Fraser and Brown replyWe believe Drs. Cohen, Gould, and Sidel, for whom we have the highest respect and whose opinions we value, have missed the point of our Viewpoint [Public Health Rep 2000;115:326-30]. They recognize that “neither foodborne disease nor chemical spills has received a fraction of the public attention given to bioterrorism.” This is absolutely true. The everyday issues that public health agencies deal with regularly have for decades been addressed haphazardly, if at all, through a series of categorical programs that address individual diseases or public health threats. The issue of bioterrorism has drawn public attention and resources to the need for improvement in basic public health capacities, those germane to all of public health practice, in a way that other public health issues have not.

We wholly agree that what Cohen et al. call “the real challenges” of public health merit greater attention. But these challenges have not been getting that attention. This fall Congress passed and the President signed the “Public Health Threats and Emergencies Act,” legislation designed by its sponsors, Senators Bill Frist (R-TN) and Ted Kennedy (D-MA), to address the specific problems of antimicrobial resistance and bioterrorism preparedness. The first section of the Act authorizes the first-ever federal funding designated for performance standards, assessment, and competitive grants to states and localities to improve core capacities to detect and respond effectively to “significant public health threats.” The capacities include workforce, laboratory, and communication capacities, the infrastructure that we believe underpins the ability of public health agencies to carry out all of their work, to perform the essential public health services. Like it or not, the issue of biological terrorism was effective in capturing the awareness of policy makers and helping them understand the concept of core public health capacities. We have no doubt that, had the two issues not been joined, we would not have made this leap forward in supporting public health infrastructure. This is the practical reality of policy making.

We also note that the bioterrorism preparedness spending of which we are proponents is not the $1.5 bil¬lion to which Cohen et al. refer, which includes large sums appropriated to the Departments of Defense and Justice. Rather, we have been advocates for the $222 million for the Centers for Disease Control and Preven¬tion to address bioterrorism, and we stand by our posi¬tion that the expenditure of this sum on bioterrorism preparedness that also benefits general public health preparedness is wholly justifiable and, in fact, insufficient. Cohen et al. should note that in our Viewpoint we took no position whatever on the issue of military spending. Now that Congress has explicitly authorized spending for basic public health infrastructure, we hope the entire public health community will join in advocating for the highest possible level of new funding for improving the nations public health system.