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Bracing for Armageddon?

January 30, 2009

Months and months ago, I posted on a piece that introduced Dr. William R. Clark’s book, Bracing for Armageddon? At the time, I was less than enamored with the position credited to Dr. Clark’s book, but I bought a copy and promised to find out for myself. After reading it, my position remains the same. I’m still less than enamored–but I also think that Dr. Clark presented his position poorly.

You see, the first 155 (of 190) pages are chock full of reasons why bioterrorism planning and programs are important; full of successes that saved lives and failures that took lives. Seriously, I would take those first 155 pages (and some of the following), remove the question mark from the title and sell that book, having it act as an effective counterpoint to Dr. Clark’s book.

His arguments against bioterrorism funding in the last 35 pages are not at all convincing, either.

He starts by citing GAO and RAND studies, published prior to 2001, that question the focus on bioterrorism spending, saying that the chances that it would happen are miniscule and that proper risk-assessment studies had not been completed. This series is coupled with the figure that we’ve spent more than $40,000,000,000 (yes, he puts all of the zeroes in there each time-which is a clever trick because nine zeroes looks like a lot more money than just saying “billion,” an effective trick, but still a trick) after 2001. I wonder if something happened in 2001 to change our feelings toward the likelihood of a bioterrorist attack? That would probably be the bioterrorist attack that happened that year.

The next chapter, Assessing the Threat, is my favorite. A full third of the chapter is dedicated to previous bioterror (and biocrime) attacks and how our BT preparations have reduced the likelihood of future attacks. To me, that sounds like an amazing vindication of previous efforts. It sounds like that money was spent well, if it’s reduced the chances that another attack would happen. Acts like the 2002 Bioterrorism Act have helped secure potential bioweapons to the point where it becomes exceedingly difficult to prepare an effective weapon.

At the end of the chapter, Dr. Clark points toward what he considers to be much more likely threats, namely emerging and re-emerging infectious diseases, including pandemic influenza and XDR-TB, and global climate change. I certainly can’t begrudge him these two things. I agree, they’re huge problems–not nearly as big a problem as existing infectious and chronic diseases, but that’s beside the point. Dr. Clark recommends that we focus on preparing for these certainties as opposed to the possibility of bioterrorism. It’s on this point that I challenge Dr. Clark: find anyone working on pandemic flu planning that does not have a background, is funded by, benefits in terms of infrastructure or staffing, or works concurrently on issues of bioterrorism planning. I would argue that person doesn’t exist. Bioterrorism planning supports public health infectious disease planning. Either by paying the salary of additional epidemiologists, lab technicians, paying for communications and computer systems, or by the development of all-hazards outbreak response plans.

Dr. Clark closes with the following passage:

It’s time to move on to other things.

I disagree. It’s time to expand the definition and thrust of bioterrorism planning and funding. There was a strange set of passages at the beginning of the book wherein Dr. Clark tries to tease out the difference between bioterrorism and biocrime. I didn’t understand it at the time, but as I finished the book I saw that his problem was the focus on bioterrorism to the exclusion of everything else. I worry that his problem is with the terminology, the definition. And he wants to stop funding bioterrorism planning and focus on other things because of that small definition. Maybe, ultimately in a roundabout way, he’s right; it shouldn’t be bioterrorism, it should be public health preparedness–it should be public health.

Image courtesy of Amazon, the finest used book store out there.

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