anthrax anxiety that grips our nation only hints at the threat of
bioterrorism. Most cases were readily diagnosed and treated; infected
individuals pose no risk to others; and many effective antibiotics
are available, in plentiful supply, to treat those infected or exposed.
It is sufficiently scary, however, to remind us all of the hopelessness
of past generations facing deadly infectious diseases whose causes
were often unknown; the means of spread a mystery; and treatment
unavailable. Those "medieval" times are not so distant.
The influenza pandemic of 1918 killed 20 million people. It was
an aggressive, contagious virus at a time when we barely knew what
a virus was and possessed neither a treatment for those infected
nor a vaccine to prevent it. The summer polio epidemics of the 1940s
and early 50s gave rise to wards filled with iron lungs, and to
childhood paralysis and deaths. With the route of contagion unknown,
people shunned pools and movie theaters, and headed, if they could,
for more rural retreats (often to no avail).
More recently still was the early 1980s "epidemic" of
previously rare forms of cancer that heralded another mysterious
outbreak, whose cause and means of spread were at first equally
baffling: HIV/AIDS. Each of these once mysterious visitations yielded
to informed, effective public health intervention: epidemiologic
surveillance and detective work that identified cases, traced their
origins, and tracked down their modes of spread; and laboratory
and field research that developed, tested, and deployed effective
vaccines that have kept influenza deaths to a minimum despite the
virus mutating every year, have eliminated paralytic polio from
the northern hemisphere, and have eradicated smallpox from the face
of the earth.
is now a generation for whom I will never again need to explain
what public health is and why it is important; how the Johns Hopkins
Bloomberg School of Public Health is an essential guardian of our
lives and our health; why it is critically important to support
and strengthen schools of public health and other components of
our nation's public health infrastructure; why staying "well"
and healthy is not the natural order of things but the dearly bought
outcome of hard and devoted public health work; and why these can
only be as successful as investments in public health allow.
We are immensely fortunate. Our public health enterprise, severely
depleted and undercapitalized compared with the past and the enormity
of today's threats, has not (as of my writing) been challenged by
anthrax engineered to be resistant to available antibiotics; or
by a thousand simultaneous cases of smallpox among suicidal terrorists,
each infecting two to eight unsuspecting contacts, resulting in
an exponential spread of deadly, untreatable disease. But a strengthened,
resilient public health infrastructure, armed with a more robust
science base and adequate stockpiles of vaccines, would promptly
identify new cases, contain the spread of contagion, and ultimately
protect the nation's citizenry unless, of course, we fail
to heed the terrorists' lessons of the past few months, or nature's
lessons of past millennia.