Challenges to global public health

The threat of bioterrorism will likely persist and continue to present challenges to global public health. Adding to the concern is the possibility that advances in biomedical research may be used for malicious purposes - a possibility that has recently resulted in the creation of the National Science Advisory Board for Biosecurity by the US Department of Health and Human Services, to counsel government agencies regarding the dissemination of results from "controversial experiments" (Steinbrook, 2005). While the overall risk of bioterrorism is probably low from a practical standpoint, the consequences are potentially quite high; thus it is essential that we continue to develop countermeasures and response plans. There is otherwise a tendency to move on in our thinking to "the next big thing" and to leave these threats incompletely addressed. This concept of "bio-terrorism fatigue" can be quantified (Figure 12.1).

Bioterrorism represents the ecological niche that lies at the confluence of global geopolitics, sociology, biology, public health, and medicine. So too do

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Figure 12.1 "Bioterrorism fatigue": declining volume of publications using the keyword "bioterrorism" as referenced in the PubMed database from 1997 through 2006 (the latter year represents an annualized number) with superimposed federal bioterrorism funding from 2001 through 2006 (©2006, Center for Biodefense and Emerging Pathogens).

emerging infectious disease threats, such as pandemic influenza. Fortunately, the resources, human and economic, and technology that must be allocated to a cogent biodefense strategy are similar to those that are needed to combat naturally occurring disease threats (Artenstein, 2003; Relman, 2006). The duality of biodefense offers society the luxury of not having to choose between the two; it instead speaks to the need for a nimble and robust approach that can be adapted to changing circumstances.

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