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OPINION
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BIOTERROR AND THE NEW CDC
By Scott Simpson
Osama Bin-Laden might just save your life one day. In addition to a new foreign policy stressing military pre-emption and a wave of for-better-or-for-worse U.S. patriotism, the 11 September 2001 terrorist attack has sparked a significant change in health protection in the United States. Political pressure has not only brought about immediate projects in response to sensational threats - like smallpox vaccination - but also fundamental, vital changes to the public health system and its role in identifying, treating, and preventing disease.
The public health infrastructure in America today is seriously out of date. The electric blackout in the Northeast last August alarmed people about the inadequacy of what some experts called the country's "third world" electric grid, and awakened them (if briefly) to the danger of reaping the massive benefits of modern technology while ignoring the system's underpinning foundations. But if you thought the blackout was dangerous, just wait until you get sick.
The U.S. public health system is as antiquated as its electric one; the country just hasn't received its shock yet. There is a dire shortage of vaccines some years (notably, the flu vaccine this season), of nurses every year, and of health-system-wide communications. An exorbitant one-third of American healthcare costs are spent on administrative needs because transferring insurance and health care information is still done in person by fax or phone - corporate America, in contrast, has automated even their most secure transactions.
Now, the U.S. government has decided that the weak infrastructure of American health care is insufficient for homeland security, if not a direct terrorism target itself. The first step in managing any public health threat - a new infectious disease, a chronic illness, an increasing rate of some type of accident - is to recognize the danger in order to fashion a response. But unless an entire town falls ill, America lacks the perceptive capability to realize what is happening. Right now, to track the outbreak of epidemic diseases, state and local healthcare departments have hotlines for clinics to report peculiar cases. After a physician's office has recognized an illness, reported it, and health department officials have analyzed it, days may have passed.
After a week, what could be a small outbreak of anthrax or smallpox could spread widely, and tracking down all potential victims might be almost impossible. Consider the anthrax mailings: connecting cases from Miami to Washington, DC, was a deliberate, prodding process. No single agency was in charge, and trained responders were not always available. American healthcare is plagued by balkanization - there are a variety of providers, including federal government, local government, universities, foundations, private hospitals, and small clinics, but there is no unified means by which these elements can communicate.
The consequences are severe. The government has trouble following the prevalence or patterns of illness; research is hindered by the inaccessibility of health records and statistics. Natural outbreaks spread farther than they should before the front-line medical watchdogs - state and local health agencies - comprehend the more far-ranging danger. Furthermore, this environment of confusion makes it difficult to collect reliable data on the progression of illnesses that are slow to develop. Unusual clusters of cancer victims, for example, have gone unnoticed for years.
The September 11 attacks galvanized a nationwide, guttural passion to respond by looking at established systems and ideas. Just as the government dismissed lax airport security as the norm, and rogue states as post-Cold War misfits, it is starting now to view healthcare informatics as an aging industry that must eventually catch up with the better-managed systems of the information age. Urgency - not importance - was the missing impetus needed to address these dangerous issues. And in the wake of 2001's terrorist attack and the anthrax scares, the public woke to this need with a new mandate for the Centers for Disease Control and Prevention (CDC).
CDC was once the small stepchild of the federal Department of Health and Human Services (HHS). Though it expanded rapidly throughout the 1990's, CDC had never held a press conference before 9/11. The agency attempted to address a plethora of health issues, but with under-funded mandates and little Congressional attention. Now, however, almost 25% of an increased CDC budget is earmarked for "homeland security," and the agency has been given a leading role in responding to bioterrorism threats.
The $2 billion of CDC's terrorism budget constitutes the most urgent effort to update the public health system in decades. Most of this money is not being spent on actual counter-terror measures like gas masks and chemical-weapons response training; rather, American healthcare is receiving the foundational lift that has been costing America numerous lives each year. In the 2004 fiscal year, the CDC plans to spend almost $1 billion upgrading the response capacity of state and local health agencies. A Public Health Information Network - along with improved statistical gathering capacity - is being established with $10-15 million; about $300 million is being spent on the national vaccine stockpile. Under HHS Secretary Tommy Thompson, the CDC has been ordered to place a first-response official in all 50 states. Officially considered anti-terrorism agents, these Epidemic Intelligence Service personnel now provide a unique channel between the federal government and local entities in protecting public health, not only in emergencies, but also in day-to-day life: water and food supplies, for example, are now being monitored for the consequences of terrorism, and the National Institutes of Health is providing grant money for terrorism-related research which could have significant spin-off benefits.
The current public health revolution is funneling tremendous resources into one of the areas of American medicine that needs it most. Bio-terror dollars are not being spent on elaborate vaccines to "designer" weapons. They are being spent on computers and information infrastructure. Even the flashiest products of 9/11 paranoia are being used against relatively mundane (and yet far more lethal) threats - the CDC's extravagant Emergency Operations Center in Atlanta, GA, is more likely to engage in tracking SARS or West Nile Virus or winter flu than a 24-style doomsday terror scheme. Public health is riding the bio-terrorism wave finally to close the technology and awareness deficiencies that have plagued American healthcare.
A number of major consequences are foreseeable: Will a Public Health Information Network be the first step to a national medical database? Will health-services research now make exciting and life-saving discoveries with the compilation of a variety of health statistics that were previously isolated? Might we be able to recognize and respond to even natural epidemics much more rapidly as a result? Such steps will undoubtedly take time, but the recent massive response to terrorism has brought them into focus and jumpstarted the drive to a stronger national health framework.
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