Public health emergencies such as an intentional anthrax release, or infectious disease threats such as severe acute respiratory syndrome (SARS) and pandemic influenza, highlight the ever-changing threats posed by acts of terrorism and other public health emergencies, while also underscoring the pressing reality of these events. However, these events present different stresses on the public health community. As discussed during the workshop, a bioterrorist event such an anthrax attack represents a deliberate attack that threatens our national security and our public health. A naturally occurring event such as an influenza pandemic is a public health crisis with national security implications (due to the numbers who might become ill—armed forces, public safety workers, etc.). Therefore, the key is for the nation to plan aggressively to counteract the threat of future public health emergencies, said Dr. Gerald Parker, the principal deputy assistant secretary in the Office of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services (HHS). However, he asserted, the United States is unprepared to confront the full range of threats.

Another presenter noted that one of the main criticisms leveled at the federal government by the 9/11 Commission was a “failure of imagination,” underscoring the point that the government did not anticipate the nature of the threat and thus had no systems in place to counteract it. Many other presenters sounded the alarm that the public health system has been beleaguered since the 1980s (IOM, 1988) and is inadequately staffed for a widespread attack. Issues presented at the workshop as impediments to successful, comprehensive antibiotic countermeasure delivery to the population included labor, physical facility capacity, security, liability, and financial sustainability.

The anthrax example, Parker said, dramatically brings to light the seriousness of the threat and the nation’s lack of preparedness in two major ways. The first is the need to dispense countermeasures within an extremely short time window to minimize morbidity and mortality from anthrax. The second is the allure of anthrax or other biological toxins (e.g., ricin) to terrorist groups because of their relatively low cost and ease of production and dispersal. Many existing technologies can be used to disperse aerosolized forms of these agents over massive and heavily populated areas, posing a risk to hundreds of thousands of people (Baccam and Boechler, 2007).