for Disease Control and Prevention said foreign-born people accounted for 46 percent of the 16, 377 new U.S. cases of tuberculosis in 2000 and 72 percent of the more serious 141 drug-resistant TB cases."

• "The rate of infection in this group was more than seven times higher that for those born in the United States and those born outside its borders to U.S.-born parents."

• "Eight million new cases of TB are reported around the world every year, leading to 2 million deaths."

• "CDC officials also said that poor access to health care, adequate housing and nutrition for foreigners living in the United States, especially among illegal aliens, likely contributed to the high TB rate in this group."

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