1. A4287-1 10/02 Issues in bioterrorism response Nicole Lurie, M.D., M.S.P.H. RAND

2. A4287-2 10/02 Criminal Acts Intended To Coerce Governments and Populations To Change Policies New faces of terrorism Lessons from 9/11 and anthrax Importance of dual use Community health security systems Challenges for the future

3. A4287-3 10/02 New Faces Of Terrorism Ideology vs. poverty Middle class vs. uneducated Mass casualties vs. messages Non-state vs. state origin Domestic vs. foreign

4. A4287-4 10/02 Lessons From 9/11 and Anthrax Public health infrastructure has decayed Communications failures were rampant Lab and investigatory capacity were overwhelmed Our surveillance and information sharing systems are underdeveloped and inadequate Involved ‘community response’ must be broad

5. A4287-5 10/02 Uniqueness of Biological Events Slow to evolve Progressive nature Occult presentations Distinguishing natural from man-made Focus on surveillance and response Vaccines and antibiotics Fear!!!

6. A4287-6 10/02 Systems are being built and rebuilt Dual use is critical –Cost effectiveness –New and emerging infections –Antibiotic resistance Must serve interests and needs of health delivery and public health systems Must involve broader public

7. A4287-7 10/02 Community Health Security Systems Public Health Medical EMS Public Safety Defense and intelligence Media Community organizations Disaster organizations

8. A4287-8 10/02 Federal, State and Local Responses Federal funds State organizations Local responses

9. A4287-9 10/02 Challenges Maintenance of interest and effort Coordination Who is in charge Law enforcement vs. health? Communications Between entities Data sharing and surveillance Media Spokespersons

10. A4287-10 10/02 Challenges Research needs- vaccines, antibiotic resistance Public health needs Surveillance techniques e.g. syndromic approaches Lab capacity and reporting Preparedness and response Trade-offs?? National vaccine strategy Cost effectiveness (people, beds, and funds) Ethical and civil liberties Academic openness vs. security

11. A4287-11 10/02 The Intelligence-Health Interface National Intelligence Fusion Center Privacy HIPAA Security Clearances Standards???

12. A4287-12 10/02 Challenges for compliance community Lack of standards Inconsistent measures, metrics, reporting formats Unclear data sharing agreements and procedures Meeting needs of bioterrorism surveillance, public health, and health care simultaneously

13. A4287-13 10/02 Looking Ahead Living with risk Maintaining our values Serving as effective stewards of societal resources Strengthening our security Maintaining our perspective