Are we safer today compared to 9/11/2001?
As the Tenth Anniversary of the 9/11 and anthrax attacks approaches it’s reasonable to ask whether we – Americans, allies, citizens of the world – are safer in September 2011 than we were on September 10, 2001. A corollary of that question is whether the hundreds of billions of dollars spent on security-related measures, and trillions on wars in Iraq, Afghanistan and Pakistan have bought freedom from fear.
The questions are complex, and I devoted nearly eight years to their study and analysis, recently published in my new book, I HEARD THE SIREN SCREAM: How Americans Responded to the 9/11 and Anthrax Attacks. From a public health point of view in America I must conclude no, we are not. My perspective differs sharply with that of the Rand Corporation’s “Shadow of 9/11” recent report, which argues that large sums of money spent on the health infrastructure of the U.S. = “security”.
The largest public health expenditures made in the name of antiterrorism were for purchase of smallpox vaccines, training personnel to execute immunization for that virus, and a variety of technologies that are aimed at diagnosing and responding to germ threats. There are two problems with the approaches:
- There never was real evidence that al-Qaeda or any other nefarious group possessed smallpox samples. The threat was hypothetical, driven by role-playing scenarios executed long before the 9/11 attacks, in which make-believe terrorists spread the virus. An enormous amount of money was spent – at least $6 billion – to stockpile smallpox vaccines and teach public health employees in towns and states, as well as outside of the U.S., how to carry out mass ring vaccination campaigns to control spread of the hypothetical threat. Though much was made of the “dual utility” of these activities, offering pandemic response skills to local health workers, the actual methods of immunization and the social ring control approach are both unique to smallpox.
- As former Republican leader of the Senate Bill Frist (R-TN) explained repeatedly in 2001 and 2002 “public health” is an infrastructure based largely on government employees trained in a broad range of health-related skills. As inane as it is to imagine “education” without human teachers in the classroom, so protection of the health of hundreds of millions of people depends on continued support of a broad spectrum of skilled individuals, from meat inspectors to trauma surgeons. Even when dollars were focused in the post-2001 era on skills training, at the local level the counterterrorism effort meant either adding tasks to already-burdened government and hospital workers, or shifting them off other vital public health activities to counterterrorism.
Many State legislatures cut public health budgets by roughly the same amount as the federal government sent for bioterrorism response. While the political leaders rationalized that the size of the pot was unchanged, in practice this compelled elimination of cancer preventions programs, HIV testing, tuberculosis surveillance, water treatment and hundreds of other activities that could not be ”fudge-ably” financed with designated bioterrorism funds.
Ten years later we find ourselves saddled with severely weakened public health infrastructures, not only inside the U.S. but worldwide. At the top the World Health Organization is now laying off 20% of its employees amid a $1 billion deficit in donor support. Global health programs of all kinds are experiencing downturns in support that are translating directly into decreased activities, fewer programs and less money to treat the sick. While overall donor support for health, development, food and humanitarian aid programs in poor and middle incomecountries rose dramatically between 2005 and 2009, by mid-2010 real funds in the field declined.
This global situation reflects the dire economic pressures felt inside traditionally wealthy donor countries, such as those of Europe and North America. Europeans have experienced a sharp increase in suicides since the 2008 financial markets crash, and pressures on national health systems are acute amid default-status credit crises in Ireland, Spain, Greece, Italy, Portugal and Greece. Inside the United States most of the provisions of the 2010 Patient Protection and Affordable Care Act have yet to be implemented, and many are subject to legal and political challenge. In the meanwhile, high unemployment and other changes in the labor market have pushed millions more Americans out of the health insurance market. According to a recent study by the National Institute for Health Care Management, the U.S. spent $2.5 trillion in the aggregate, or $8,100 per person, and 17.6 percent of GDP in 2009 on health. Nine million Americans have lost health insurance since the 2008 market crash, bringing the total of uninsured to 52 million. In addition, 1-out-of-5 children under 18 in the U.S. in 2011 live in households that meet the U.S. poverty standard.
Are we better prepared, despite these grim figures, in terms of our biotechnology and ability to properly and rapidly detect a threat, determine its origins, and stop its spread?
Recently the U.S. Department of Health and Human Services noted that the Secretary of Homeland Security says, “there is a significant potential for a domestic emergency involving a
heightened risk of attack with a specified biological, chemical, radiological, or nuclear agent or agents -- in this case, Bacillus anthracis,” aka anthrax. In so noting, HHS authorized use of the cheap, generic antibiotic doxycycline for treatment of anthrax infection – a marked improvement over the 2001 hundreds-of-millions-of-dollars wasted on use of the expensive, patented Ciprofloxacin for anthrax. So the good news is Americans won’t waste money and suffer side effects, as occurred in 2001 amid the anthrax mailings.
But anthrax, the microbe that had a devastating impact on businesses, lives and government in 2001, continues to stymie authorities. Since early August 2011, for example, health authorities with the U.S. Centers for Disease Control and Prevention (CDC) and State of Minnesota have struggled to explain how an individual in that state recently contracted pneumonic anthrax. Similarly, dozens of cases of anthrax infection and death have surfaced over the last 18 months in Scotland, England and Wales, apparently involving contaminated heroin, but the source of the anthracis-laced narcotics, believed to have originated in Afghanistan, has never been identified.
On August 13 bioterrorism alerts were issued in the U.S. and in India regarding the castor bean toxic, ricin. According to intelligence operatives the al-Qaeda affiliated group in Yemen is actively seeking to develop (or has developed) ricin toxin for use as a bioweapon. The language of these warnings, and their fear-inducing claims, hearken to the many similar claims that flooded the media following the first anthrax death of Robert K. Stevens in Florida on October 5, 2001. It is impossible to get a handle on the al-Qaeda ricin allegation. Ricin is certainly an odd weapon of choice, as the only effective uses of it have entailed assassinations, poking poison-saturated tips into victims’ bloodstreams. As was the case in 2001, the public in 2011 is left to scratch its head, having no idea whether or not to worry, or what to do if grounds for fearfulness seem valid.
I have argued strenuously in I HEARD THE SIRENS SCREAM, and will continue to maintain that “safety” remains elusive when the nature of the threat continues to be poorly defined, the status of public health remains under-funded and inadequately trained, and large swathes of the domestic and foreign populations have no access to healthcare either in normal or terrorist circumstances.
No, we are not safer in 2011.