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Week of September 24, 2006 - September 30, 2006

Terrorism: Public Health or War model?


A "War against Terrorism", of course, is fundamentally as silly as a "War against Tanks" or a "War against Longbowmen Protected by Pikes". These are all methodologies or tactics.


A "War against Jihadists" comes somewhat closer, but it's still murky. Is an attack on Australians in Bali part of the US war, which the US hasn't declared against anyone?


While the potential for massive events exists, remember that the US death toll from terrorism is far less than the toll from motor vehicle accidents or heart disease or end-stage lung disease. We treat those, however, as public health problems. I propose terrorism should be treated as another such problem, not a "War".


Using a public health approach, one has surveillance, prevention where possible, and treatment. Would anyone argue we've been fighting a "War against Influenza" for a century or so? The 1918-20 pandemic was as lethal as any shooting war. We've had periodic pandemics, none that lethal.


We now have weapons: vaccines that guess at the strains that will be prevalent in 6-9 months, and four drugs that can prevent or cure an infection, if given in the first 48 hours. Some theoretical work suggests that much more general vaccines are possible. No one, however, predicts the end of influenza in the imaginable future.


I suggest that mediating the effects of influenza and terrorism are similar problems. Public health epidemiologists identify risks, and I'd much see protection of key US infrastructure than new operations in Iraq or especially Iran. Remember Bhopal, admittedly with a shantytown that never should have been next to a poorly run chemical plant. Consider, however, if a systematic attack were made against any of thousands of chemical plants making or storing toxic gases.


Epidemiology has one apparent victory, with the eradication of smallpox. We hope that there are only the two reference samples in Atlanta and Moscow, and that no one diverted any from the Soviet program, especially the nastier mutants. If there is a moderate outbreak, we do have things we can do about it.


Polio may also be close to eradication. Eradication programs, however, appear to require an effective vaccine, immediate detection and quarantine of cases, and continued awareness. Can we do any more against terror?

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Howard C. Berkowitz

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