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Until recently, few considered the medical and public health implications of biological, chemical, and nuclear terrorism subjects relevant to the professional lives of the vast majority of medical and public health practitioners. Diseases like anthrax, tularemia, plague, and smallpox were presented largely as curiosities of medical history or geography, or in the case of smallpox as the paramount example of the stunning potential that medical science and international public health cooperation offered the world. We might recall a factoid from an infectious disease lecture about anthrax as an occupational hazard for farmers or veterinarians, but who could have imagined a time when postal workers, government employees, politicians, or media personalities would be at risk of contracting the disease?

This view changed in the months following the aerial attacks on the Twin Towers and the Pentagon. In rapid succession, death and disruption caused by anthrax-contaminated mail, a national smallpox vaccination campaign, and the initial uncertainties regarding the capability of the Iraqi army to use biological weapons in the lead up to the Second Gulf War highlighted the critical need for a reinvigorated and proactive public health workforce and an informed health care community.

Much has been accomplished in the past several years, but preparing the nation’s public health workforce and medical community to respond to the immediate and long term consequences of biological, chemical, and nuclear events remains an enormous challenge. One reason for our present dilemma is that for too long, the public health systems have been under-funded and, many have argued, antiquated. The reasons for this state are complex. For one, the nation’s discretionary health care dollars have flowed increasingly toward curative medicine as socioeconomic, technological and pharmacological advances—such as better nutrition, hygiene, housing, and vaccinations—caused many of the major health issues of the early and mid 20th century to fade.

The deterioration of the nation’s public health infrastructure did not happen overnight, however, and remedying this situation is no short term task. To be sure, federal and state funding for public health has increased meaningfully in the past several years, much of it earmarked specifically for bioterrorism. However, many in the public health community honestly and fairly question whether the focus on bioterrorism is justified in light of equally compelling public health priorities, such as AIDS, environmental pollution, gun violence, or tuberculosis. Increasingly, one hears a compelling argument in favor of the concept of “dual use.” Put simply, supporters of the dual use concept argue that pragmatism and prudence dictates that we use the opportunity afforded by the influx of bioterrorism funding to make longer term investments in the nation’s public health infrastructure. Put more concretely, improvements in disease surveillance, communication systems, and public health preparedness are as applicable to other contemporary public health threats as they are to bioterrorism. The international SARS epidemic is a relevant case in point. As noted in Chapter 3, a more rapid and efficient mobilization of the nation’s ...

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