摘要：Bioterrorism preparedness programs have contributed to death, illness, and waste of public health resources without evidence of benefit. Several deaths and many serious illnesses have resulted from the smallpox vaccination program; yet there is no clear evidence that a threat of smallpox exposure ever existed. The anthrax spores released in 2001 have been linked to secret US military laboratories—the resultant illnesses and deaths might not have occurred if those laboratories were not in operation. The present expansion of bioterrorism preparedness programs will continue to squander health resources, increase the dangers of accidental or purposeful release of dangerous pathogens, and further undermine efforts to enforce international treaties to ban biological and chemical weapons. The public health community should acknowledge the substantial harm that bioterrorism preparedness has already caused and develop mechanisms to increase our public health resources and to allocate them to address the world’s real health needs. RECENT BIOTERRORISM preparedness programs that illustrate irrational and dysfunctional responses to inadequately characterized risks should be of urgent concern to all members of the public health community. Since anthrax spores were released in the US mail system in 2001 and caused 5 fatalities and widespread panic, the spores have been linked to a US military research program, suggesting that the release might not have occurred had the anthrax program never existed. The smallpox vaccination program has also been linked to fatalities and other serious adverse events, although evidence of risk of exposure to smallpox has been minimal. Indeed, the smallpox vaccination campaign may have been motivated by a political rather than health agenda. Continuing bioterrorism preparedness programs are similarly characterized by failure to apply reasonable priorities in the context of public health and failure to fully weigh the risks against the purported benefits of these programs. Such programs may cause substantial harm to the public health if allowed to proceed. Efforts by the United States to prepare for the use of biological agents in war based on flawed evaluations of risks have had serious health consequences for military personnel and have led to significant weakening of international agreements against the use of biological agents. Massive campaigns focusing on “bioterrorism preparedness” have had adverse health consequences and have resulted in the diversion of essential public health personnel, facilities, and other resources from urgent, real public health needs. 1 Preparedness proponents argued that allocating major resources to what were admittedly low-probability events would not represent wastefulness and would instead heighten public awareness and promote “dual use” funding that would serve other public health needs. 2 Public health resources are woefully inadequate, and the notion that bioterrorism funding would bolster public health capability seemed plausible to many, even though we and others have argued that the “dual use” rationale is illusory. 3, 4 An evaluation of recent experience concerning anthrax and smallpox can help illuminate these issues.
