The United States government has been boosting its investment in research to combat biological weapons threats, funding a broadening range of programs in public health and law enforcement (Nature Med. 6, 1304; 2000). Although many of the new programs may be helpful in improving disease surveillance and responses to outbreaks, public health experts are becoming increasingly critical of the government's overall approach, which some see as misdirected, uncoordinated and politically tainted.

“The current campaign to take action . . . is vastly overstated, vastly overdrawn and can be extremely dangerous,” says Victor Sidel, professor of Public Health at Albert Einstein College of Medicine. Sidel and others argue that other public health issues dwarf the threat of bioterrorism, and that the emphasis on biological warfare agents is feeding growing public hysteria.

So far, the statistics appear to support some of Sidel's claims. There has only been one documented incident of successful bioterrorism, in which members of a cult in Oregon caused a 1984 foodborne outbreak by inoculating salad bars with Salmonella, causing 751 illnesses but no deaths. The Japanese cult Aum Shinrikyo attempted to deploy biological weapons, but failed to cause any illnesses. At the same time, food-borne illnesses result in 325,000 hospitalizations and 5,000 deaths annually in the US.

Instead of bioterrorism research, “more money needs to be put into public health infrastructure programs. That should not be in the context of preparation for bioterrorism, that should be in the context of a vastly underfunded public health infrastructure,” according to Sidel.

Other experts are less severe in their criticism of current programs, but there is broad agreement about one problem: “there are a number of pork barrel projects with money flowing to entities with neither experience nor plans to deal with the problem. Very few of the expenditures are peer-reviewed,” according to Donald Henderson, director of the Center for Civilian Biodefense Studies at Johns Hopkins University. Henderson adds, however, that “There is a [bioterrorism] threat, of that there is no question.”

The exact nature and magnitude of the threat has remained a subject for speculation. According to Nicole Coffin, a spokeswoman for the Centers for Disease Control and Prevention (CDC), determining the risk of a biological attack on the US has been left to the Department of Defense and intelligence organizations, whose research methods have not been made public.

Bioterrorism researchers argue that the exact level of risk is irrelevant. “To me it's a pretty simple calculation. There's a threat out there, we know that people have [biological weapons], and we know that people don't like the US,” says Samuel Watson, director of the Public Health and Bioterrorism Response Program at the University of Pittsburgh (Pittsburgh, Pennsylvania).

In the current federal budget, the CDC received $177 million for bioterrorism-related projects, at least half of which is earmarked for distribution to state-level programs. The remainder funds efforts like the National Pharmaceutical Stockpile, a set of shipping containers filled with medications and supplies likely to be useful in responding to a biological attack.

Programs like the Stockpile may be appropriate for countering biological threats, but many state and local agencies may have a less useful response. As a result of the way public discussions have been framed, “I think there is a conceptual flaw in lumping nuclear, chemical, and biological threats together, where people talk about weapons of mass destruction and then pretend that you can have a uniform policy towards all three” says George Poste, CEO of Philadelphia-based Health Technology Networks, and author of a recent Royal Society report on bioterrorism. At the state and local levels in the US, for example, response plans have often focused on providing new training and equipment for firefighters and police, groups unlikely to be involved in the initial response to a biological attack.

Proponents of increased bioterrorism-preparedness funding contend that it has other benefits: “It's important to note that the country becomes better prepared to respond to any outbreak of emerging infectious disease,” says Coffin. Sidel disagrees: “This is trickle-down of the worst sort. Only a very minor fraction of the money going to bioterrorism goes to support public health infrastructure, [and] it ties public health to the military and law enforcement.”