Markkula Center of Applied Ethics

Homeland Health Security

By Margaret McLean

Those who had been imagining that industrialized Western countries could cope very well with any infectious disease outbreak had another think coming Monday, when Canadian public health officials conceded that their precautionary measures had failed to prevent dozens of possible new cases of SARS.

Talk about a Red Alert! As we in the United States beef up national security against human terrorists, the SARS epidemic should convince us to prepare for the terror of disease-bearing microbes. Just as September 11th woke us up to the danger of enemy attacks, the creep of infectious disease should shake us out of our complacency that we are ready to confront a major disease outbreak.

For the past four decades, we have lived under the shelter of antibiotics and vaccines. We have been protected from pneumonia and polio, measles and meningitis — diseases that run rampant elsewhere.

In many ways, we have been lucky with SARS — 8,000 infections worldwide with 700 deaths, none in the United States. As Guenael Rodier, the World Health Organization director of communicable disease surveillance, said, "The good news is that this was not influenza. Influenza has the capacity to spread so much faster." The last flu pandemic killed 40 million people.

So far, the U.S. health system has weathered the potential SARS storm. There have been no quarantines or mandatory wearing of surgical masks. The Centers for Disease Control lists 65 "probable" SARS cases in the United States. But the health system has hardly been challenged and CDC Director Julie Gerberding has warned that there are weak links. These include too few medical personnel and too few hospital beds to deal with large-scale infectious disease. It is doubtful that we would do any better at responding to SARS than our Canadian neighbors — and we may well do worse.

Public health officials believe we are one "super spreader" away from disaster. State health departments are already strained by bioterrorism concerns including the poorly planned rollout of potentially unnecessary and possibly harmful smallpox vaccinations. We need to ask the question of whether or not we are prepared not only for bioterror but also for naturally occurring SARS-like epidemics. Both can frighten and kill. Both ought to be security priorities.

The public's health should be part and parcel of Homeland Security. After all, security of health is vital to each of us. Our health is faced with real and certain danger, not only from imported infectious disease but also from homegrown neglect. A Superpower reeling from an epidemic cannot lead and cannot defend. How can our homeland be secure if our public health system is stretched to the point of breaking?

In a recent letter to his supporters, President Bush wrote, "We have no more urgent and important duty than to wage and win the war on terrorism. We must make use of the moment history has given us to extend liberty to others around the world, because in the long term, freedom and hope are the best weapon against terror."

To these, we should add a third weapon--healthy people — men, women, and especially children. Protection of human health demands as much public support and strategic planning as the recent war — maybe more. Only then will our homeland, and homelands across the globe, be secure.

Feb 2003

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