Preparing for the next outbreak: is America asking the right questions?

• Author: Chapman, Sandra
• Position: Microbe: Are We Ready for the Next Plague? - Brief article - Book review

Microbe: Are We Ready for the Next Plague? Alan P. Zelicoff, M.D. and Michael Bellomo (New York: AMACOM Books, 2005), 273 pages.

In 1993, the filtration process that ensures the capture and removal of particulate matter from municipal water systems failed on a massive scale in Milwaukee, Wisconsin. In the largest infectious disease outbreak in a single month in the history of the United States, over 400,000 people became ill with cryptosporidiosis before public health officials were advised that something was wrong--and not by medical practitioners, but by pharmacists who thought it odd that they had completely run out of diarrhea medicine. (1)

Using examples such as the Milwaukee cryptosporidiosis outbreak, Microbe: Are We Ready for the Next Plague? offers a crash course on the recent history of novel infectious disease outbreaks, focusing on the weaknesses in America's public health infrastructure. Authors Alan Zelicoff and Michael Bellomo argue convincingly for the institution of an electronic early-response Syndrome-Based Disease Surveillance System (SBDSS) that would help physicians, veterinarians, public health officials and even school nurses coordinate information and catch emerging infectious disease threats as close as possible to the index case, the earliest documented case of a disease. Two primary themes are identified early in the book, which highlight the importance of early detection and the need for an integrated communication system that allows real-time tracking of emerging diseases in human and animal populations. From a health policy perspective the concept of prevention can be conceived broadly to include government policy and campaigns to change health and social behaviors. However, the definition of prevention employed in Microbe is limited to catching an infectious disease outbreak at its inception in order to prevent its spread, which limits the scope of the authors' policy analysis to actions taken once an outbreak has already begun. (2)

For Zelicoff, former senior scientist at Sandia National Laboratories' Center for Arms Control and National Security, Microbe is the most recent chapter in a long campaign to promote the use of syndrome reporting in the United States. Over the past few decades, the World Health Organization, the European Union and other international bodies have begun to move toward such systems, focusing on the importance of early detection and enhanced communication techniques in the fight against infectious disease and bioterrorism. (3) In a February 2005 interview with Dr. Moira Gunn on National Public Radio's weekly program BioTech Nation, Zelicoff characterized the U.S. public health infrastructure:

[I]f you sat down with a blank sheet of paper and tried to design a system that was poised to fail, you could not do better than what we have now. Remove the stove pipes, and instead of going up and back down vertically through a bureaucracy, just go horizontally by sharing the data among all the user communities who need it. (4) In line with the theme of much of Zelicoff's published work, Microbe illustrates the ways in which improved SBDSSs--funded by the federal government and implemented at a nationwide level--could give the United States a better chance to prevent disaster in the event of a serious outbreak of infectious disease or a bioterrorist attack. (5)

In the first ten chapters of Microbe, Zelicoff and Bellomo note examples of recent infectious disease outbreaks, both in the United States and abroad, and underscore the ways in which a lack of open and rapid communication between medical practitioners, veterinarians and public health officials exacerbated each incident. The tenor of this discussion appeals to a certain U.S. nationalism and a mentality of constant fear and alertness reminiscent of the Cold War that has reemerged with the War on Terror. SARS in China and smallpox in the former Soviet Republic of Kazakhstan are the only international examples, and the authors use ideologically loaded language to critique the functioning of the public health systems in both countries. In the case of domestic disease outbreaks, the authors' circumscribed definition...