Terrorism and Public Health: A Balanced Approach to Strengthening Systems and Protecting People

VICTOR W. SIDEL AND BARRY S. LEVY

Of all the forms of terrorism, bioterrorism may inspire the most fear—perhaps because of the public perception that biological agents may not be visible, are easy to disseminate, can spread easily from person to person, and can cause horrific diseases. While not all of these perceptions are necessarily accurate, much public and professional attention has focused on bioterrorism. Before the 1990s, public concern about bioterrorism centered on the types of biological weapons that might be used by nation-states that had the capability to produce such weapons.^1,2During the 1990s, the potential for bioterrorist attacks by individuals and nongovernmental groups was widely publicized in the United States, and the U.S. government began developing policies and programs to address the threats posed by bioterrorism.

Bioterrorism began to be perceived as a greater threat in the United States following the attacks on the World Trade Center (Chapter 2) and the Pentagon on September 11, and especially following the dissemination of anthrax spores through the mail in September and October of 2001 (Chapter 6). Five people died of inhalational anthrax, six more people developed and survived confirmed cases of inhalational anthrax, and 11 others had confirmed or suspected cutaneous anthrax. In addition, thousands of postal workers, news-media workers, and others received prophylactic treatment,

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