BY SCOTT P. LAYNE

The U.S. public health system is a patchwork of jurisdictions and capabilities that work together on occasion. As a result, the pace at which infectious disease outbreaks are identified and investigated is variable. As seen with West Nile virus and foodborne outbreaks crossing multiple states, it sometimes takes weeks to months to even suspect deadly outbreaks. In addition, there is no single laboratory and database system (or clearinghouse) that routinely tracks infectious disease outbreaks and organizes the information on a regional or national basis.

These limitations were not fully appreciated until October 2001, when a handful of anthrax letters made it apparent that Americans are vulnerable to biological attacks — and made it clear that the United States must devise a broader plan to prevent, deter and respond to the long-term threats of biological terrorism.

What are the roles of public health in response to the threats posed by biological terrorism? I believe we need two kinds of undertakings.

The more traditional undertaking involves upgrading local response capabilities and giving the public health system enough resources and tools to work with others. The less traditional, yet equally important, undertaking involves engaging the public health system in national and international efforts to deter and prevent biological attacks. The 1972 Biological Weapons Convention, agreed to by 162 nations, bans the maintenance of offensive bioweapons programs but offers no provision for verification and compliance — the world still relies on the goodwill of nations to self-report activities and curtail offensive bioweapons programs.

One important way to overcome the current gap is for the United States to build a high-speed/high-volume infectious disease laboratory and information-processing system that relates the molecular fingerprints of biological agents to their sources worldwide. The new system, built on existing science and technology from the academic, industrial and governmental sectors, would integrate various disciplines, interests and expertise to deal with the threat of bioterrorism in the most effective ways possible.

The high-speed/high-volume laboratory and database system would provide accurate identification and attribution for effective and rapid action. It would also provide the technological foundation to develop robust national policies and take appropriate actions against those who use or might use bioweapons. Because microbial forensics can determine the origin of bioagents with a high degree of certainty, it would have a potential role in counterterrorism and nonproliferation.

The collection of samples would be accomplished by a concerted effort worldwide. The system would also work in conjunction with outbreak investigations and syndromic surveillance efforts. Such capabilities would operate continuously, provide real-time information and serve as a global biodefense sentinel.

The 1918 influenza pandemic killed 40 million people worldwide. It has often been pointed out that more people will die from an unpredictable influenza pandemic than from a biological attack. This argument may be correct. Yet a well-planned and implemented biological attack could have equally severe social and economic consequences. We should therefore be better prepared for both.

Layne is associate professor of epidemiology in the School of Public Health. He is also an instructor on bioterrorism preparation and response for the U.S. Department of Justice.