Note: This is an early draft of a paper written for college. The submitted copy has since disappeared.

There may be a fundamental problem in how the United States government is assessing the threat and defending against the threat of bio-terrorism and infectious disease. To the casual observer of the United States public health system, the weaknesses are obvious. The RAND study that Ficker quotes shows that few first responders have plans in the case of a biological crisis (3). He qualifies that by noting "a plan guarantees little about whether an organization can execute a successful response" (2). Yet, the public health bureaucracy by in large is stuck in the plan is everything mentality. Bureaucratic-rational mentality looks for quantifiable results, and ignores the real world, made up of a rather unpredictable and complex public and civil society. Glass is a descending voice in the public health community, and his argument will be central in this essay. Assessment and defense against bio-terrorism and infectious disease can best be improved by thinking outside of the bureaucratic-rational box, and going to the public and community for assistance.

Why should the state enlist the public as a capable partner in dealing with infectious disease and bioterrorism? It would seem rather dangerous to involve the public, as they need crowd control and are prone to panic, as demonstrations like Dark Winter suggest (Ficker 3). Glass uses examples to show that this is rarely the case. He cites the lack of panic in New York City after the World Trade Center attack on September 11 and 1918 Spanish Flu (219). Additionally, if people reject the grounds for such control, they are likely do to do things that cannot be controlled by the government. We can send in National Guardsmen to a quarantined area that deters people physically escaping, but as Outbreak showed, some may still escape. People would have been a lot more calmer, happier, and safer, if they felt their neighbors were in charge and protecting them, then some strange bureaucrat from Washington DC. There is a national desire and state interest to combat bioterrorism, but such an interest should be balanced with local interests.

One of the most basic building blocks of community is not the government, but civil society. It is all but ignored in Strogin and Fricker. Yet, it plays an important role in the inital response and long after the incident. Volunteers staff many fire departments, they do not receive government pay nor benefits. Groups like the Red Cross provide a variety of emergency services, like help with recovery and blood. Even other groups and individuals provide help in an emergency, be it a neighbor taking in a homeless neighbor. Disasters in the past have shown that while agencies in FEMA take an important role in cleaning up, community and civic organizations take a dominant role. Citizen organizations are even taking on the roles conventionally given to government, such as security. Neighborhood watches and conservation groups like Green Peace and the Oregon Forest Rangers Association (Forest) all attempt to provide security in a non-governmental away. Yet, many policy makers are afraid to tap these resources, as they can not be totally controlled, they are a threat to state sovereignty. Without any such inclusion of NGOs, it is unlikely that essential functions of coordination, communication, and information dissemination will be met. Too often, the public is looked at as little more then a group of vigilantes as the Dark Winter scenario views it.

Glass gives another important reason for reaching out to the community. The medical community simply may not be able to handle influx of patients. In the past decade, streamlining the medical community has greatly reduced the number of hospital beds in most major cities (220). Fidler argues that hospitals might even be reluctant to treat many of the people in a bio-terrorist attack or infectious disease epidemic, due to the large liability risk it poses (qtd. in Strogin 5). A solution would be to keep many such people in the community in their own houses (Glass 220). This might mean that others who are sick might be displaced, but community organizations like local schools could help. Even organizations farther away from the epicenter might be able to take-in non-ill people to protect them from contact with the ill. This is disappointing, as citizen action and preparedness may be our best defense against attacks.

Most policymakers believe that communication with the public is essential. The question of communication is addressed by all of the articles. Most of the focus is on interagency communication, but all articles recognize that the public also needs to receive essential information. Quinlisk cites the importance of having information systems that "permit effective analysis and interpretation of health data and provide public access to health information." She also notes the importance of communication systems to provide a similar role in communicating "accurate information to the public" (qtd. in Strogin 4). Fricker’s study never asks about this question directly, but inevitably, most of the plans that include interagency communication do not overlook the public. Many agencies that fill out the survey may have just assumed that this was an implicit part of the answer to the communication question. Glass argued the most for the importance of communication with the public, noting that:

"relevant historical examples suggest that effective leadership and delivery of clear, credible, and timely information both during and after a bioterrorism attack would be critical components of a response (220)".

He goes on to say such information would reinsure the public and helps garner their support, argumentatively the most important part of any response. The opposite would lead to a discrediting of the authorities, and the undermining of their ability to deal with attack in an efficient way. Communication with the public is essential to ensure an effective response.

Are national plans and organizations for dealing with infectious disease and bioterrorism going to be effective, or will the affected population reject them and ignore governmental suggestions and control? Glass argues for the importance of designing plans that represent the "values and priorities of the affected populations". An attack could generate a need for a Machiavellian-like response. It might involve a "violation of individual rights such as forced quarantine or isolation, compulsory treatment, or vaccination, and the seizure and destruction of property" to protect the greater good (Rule of Law qtd. in Stogin 5). These concepts are violations of American constitutional norms. Would the affected population accept such drastic measures, and would the greater society accept them? Glass notes that "if the public doesn’t trust the doctor, they won’t take the pill". If such measures seemed unjustified to certain segments of the population, they might revolt. The ghetto riots of 1968 seem like a plausible response if injustice to a minority community is great enough. Government was ineffective at controlling them, even Mayor Daily’s "shoot to kill arsonists" order was not effective to stop them. There are many ways to interpret that Sticker’s concern with the "worried well’s short and long term mental health needs" (3). Certainly many members of the community may suffer from some kind of post-traumatic syndrome. Yet, mental health community can abuse their powers to oppress dissent after a bio-terrorist attack. Many opportunist regimes including the Nazis used professionals to oppress decent, categorizing dissenters as ill individuals. Community standards and professionalism on the part of health care professional are the only way to prevent this.

Fricker notes that a core part of preparedness is deciding what is acceptable risk and that it is " a largely philosophical one that requires further debate" (1). Who better then the community to decide what is an acceptable risk? He also argues that "assessments must anticipate and prioritize the events and circumstances for which preparedness is desired," something that is best decided by the community instead of men in a smoke filled room. The people Lewis County, NY of are going to have different idea on what kind of biological hazards they must be prepared for such as agri-terrorism, then the people of New York City. A formula might be able to adjust for differences in land area, but it is unlikely to consider the best way to deal with independent minded-dairy farmers versus fiscally conservative Wall Street investors. Certainly, chasing around 1200 pounds of bull is going to lead to a different outlook on the world then chasing around $1200 million of stocks. Values must be reflective in any planning.

One can not successfully defend against of bio-terrorism and infectious disease, if they are constantly deluding themselves on the reality of responding to an attack. While it may be in the interest of certain agencies to promote their agency in a response, they should not ignore the public. Only when we include the public as an important and vital actor in preventing and dealing with problems will we have an accurate picture. Counting bureaucratic plans and dealing with abstract legal issues may give a gauge of preparedness, but it will prove significantly weaker when we actually have to use it. Attacks and outbreaks will happen on the public, and they are most effective actor to deal with them.