30 J.L. Med. & Ethics 254 (2002)
Bioterrorism Law and Policy: Critical Choices in Public Health

handle is hein.journals/medeth30 and id is 258 raw text is: Bioterrorism Law and
Policy: Critical Choices
in Public Health
James G. Hodge, Jr.

here is perhaps no duty more fundamental to Ameri-
can government than the protection of the public's
health, safety, and welfare.' On September 11, 2001,
this governmental duty was severely tested through a series
of terrorist acts. The destruction of the World Trade Towers
in New York City and a portion of the Pentagon in Washing-
ton, D.C., presented many Americans with a new, visible
reality of the potential harms that terrorists can cause. The
staggering loss of lives (estimated from 2,600 to 2,900)2 dam-
aged the national psyche in ways far exceeding the physical
scars to American institutions.
As horrific as the images of destruction and loss of hu-
man lives may be, events that unfolded after September 11
revealed another dreaded, and potentially more catastrophic,
threat to Americans' sense of security and public health:
bioterrorism. Unlike terrorists that use bombs, explosives,
or other tools for mass destruction, a bioterrorist's weapon
is an infectious agent. Bioterrorism involves the intentional
use of an infectious agent (e.g., microorganism, virus, infec-
tious substance, or biological product) to cause death or disease
in humans or other organisms in order to negatively influ-
ence the conduct of government or intimidate a population.3
In the weeks that followed the terrorist attacks on Sep-
tember 11, public health and law enforcement officials
discovered that some person or group had intentionally con-
taminated letters with potentially deadly anthrax spores.
These letters were mailed to a variety of individuals in gov-
ernment and the media in three states and the District of
Columbia. Dozens of persons that handled or received the
tainted letters tested positive for anthrax exposure. To date,
at least five persons have died. Many government officials
predict the potential for additional bioterrorism attacks as
Journal of Law, Medicine &Ethics, 30 (2002): 254-261.
© 2002 by the American Society of Law, Medicine & Ethics.

the war on terrorism continues in Afghanistan and sur-
rounding territories.
For state and local public health agencies that may find
themselves on the frontline of defense to a bioterrorism event,
prevention through preparation is essential.4 Prior training
exercises have demonstrated that preventing mass causalities
or infections resulting from bioterrorism is difficult.' Public
health authorities, medical practitioners, and hospitals6 may
lack the infrastructure,7 resources, knowledge, or tools to
effectively respond to mass exposure to diseases for which
there are potentially inadequate detection' or tests,9 no (or
insufficient) vaccines, few treatments, or no cures. Prior to
September 11, federal and state public health authorities had
already allocated some resources and engaged in efforts to
prevent a major bioterrorism event.10 Congress authorized
the spending of over $500 million in 2001 for bioterrorism
preparedness through the Public Health Threats and Emer-
gencies Act. Additional commitments to improve
surveillance of unusual diseases or clusters, train health-care
workers, improve existing vaccination12 and treatment sup-
plies through increases of national stockpiles, and collaborate
across jurisdictions are needed to improve the public health
Public health authorities must also be legally empow-
ered with the authority to respond to potential or actual
bioterrorist threats.14 Some states have legislatively (e.g.,
Colorado) or administratively (e.g., Rhode Island6) devel-
oped public health response plans for a bioterrorism event.
However, in many states, existing legal standards for response
are absent, antiquated, or insufficient. Prior to September
11, many state health departments did not address bioterrorism
in their emergency response plans.7 Recently, public health
lawyers and scholars at the Center for Law and the Public's
Health at Georgetown and Johns Hopkins Universities were
asked by the Centers for Disease Control and Prevention and

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