The Vigilance Defense: Proven Systems and Well-Prepared People Are Our Best Protection Against Bioterror

Last fall, when physicians diagnosed anthrax in a Florida man named Robert Stevens, they initially suspected that they were seeing a rare, natural case of the disease. The infection of a co-worker of Stevens, however, put the country on alert. Five people eventually died, but the quick recognition that the earliest anthrax infections resulted from a purposeful release of bacteria surely saved many lives: infected people were diagnosed and treated sooner, and officials isolated anthrax-tainted mail. Federal and local governments have long considered bioterrorism a law enforcement issue. But both the anthrax episode and recent simulations of simultaneous smallpox releases in Atlanta, Philadelphia and Oklahoma City and of a plague attack on Denver highlight what perhaps should be obvious: bioterrorism is first and foremost a public health concern. For now and the foreseeable future, the first indication of a bioterror attack—as in a natural outbreak of a dangerous infectious disease—will be sick people showing up at emergency rooms rather than a high-tech device sounding an alarm that a pathogen has been released in a public place. The smallpox exercise in particular showed that the health care system is unprepared for the large numbers of people who would become sick in a worst-case scenario, not to mention the demands for attention from the “worried well,” who would merely fear that they might be ill.