New Public Health Demands

Anthrax spores found near the heart of U.S. government--the offices of Senate Majority Leader Tom Daschle--have cranked up bioterrorism anxieties. The worry is still out of proportion to the immediate danger. Only one person has died of anthrax to date. While 31 congressional employees have tested positive for anthrax exposure, none show symptoms. And the pathogen cannot be contracted through exposure to an infected person. Still, the attacks reveal significant flaws in federal public health coordination that Congress and the Bush administration should address.

First, the short term. The federal Centers for Disease Control and Prevention needs to distribute guidelines to curtail the prescribing of antibiotics when they aren’t needed. A perceived national shortage of Cipro, the U.S. trade name for the antibiotic recommended to treat anthrax, was eased by the manufacturer’s decision to triple production and more significantly by the Food and Drug Administration’s announcement Wednesday that it will tell doctors how to use two other widely available antibiotics--doxycycline and penicillin--against anthrax.

Many doctors have too quickly acquiesced to patients’ demands for antibiotics, and not just for anthrax fears. The overuse of antibiotics in medicine and in agriculture, where farmers use them as livestock growth promoters, has helped create super-resistant strains of bacteria.

A broader problem than antibiotic overuse is that the U.S. public health infrastructure, from emergency rooms to disease surveillance, has been crumbling. Although largely ignored by Washington, the problems, including last year’s delays in distributing flu vaccine to public health departments, are familiar to most Americans.

President Bush can begin a more vigorous defense of the public health by appointing a respected, politically seasoned biologist like Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, to a Cabinet-level post overseeing the U.S. Public Health Service. This is an unconsolidated, uncoordinated mess of 7,000 public health departments scattered throughout the government.

The new agency’s first priority should be to give underfunded local public health departments guidance on who would dispense medications, how people would get them and how diagnoses would be made. It is to local departments, already dangerously strained, that people would turn first. Federal anti-terrorism guidelines for states and counties, crafted after the 1995 bombing of the federal building in Oklahoma City, only address nuclear, chemical and conventional explosive attacks.

The agency should also look at other biological hazards. For instance, should the federal government once again require vaccinations against smallpox, a highly infectious disease that has disappeared from nature but not from weapons development?

Those steps would sharpen the bureaucracy. To sharpen the science, Bush should bring together health, military, business, federal and local bioterrorism experts to advance biology research much as the Manhattan Project revolutionized physics in the early 1940s. A new kind of war needs new forms of civil defense. Given the rapid advances in biotechnology for both good and evil in the late 20th century, nowhere is the need for innovation greater than in biology.