The report, "Breathing Easier," issued by the Century Foundation, sets out a six-point plan that proposes setting standards and definitions for public health departments, enlarging the workforce and updating the laws concerning public health emergencies.
Also included -- not surprising -- is a suggestion for steady funding for public health activities with the strong assertion that what is good for public health in general also is good for biodefense specifically. Therefore biodefense money should come with enough flexibility to allow it to be used for broader aspects of public health.
The point has merit. There is no question many of the population-monitoring systems needed to warn of a bioterror attack would help spot a SARS outbreak or a run of food poisoning. If there are not enough people to assist during a flu epidemic, there are not going to be enough people to assist after an attack with smallpox.
"Preparedness for a potential epidemic ... if done well ... will be entirely relevant for everyday public health -- everyday infectious disease monitoring and response," said Brad Smith, a fellow at the Center for Biosecurity.
Public health officials, however, long starved for resources, have begun to see biodefense as an easy path to obtain the money and latitude they need to solve broader problems, fund staff positions and improve the general infrastructure.
It is easy to see why they would think that. After the anthrax attacks in 2001, Congress threw money into biodefense. Where spending had been $50 million in 2001 it jumped to nearly $950 million in 2002, according to Ed Thompson, chief of public health practice at the Centers for Disease Control and Prevention in Atlanta. Federal biodefense funding continues at a brisk pace with Washington having spent about $849 million in 2004 and planning to spend $865 million this year.
In contrast, public health, which looks after the health status of the community at large, has had difficult time getting funding, said Leif Haase, a health care fellow at the Century Foundation and member of the report panel. Part of the reason, he told United Press International, is the public is confused about what public health professionals do and associate them with healthcare for the poor.
This confusion, plus a lack of the sort of accreditation associated with medical disciplines, undermines the profession's status and ability to get support. Now bioterrorism has thrust public health officials into the limelight in their role as first responders and health watchdogs. That role has come with more funding as well.
Is there is a risk in tying the fortunes of public health to terrorism? Will a focus on biodefense skew the normal and necessary tasks of public health such as food safety and tuberculosis control? Could a sudden lack of interest in bioterrorism hurt the gains already made?
"To the extent that public health follows the funding -- meaning that people only fund terrorism -- it does run that significant risk," said Dr. Georges Benjamin, executive director for the American Public Health Association and one of the panelists presenting the report. "I've certainly argued, and I think the report tries to make the case, for the fact that bioterrorism is very important -- but it isn't the only thing we have to do."
Haase said there is a danger "there will be too much focus on things like smallpox preparedness. He added that could lead to neglect of other public health priorities.
"Public health, especially in the last 20 to 30 years, has taken on more mandates than it can be expected to fulfill," Haase told UPI. He said the new biodefense role could prompt a debate on whether the public health system is really the place to address needs such as healthcare for the uninsured.
Though some states have chosen to cut funding for public health as new federal biodefense money has rolled in, Benjamin does not see state cuts as increasing the threat of dependence on counter-terror funds.
"That is not a function of bioterrorism money," Benjamin said. Such cuts happen when the states get increased immunization funding too. "It happens with every funding stream that comes into public health," he said.
What is really important, Benjamin asserted, is that the other roles of public health must continue to be funded.
"The point we are trying to make is that we should not (become dependent)," Benjamin told UPI. "Bioterrorism is an additional duty. It should be funded as an additional duty ... that doesn't mean you don't fund your public health laboratory or do public health laboratory stuff."