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Book Review
The Global Threat of New and
Reemerging Infectious Diseases: Reconciling U.S. National Security and
Public Health Policy
Jennifer Brower and Peter Chalk
Rand Science and Technology, Santa Monica, California, United States,
2003, ISBN: 0-8330-3293-3, Pages: 146, Price $20.00
Suggested citation
for this article:
McCionnon PJ. The global threat of new and reemerging infectious diseases:
reconciling U.S. national security and public health policy. Emerg Infect
Dis [serial online] 2003 Sept [date cited]. Available from: URL:
http://www.cdc.gov/ncidod/EID/vol9no9/03-0442.htm
Brower and Chalk, authors of The Global Threat of New and Reemerging
Infectious Diseases: Reconciling U.S. National Security and Public Health
Policy, describe their book’s purpose as examining “the changing nature
of security” and focusing on “the threat of infectious diseases.” There
are many examples in today’s world where the intersection of threats to
public health and national security should direct the attention of policymakers,
security and public health strategists, and the systems that support each
toward an organized response.
The authors use two case studies: HIV/AIDS in South Africa and the U.S.
public health response system. The first case, in South Africa, illustrates
how a single microbial agent can undermine the economic, social, and medical
underpinnings of a developed country. The second study shows the negative
effect of newly emerging diseases such as HIV/AIDS, Hantavirus infection,
West Nile virus infection, Creutzfeldt-Jakob disease, and intentionally
released agents (Bacillus anthracis). This study demonstrates how
events can overload the public health response system and weaken public
confidence in its government. The reader can easily conclude that the
intersection of disease and national security can be dangerously destabilizing
and seriously undermine a nation’s social, economic, and political order.
The recent outbreak of severe acute respiratory syndrome reinterates the
global nature and warp speed of emerging infections.
In their summary and conclusions, the authors provide recommendations
for policymakers addressing both public health and security issues. The
thrust of the authors’ conclusions is to push policymakers and strategists
to actions that strengthen the infrastructure of a public health response
system and broaden the traditional definition of national security to
include the impact of naturally occurring and intentionally released microbial
agents.
The authors present a compelling case study for HIV/AIDS in South Africa,
where an emerging disease has gone unchecked and is having a devastating
effect on a developed country. The case study of the U.S. public health
response system is interesting and thoughtfully presented but lacks sufficient
and carefully documented detail to aid the reader in drawing conclusions
and formulating solutions. Unsubstantiated or incorrect examples also
detract from the overall presentation of this case study. For instance,
the contention that lack of good communications with area physicians and
hospitals resulted in the deaths of postal workers in the fall 2001 anthrax
crisis is not supported by the author’s reference or by any other authoritative
materials known to this reviewer. In the public health response case study,
the authors provide broad recommendations aimed at strengthening the public
health infrastructure. Also included is an excellent summary of the current
status of efforts begun in the mid-1990s in the United States to address
the infrastructure of public health. The recommendations are presented
in such a way that the shortcomings of the system can be addressed in
critical areas, including a well-trained public health workforce; interagency
coordination; private sector, hospital, and emergency response integration
in public health; technical and educational interventions; and domestic
and global investment in public health.
Brower and Chalk’s book is a powerful and useful argument for the urgent
need to integrate and streamline public health and national security strategies.
Patrick J. McConnon*
*Council of State and Territorial Epidemiologists, Atlanta, Georgia, USA
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