Addressing bioterrorist threats: where do we go from here?

In discussing the threat of bioterrorism, planning, coordination, and preparedness are recurrent themes. State and local planning are of particular concern to me, having served as a local health officer and as health commissioner in New York City during the World Trade Center bombing. I have no doubts that the threat of terrorism within our borders is real. And several years later, when the sarin attack occurred in the Tokyo subway system, it was hard not to imagine what such an event would have meant in the New York subway system. A fundamental step toward addressing the threat of bioterrorism is comprehensive planning that focuses first and foremost on local preparedness and response capacity—integrating the role of state, regional, and federal governments, as well as state, regional, and national assets. To plan effectively, we have to think through the different types of scenarios that may confront us, including the announced release of a biological agent, the silent release of a biological agent, or some kind of hybrid event, such as having a bomb go off, that is followed by the release of a biological or chemical agent. In addition, we have to think about the scenarios where person-to-person transmission can occur or those with noncommu-nicable infectious diseases. Bioterrorism covers a very broad spectrum of concerns, from catastrophic terrorism with mass casualties, to microevents using low technology but producing civil unrest, disruption, disease, disabilities, and death. All these scenarios must be considered. We need to identify the assets and capabilities at all different levels and identify the gaps, critical players, policymakers, and stakeholders, and we must forge working relationships within the public health and health-care community as well as with outside partners. We need to develop shared understandings and mechanisms of communication. All of these efforts are best undertaken before an emergency or crisis. We need to strengthen our nation’s public-health infrastructure. This means enhancing our surveillance and epidemiologic capacity; our laboratory capacity to support surveillance efforts; and our communications systems to collect, analyze, and share data. A strong and robust public health system requires effective working partnerships with the medical care community. For a host of reasons over many years, the worlds of public health and medicine have existed too far apart, even though they share a common set of goals and the mission of promoting health and preventing disease. We need to build linkages and understanding. We also need …