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Beyond Preparedness: Time to Rethink the Connection between Public Health and National Security

Last month, the FBI announced named a suspect for the 2001 anthrax attacks on the U.S. mail – Bruce E. Ivans, a former scientist at the army’s Medical Research Institute at Fort Detrick. With Ivans’ suicide, the question of his guilt or innocence is likely to remain disputed. Beyond dispute is the magnitude of the attack’s impact on U.S. public health law and policy.

Coming shortly after 9/11, the anthrax attacks struck at a time of heightened fear and vulnerability. Perhaps as a result, public health quickly became part of the “war on terrorism” as the country began to prepare for a microbial weapon of mass destruction. In the next few years, Congress regulated laboratories working with dangerous pathogens, enhanced the nation’s stockpile of drugs and vaccines, increased funding for the development of so-called countermeasures, enacted a smallpox compensation program and provided immunity for manufacturers and suppliers of vaccines and drugs used in a “public health emergency.” In addition, the Centers for Disease Control sponsored the Model State Public Health Emergency Powers Act, which was designed to clarify and enhance the states’ authority to take decisive actions in the event of a public health emergency. Preparedness became the preeminent public health policy.

Seven years later, it is worth assessing this approach’s impact on public health policy and ethics. Undoubtedly, many of the actions that were taken, including the regulation of research with dangerous pathogens and the increase in funding for vaccine development, have been useful. Other measures are more problematic.

Especially troubling has been the close association between public health and national security concerns – an association epitomized by the deployment of the smallpox vaccination program in the lead-up to the Iraq war and reinforced in 2005 when President Bush discussed the possible use of the military to cordon off an American city in the event of an influenza pandemic. While the conflation of public health with national security has undoubtedly added to the salience and prestige of public health agencies (although not ultimately their funding), it has also threatened to ensnare public health in controversial aspects of the war on terrorism. In addition, all too often it has led public health officials to view public health risks in Manichean terms. Thus just last June, CDC hosted a conference on the obesity epidemic that featured thoughtful discussions of how law could be used to control the epidemic as well as a strangely Orwellian title: “Legal Preparedness for Obesity Prevention and Control.”

Not surprisingly, public health ethics has also been affected. For seven years, much of the debate in the field has centered on the coercive powers of the state and the question of when it is ethical (and also legal) for the government to sacrifice the rights of the individual to save or merely benefit the many. Often lost in these arguments over public health’s own version of the “ticking bomb scenario” are numerous critical questions: is it ever ethical to treat a person as an enemy merely because he or she is infected? Is public health best protected by limiting or respecting the rights of affected communities? And is the risk of bioterrorism enhanced or diminished by increasing research into bioterrorist countermeasures and immunizing those who make and manufacture such items?

Five years after the invasion of Bagdad and four years after the disclosure of the atrocities at Abu Ghraib, attitudes have changed toward the larger war on terrorism.  Many have come to regret the human rights violations that have been committed in its name. Perhaps with the identification of Bruce E. Ivans as the chief suspect in the anthrax attacks, it is also time to close the door on our initial response to those heinous crimes and decouple public health from national security. By so doing, we may develop a new approach that sees health and human rights as complementary rather than antagonistic goods, and that values public health not because of its importance to national security but for its own sake.

Wendy E. Parmet is Matthews Distinguished University Professor of Law at Northeastern University School of Law. She writes for Bioethics Forum by arrangement with the American Society for Law, Medicine, and Ethics.

Published on: September 11, 2008
Published in: Public Health

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