Bioterrorism preparedness: potential threats remain.

As a public health leader with senior-level experience in the government (as a state chief medical officer and as a member of the National Advisory Committee on Children and Terrorism) and now in the academic sector, I was excited by the title of the commentary by Cohen et al. regarding bioterrorism preparedness.1 A number of the authors’ specific details on smallpox and anthrax were enlightening, and I, for one, fully appreciate the need for significant increases in funding for many other critical health problems that face our nation, in the vast realm of public health as well in the larger venue of social justice. However, I believe the authors were unfairly dismissive of the many potential threats that still exist in the broad area of bioagents, chemical agents, nuclear entities, and other possible threat agents—which are not limited to anthrax and smallpox. More important, the authors say that funding for terrorism preparedness does not build public health capacity, calling it an “empty promise.” Where are the local, state, or national data presented to adequately support such a strong and debatable contention? Much of this funding, through states and several large cities, has gone to help build up the epidemiological, informatics, and risk communication structures of our nation’s public health system—structures that were previously woefully lacking.2–5 It is simply not reasonable to fail to acknowledge that much of this newly built capacity could and would be used for pandemics, natural disasters, environmental hazard releases, and other situations not related to bioterrorism. Unfortunately, terrorism preparedness is and will assuredly stay an essential part of the world we live in. The key for leaders in public health will be to continue to strive to make this funding and these programs adaptable to the other critical needs of the public health sector—and not to ignore a real threat.