Preparing health system's response to bioterrorism

Commentary. By Leonard J. Marcus, PhD, and Barry C. Dorn, MD, AMNews contributors. Oct. 7, 2002.

COMMENTARY

Observations on the state of medical practice and medical life

SEE ARCHIVES

In July, the Harvard School of Public Health was designated by the Centers for Disease Control and Prevention as an Academic Center for Public Health Preparedness. We are part of a consortium of schools, state and local health departments and agencies across the country working to develop and to disseminate training materials to assist in the massive effort to prepare for and potentially respond to a bioterrorist attack.

Conflict analysis and the development of conflict resolution capacities are among the foci of our center. Knowing that preparation for and response to a bioterrorist attack ultimately will involve all physicians and health facilities, we share here initial observations and recommendations.

What are the potential conflicts? First, there are matters of jurisdiction. Much of the financing for this effort is derived from federal sources. The bulk of the on-the-ground preparation is being directed and managed through state agencies. Large metropolitan areas are receiving special funds to mount their own preparatory efforts. How this ultimately will impact physicians, hospitals and practitioners on the local level -- people at the front lines of first detection -- remains unclear.

Among these different constituencies and authorities, conflicts are emerging about decision-making, control and funding. Local health officials report that they do not have adequate resources or capabilities to respond to a bioterrorist incident and question the concentration of resources on the state level. By way of illustration, the federal government seems positioned to let states determine their own policies regarding the first round of voluntary smallpox vaccinations, a strategy that could cause consternation if different states or localities choose significantly divergent policies. [...]