A recent analysis of bioterrorism preparedness spending reveals that of the $1.5 billion allocated specifically for bioterrorism, $222 million (15%) has gone to programs that could be included in Fraser and Brown’s concept of dual use—building the public health infrastructure for all hazards. The rest has been spent on what could be called “dual-useless” items such as military and police exercises. Can a 15% allocation to public health be considered an efficient use of limited funds?
Wasted resources are not the only problem. In the last several years the US Department of Defense has tried to vaccinate all active duty personnel with an anthrax vaccine. The vaccine has never been proved useful against the weaponized spore form of inhalation anthrax, and many soldiers have complained of adverse reactions from the vaccine. The manufacturer (a for-profit concern) was plagued with safety problems and tainted by a potential conflict of interest (a former Joint Chiefs of Staff head is a principal stockholder).
While the military is spending millions to manufacture an unproven and potentially unsafe anthrax vaccine, and millions of doses of smallpox vaccine are being produced to protect against an eradicated disease, the supply of influenza vaccine is not secure.10 Annually, even without a vaccine shortage, there are approximately 20,000 deaths and 110,000 hospitalizations in the US directly or indirectly related to influenza.
Such upside-down priorities are not coincidental. Viewing public health challenges through the lens of bioterrorism necessarily distorts the picture. Fraser and Brown note that “the idea of working with the National Guard, the Department of Defense, and other military groups may seem foreign to many public health practitioners.”1 This is understandable since the track record of the military on public health concerns has been abysmal. Public health advocates have long been in a (losing) competition with the military for funding.
Is “dual use” simply a euphemism for “trickle down”? Have public health advocates given up hope of ever overcoming the unequal funding competition, now believing that the only answer is to attach real public health needs as a caboose to the military-spending gravy train?
It is perhaps possible to interpret the 85% waste in bioterrorism funds as a 15% gain for public health. The approach may seem pragmatic, if not overly optimistic. However, subordinating public health needs to what is essentially a military and law-enforcement agenda comes with many risks and a heavy price.
Public health planners collect incidence and prevalence data in order to set priorities. Designing preparedness programs for unlikely bioterrorism events is at best wasteful. Manufacturing the wrong vaccines and stockpiling the wrong medicines may have far-reaching opportunity costs. Research and development on potential bioterrorism agents increases the risk of deadly accidents with these agents. Worse, other countries may not believe Pentagon assurances that its biological and chemical agent research programs are defensive only, and may begin or accelerate their own programs as a deterrent—engendering a new arms race in deadly pathogens and toxins. Space does not permit a full explanation of these and other risks, which we have discussed in detail elsewhere.
Public health educators and practitioners should be especially concerned that bioterrorism programs could prove a disaster by miseducating the public as to the real threats to public health. Do we really want members of the public to be anxiously looking under their beds for terrorists while corporate negligence creates havoc with unsafe food handling, misuse of antibiotics, industrial accidents, and pollution? Will xenophobia and anti-immigrant hysteria, exacerbated by bioterrorism scare stories, stop mosquitoes at the border? Even simple measures such as teaching children to wash their hands and adults to handle food properly would prevent more infections and save more lives than a thousand bioterrorism drills. Perhaps the $10 billion allocated to anti-terrorist programs for this year could be better used to provide clean water and sanitation to all who lack these basics. According to a recent report from the United Nations, $10 billion for safe water could cut by up to one third the current 4 billion diarrhea cases worldwide that result in 2.2 million annual deaths.
The end of the Cold War was supposed to open the way for a peace dividend for public health, among other needs. The dividend never materialized, and the public health infrastructure has continued to suffer from neglect. One must ask if bioterrorism preparedness is just an excuse—a plausible threat—to justify excessive military budgets, including an estimated $4.5 billion per year for the continued development of nuclear weapons.
Brown and Fraser note with concern that “only 5% of local public health agency directors that were surveyed reported that all appropriate members of their staff had received comprehensive bioterrorism training.”1 Perhaps these overworked and underfunded staff members are too busy dealing with real public health problems to indulge in training drills to search for and destroy phantoms.
Let’s get our priorities straight and work to build national and international public health systems that can adequately handle the daily health crises we already face or are likely to face in the future. Funding public health by means of “dual-use” bioterrorism programs may prove to be a misguided stratagem that interferes with building urgently needed public health capacity.