The specter of bioterrorism has forced the U.S. government to redefine national security. But even before the anthrax scare of 2001 made the threat real, U.S. officials were expanding the concept of national security to include public health.
Not long ago, U.S. national security meant military security. But when the Cold War ended, policy makers and public health experts began worrying about another foreign threat, diseases. Among the experts was Nils Dulaire, head of a U.S. non-governmental organization, called the Global Health Council.
"The way many of us view national security is the health, the safety, and the survival of our children and our families," he said. "We have for years worried about missiles as the fundamental threat to that survival. We now see that there are many other threats, and leading among them are the infectious diseases that are worldwide, rampant, and ready to come back to the U.S. with a vengeance."
Behind this concern was the AIDS invasion and re-emergence of tuberculosis, after decades of control. The Clinton administration expanded its notion of national security to include public health.
A Central Intelligence Agency study asserted in 2000 that AIDS and other infectious diseases threaten stability, not just in the United States, but everywhere. Agency official David Gordon explained to a House of Representatives committee.
"These diseases will endanger U.S. citizens at home and abroad, threaten U.S. armed forces deployed overseas, and exacerbate social and political instability in key countries and regions where the United States has significant interests," he said.
Fifteen months after his statement, terrorists attacked Washington and New York. One-month after that, someone mailed powdered anthrax to U.S. news organizations and members of Congress, killing five people, sickening 17 others, and disrupting the postal service. Suddenly, bioterrorism galvanized U.S. political and public health officials into action - perhaps more than any public health threat ever had.
"The concept of public health preparedness has evolved, particularly in light of terrorism threats," said Dr. Julie Gerberding, head of the U.S. disease-tracking agency, the Centers for Disease Control. She says the new norm for public health officials is preparing for both infectious diseases and bioterrorist agents such as anthrax, smallpox, botulism, or others.
"We recognize that for many of these threat agents, the consequence of not being prepared is devastating," she added.
The result of the combined al-Qaida and anthrax attacks is that the U.S. public health sector is on high alert, flush with $1 billion Congress appropriated last year. That is 20 times more than the national government gave to state and local health agencies the year before.
Despite the anthrax exposure of 2001, it is smallpox U.S. officials fear the most, judging by the Bush administration's elaborate measures to acquire and distribute enough vaccine for everyone in the country. Critics argue that the government has not given equal thought to an airborne anthrax attack, which they consider just as plausible and dangerous.
Yet, whatever biological agent terrorists might deploy, some experts say they are hard to defend against. Veterinarian David Franz of the Southern Research Institute in Birmingham, Alabama, says any program to counter the threat must consider discouraging their use.
"There are no really good, simple technical solutions to this problem. I think it is useful to think about changing intent among those who might use biological agents against us," he said.
In the meantime, the Centers for Disease Control is using traditional disease protection measures. It has opened new laboratories to analyze outbreaks, trained rapid response teams, and developed an emergency plan to communicate with public safety and health officials at all levels of government.
Ironically, measures taken to protect against bioterrorism are helping detect and control three infectious diseases most Americans had never heard of a few years ago, SARS, monkeypox, and West Nile virus. As Centers for Disease Control chief Julie Gerberding says, no one can predict where the next health threat will come from.
"If there is any lesson about emerging infections in the new normal, it is expect the unexpected," she said.
This report is part of VOA's series on World Health