Emphasis on bioterror can limit efforts needed to fight viruses

Allan McCoy

is a lecturer in sociology at Meredith College in Raleigh, N.C.

America's focus on a hypothetical bioterrorism attack is leaving our country more vulnerable to the real threat of a natural spread of deadly viruses.

Avian flu recently reappeared in Australia and China. In the Middle East, more than 100 cases of the SARS-like virus MERS (Middle East respiratory syndrome) have been documented in Saudi Arabia.

Thus, it's disturbing to realize that the federal government has spent billions of dollars to prepare for a potential bioterrorist attack - yet was entirely unprepared for the swine flu pandemic of 2009.

While today's focus reflects legitimate worry about global terrorism, this fixation with bioterrorism also reaffirms a U.S. choice with a long history: the decision made two centuries ago to put the military in charge of fighting epidemics.

Even before the Sept. 11 attacks, the federal Centers for Disease Control and Prevention had taken a special interest in biological terror, producing numerous reports with such titles as "Bioterrorism as a Public Health Threat." After the attacks and the anthrax-laced letters sent to U.S. senators and media figures, consultants for the CDC produced the "Model State Emergency Health Powers Act" - calling for the legalization of a compulsory quarantine of the sick in the case of a bioterrorist attack.

In 2004, Congress allocated $5.6 billion to Project Bioshield to buy vaccines for use following an attack of smallpox, anthrax, or some other weaponized pathogen. In March, Congress poured an additional $2.8 billion into the program. This is only a small portion of the more than $60 billion we have spent on biodefense.

In contrast, when swine flu swept the nation four years ago, vaccine stockpiles were insufficient to cover even high-risk populations. While the CDC said it needed 159 million doses to inoculate pregnant women, health-care professionals, and other key groups, only 32 million doses could be produced.

In a report, the Robert Wood Johnson Foundation declared that had the outbreak been worse, health departments nationwide would have been overwhelmed - in large part because of a lack of money.

Similarly, crucial funding for research on infectious diseases - among them, malaria and tuberculosis - that continue to kill millions of people every year has been redirected into work on rare viruses, such as anthrax and tularemia, because the latter are on the government's list of potential bioterrorist agents.

How did we get to this point? Some history is instructive.

After the devastating yellow fever outbreak of 1878, the Marine Hospital Service, a military organization, was put in charge of controlling epidemics. The service relied on a maritime quarantine as its main defense, viewing target diseases as akin to invading armies to be stopped at the border.

In 1892, Joseph Holt, director of Louisiana's board of health, expressed this militaristic view of disease control in a work tellingly named "The Pestilential Foreign Invasion."

"No foreign invasion from hostile fleets," Holt warned, "could possibly work such widespread violence to the general welfare or more tremendously disturb our domestic tranquillity than foreign invasions from pestilence."

On occasion, a disease outbreak has even provided a pretext for U.S. military action. After a yellow fever outbreak in 1897, hawks of that day cited the disease as a reason to invade Cuba. The Spanish-American War was sold in part as a way to wipe out the epidemic at its source.

In the early 1900s, disease control continued to be an essential part of our military operations, notably in the Panama Canal and the Philippines.

In 1912, the Marine Hospital Service morphed into the U.S. Public Health Service, which to this day includes a uniformed Public Health Service Commissioned Corps led by the surgeon general. The CDC itself grew out of a military effort - the Malaria Control in War Areas program in World War II.

Over the decades, military and public-health concerns have become intermingled. The fixation with biological terrorism is only the latest expression.

Here's the problem: This preoccupation with assault via pathogens has left our nation even more underprepared for the next round of pandemic disease - an inevitability.

It is likely that the next outbreak of disease in America is not going to come from a bioterrorist attack, but rather a virus, such as avian flu, SARS, or MERS. Now's the time to make a shift.

It's time to switch attention away from a fear of terrorists armed with smallpox to refocus on a far more realistic threat of deadly - but natural - outbreaks of infectious disease.