Prescriptions on bioterrorism have it backwards

Editor—Rosen makes several factual misstatements in his editorial on bioterrorism.¹ For example, the vaccine for anthrax has been shown to be effective only for the cutaneous form of anthrax and not for the inhalation form used in weapons.² He states that anthrax vaccine is not being produced, but the Pentagon has embarked on a massive effort to produce this vaccine and to inoculate all US troops on active duty. This programme is now under sharp attack in Congress for possible adverse effects and lack of scientific justification.³ The statement regarding bioterrorism that “. . . it is hard to raise money to defend against a problem that has such a low incidence”¹ seems reasonable, but is just not true. Last year, the United States allocated $10bn (£6.25bn) for anti-terrorism, with a substantial portion for bioterrorism.⁴ In contrast, food borne diseases, which have high morbidity and mortality, have received far less attention and fewer resources.

Rosen does, however, make some important observations. Bioterrorist attacks have indeed been rare. The incident in 1984 in Oregon with no fatalities and the two chemical attacks in Japan in 1994-5 mentioned in the editorial are the only ones documented.

We agree with Rosen that: “It has also become apparent that the management of any biological attack must depend on systems already in place for managing new diseases or new epidemics of old diseases. Unfortunately, US public health surveillance systems are not modern, and there has been little thought about how an epidemic might be recognised quickly. Most state public health departments are underfunded and do not have the staff to investigate anything more than a recognised epidemic.”¹

Sadly, Rosen's prescription to encourage antibioterrorism programmes is likely to make this deplorable situation worse. Some programmes, such as secret research sponsored by the military that could trigger a new arms race in chemical and biological warfare agents, are inherently dangerous.⁵ Diverting resources and attention to the “unusual and infrequent event”¹ of bioterrorism increases vulnerability to the mundane but deadly everyday problems such as chronic and infectious diseases and environmental insults.

In short, the proponents of antibioterrorism programmes have it backwards. Instead of pumping more resources into ill advised and risky antibioterrorism programmes, we should build national and international public health systems that can adequately reduce, detect, and respond to natural disease outbreaks and industrial chemical spills. Then, in the unlikely event of a bioterrorist attack, these systems will be available to manage the challenge.