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Et Al: The Public Health Generation

By Alfred Sommer, MD, MHS ’73

The anthrax anxiety that grips our nation only hints at the threat of bioterrorism. Most cases were readily diagnosed and treated; infected individuals pose no risk to others; and many effective antibiotics are available, in plentiful supply, to treat those infected or exposed.

It is sufficiently scary, however, to remind us all of the hopelessness of past generations facing deadly infectious diseases whose causes were often unknown; the means of spread a mystery; and treatment unavailable. Those "medieval" times are not so distant.

The influenza pandemic of 1918 killed 20 million people. It was an aggressive, contagious virus at a time when we barely knew what a virus was and possessed neither a treatment for those infected nor a vaccine to prevent it. The summer polio epidemics of the 1940s and early 50s gave rise to wards filled with iron lungs, and to childhood paralysis and deaths. With the route of contagion unknown, people shunned pools and movie theaters, and headed, if they could, for more rural retreats (often to no avail).

More recently still was the early 1980s "epidemic" of previously rare forms of cancer that heralded another mysterious outbreak, whose cause and means of spread were at first equally baffling: HIV/AIDS. Each of these once mysterious visitations yielded to informed, effective public health intervention: epidemiologic surveillance and detective work that identified cases, traced their origins, and tracked down their modes of spread; and laboratory and field research that developed, tested, and deployed effective vaccines that have kept influenza deaths to a minimum despite the virus mutating every year, have eliminated paralytic polio from the northern hemisphere, and have eradicated smallpox from the face of the earth.

Ours is now a generation for whom I will never again need to explain what public health is and why it is important; how the Johns Hopkins Bloomberg School of Public Health is an essential guardian of our lives and our health; why it is critically important to support and strengthen schools of public health and other components of our nation's public health infrastructure; why staying "well" and healthy is not the natural order of things but the dearly bought outcome of hard and devoted public health work; and why these can only be as successful as investments in public health allow.

We are immensely fortunate. Our public health enterprise, severely depleted and undercapitalized compared with the past and the enormity of today's threats, has not (as of my writing) been challenged by anthrax engineered to be resistant to available antibiotics; or by a thousand simultaneous cases of smallpox among suicidal terrorists, each infecting two to eight unsuspecting contacts, resulting in an exponential spread of deadly, untreatable disease. But a strengthened, resilient public health infrastructure, armed with a more robust science base and adequate stockpiles of vaccines, would promptly identify new cases, contain the spread of contagion, and ultimately protect the nation's citizenry—unless, of course, we fail to heed the terrorists' lessons of the past few months, or nature's lessons of past millennia.