Bioterrorism briefing
Public-health expert Arthur Reingold

Arthur Reingold, professor of public health and a noted epidemiologist. Bonnie Azab Powell photo

20 November 2002 |

Recently, in a wide-ranging intereview with Public Affairs staffers Bonnie Azab Powell and Jeffery Kahn, Arthur Reingold, head of the epidemiology division at the School of Public Health and director of Berkeley’s Center for Infectious Disease Preparedness, talked about how well-prepared the United States is to deal with the threat of biological attack. An excerpt appears below; for the full interview, in which Reingold also talks about the pros and cons of quarantining and forced vaccination, and the long-term sickness of the public-health system, see www.berkeley.edu/news/
media/releases/2002/11/04_bioterrorism.html

In October of last year you said that the U.S. was far less prepared than it could be for a bioterrorism attack. Do you think that’s still true? What progress have we made?
Basically, it’s still true. There are two aspects of this preparation: general public-health preparedness, and things that are specific to bioterrorism, like smallpox vaccinations. We’re much better prepared for the latter. As a nation we’ve commissioned large quantities of a modern smallpox vaccine and have large stores of the old vaccine, which we’ve learned can be diluted and still give protection. And we’re at least talking about getting plans in place for how you use the vaccine and how you vaccinate people. There are monies going to medical facilities to try and improve their level of readiness; funds are being spent to develop central repositories of drugs and various kinds of medical equipment that could be flown somewhere within hours. Those kinds of quick-response things are certainly in the works; some existed before 9/11 and some have been expanded greatly since then.

What about developing systems that can detect an attack before people get sick?
Technology that can detect organisms in the environment using an air or a soil sample has been advancing over the last several years; the military has had such technology as far back as the Gulf War. Obviously those efforts have been given added impetus from the Department of Defense. Such devices still have some marked limitations, some of which may be amenable to engineering and some that won’t. They’re still not 100-percent specific — there are organisms that look like anthrax that some of the machines cannot tell apart — so we’re likely to have false positives. But even if we had the perfect piece of detection equipment, we have bigger issues: How much would they cost, how many trained people are needed to run them, where do you put them — in Las Vegas but not in Reno? in San Francisco and L.A. but not in Redding? Where in San Francisco?

So we’ll probably have to rely on the traditional public-health means of detection, where the doctor is first to identify an outbreak.
Most likely. In a battlefield situation, with a finite area, monitoring the environment makes sense, but when you’re talking about trying to protect the entire U.S., clearly there are a lot of decisions still to be made. But what people like about that idea is that we may be able to detect the problem before people get sick: using people as the sentinel canaries obviously lacks appeal

For people in public health who do the kind of work I do, the much more central issue is about monitoring of illness in the population — for example, if someone sprinkles salmonella in a salad bar or sprays smallpox virus in JFK airport. If you accept the notion that some people have to get sick before we can detect the problem, then the question is how good the existing system is for detecting that, what communications are available, what’s being done to improve those factors. It’s not just whether we’re prepared for bioterrorism, but whether the basic public-health infrastructure in general is ready to detect and respond quickly to problems.

And is it?
The infrastructure is still woefully inadequate in some ways, and that’s a problem. It’s better than it is in most countries. It’s been good enough to serve the country and society reasonably well, but it’s certainly not nearly as good as it could or should be, and the reason for that is a fundamental lack of interest in paying for public health at the local and state level.

Public health has been underfunded for decades. Health departments have fewer people than they should, and those they do have are not as well trained as they should be. The salaries are low, the infrastructure is bad, the staff support is poor, and the opportunities for continuing education are almost nonexistent. While there are some wonderfully talented people working in public health, they’re not there because of all the great things public health has to offer them.