David R. Franz
Chief Biological Scientist, Midwest Research Institute
Former Commander, U.S. Army Medical Research Institute
of Infectious Diseases
What is the likelihood that a natural pandemic could kill a million people in the United States … or that a bioterrorist attack could kill tens of thousands? We lose more than 30,000 Americans to influenza in a typical year, 80,000 to automobile accidents, 320,000 to obesity, and 440,000 to smoking-related illness. But it's difficult to find any but a few activists—and some ordinary people who have experienced personal loss—who maintain interest in these problems for more than a few minutes after the end of the nightly news. We haven't had a true large-scale public health disaster—a “pandemic” that wasn't caused directly by human behavior—for nearly a century. We're a resilient people, but we may be taking disease too lightly in this new, smaller, and very changed world.
In 1992, Nobel laureate Joshua Lederberg and Professor Robert Shope, in a National Academies of Science Report entitled Emerging Infections: Microbial Threats to Health in the United States, made an impressive case for improving our preparedness to deal with emerging infectious disease. There was little response from government to the well-thought-out plan to enhance our public health system. (Public health is, by its very nature, a function of government, although each of us can and should practice preventive medicine). Eight years later, Pulitzer Prize–winning author Laurie Garrett, in her book Betrayal of Trust: The Collapse of Global Public Health, told us of the woeful state of the United States' and the world's public health systems. Again, there was little response.
Then in 2001, when, in the wake of the World Trade Center attacks and the contaminated letters that followed, five Americans died of inhalational anthrax, our government responded with a $6 billion per year program to prevent and respond to intentional attacks with bacteria, viruses, or toxins. This unprecedented health-related response, in the context of our much greater but “expected” human losses to naturally occurring infectious and behavioral disease, should tell us something about ourselves: (1) We're willing to die of preventable causes if it takes a long time and we feel we have