BY: FR. MICHAEL D. PLACE, STD
Catholic health care is a vital component of our nation's health care delivery
system. One of every 10 U.S. hospitals is Catholic and, on average, 16 of 100
persons hospitalized each day will be admitted to a Catholic hospital. For almost
275 years, as the health care needs of individuals and communities have changed,
the ministry has evolved in response to those needs. In recent years, for example,
many Catholic hospitals were among the first to develop services and treatment
for HIV/AIDS patients.
Since September 11 and the subsequent anthrax scare, Americans
have become increasingly aware of a new challenge for which
we must be prepared: bioterrorism. As the United States
Commission on National Security in the 21st Century reported
in 1999: "For many years to come Americans will become increasingly
less secure, and much less secure than they believe themselves
to be. . . . While conventional conflicts will still be
possible, the most serious threat to our security may consist
of unannounced attacks on American cities by subnational groups
using genetically engineered pathogens."1
Bioterrorism experts, such as D. A. Henderson, MD, MPH, the newly appointed
director of the Office of Public Health Preparedness, U.S. Department of Health
and Human Services (HHS), point out that the impact of biological weapons might
be equivalent to that of a nuclear weapon, but could be potentially more
problematic. Conventional responses to nuclear and chemical threats will not
be adequate when responding to bioterrorism. Therefore, we must reconsider both
the strategy and structure of a possible response to bioterrorism.
A Four-Pillared Strategy
Fortunately, work already is being done that can contribute to that reconsideration.
For example, the American Public Health Association (APHA) has proposed what
it terms four major "pillars" of a comprehensive bioterrorism strategy. They
were outlined at November's Health Sector Assembly by Mohammed N. Akhter, MD,
president of APHA.
Prevention Even as we try to rid the world of terrorists, we must work
as a nation to minimize the possibility that future conflicts will engender
terrorist acts. In addition, we need to improve our intelligence services so
that we can gain control of bioterrorist weapons and laboratories.
Preparedness Essential to being prepared is an effective early warning
system and an integrated response mechanism with a single chain of command and
single spokesperson. We also must have medical services readily available for
those affected by bioterrorism acts, no matter what their insurance status may
be. These services must be comprehensive in nature and include counseling and
rehabilitation services in addition to medical care.
Capacity Building The third APHA pillar includes:
- Expanding the skills and services of the Centers for Disease Control and
Prevention
- Stockpiling adequate amounts of needed drugs and vaccines
- Improving hospital capacity, such as isolation facilities, and expanding
professional education for frontline health workers, emergency responders,
and public health workers
In addition, we must improve our local and state public health departments,
both qualitatively and quantitatively, and establish a "24-7-365" presence developed
at the regional level to ensure an immediate and appropriate response to a bioterrorism
event. To respond successfully, we must improve the public health laboratory
system significantly and replace our frighteningly fragmented local emergency
response systems with integrated systems. Finally, we must inform the public
about the potential health consequences of terrorist acts and tell people how
they can protect themselves against such acts.
Immediate Action Steps These steps include the immunization against
anthrax and smallpox of all frontline health and emergency response workers
and all high-risk individuals. We also must make antibiotics available for health
workers and victims in the event of an attack.
We are fortunate that HHS and the executive branch in general
(from the perspective of national policy), the APHA (from the
perspective of the public health professional), the American
Hospital Association (from the perspective of acute care delivery),
and the American Medical Association (from the perspective of
medical science), as well as other groups, are seriously engaging
this frightening new challenge. Because of the richness of these
efforts, CHA has not initiated its own project or task force
on bioterrorism. Although our ministry colleagues in Florida
and the District of Columbia have experienced the anthrax events
directly, it is not clear at the present time that the Catholic
health care ministry could contribute a useful bioterrorism
study group or task force of its own.
Ministry Concerns
Nevertheless, I suggest that our particular values and commitments cause us
to enter into the public dialogue concerning bioterrorism with some clear concerns.
I will outline a few, using the APHA pillars as a framework.
Regarding prevention, the United States Conference of Catholic Bishops,
in its pastoral message "Living with Faith and Hope after September 11," noted:
No grievance, no matter what the claim, can legitimate what
happened on September 11. Without in any way excusing indefensible
terrorist acts, we still need to address those conditions
of poverty and injustice which are exploited by terrorists.
A successful campaign against terrorism will require a combination
of resolve to do what is necessary to see it through, restraint
to ensure that we act justly, and a long term focus on broader
issues of justice and peace. . . . Our nation must join with
others in addressing policies and problems that provide fertile
ground in which terrorism can thrive. Years ago, Pope Paul
VI declared, "If you want peace, work for justice." This wisdom
should not be misunderstood. No injustice legitimizes the
horror we have experienced. But a more just world will be
a more peaceful world. There will still be people of hate
and violence, but they will have fewer allies, supporters
and resources to commit their heinous acts.2
Concerning preparedness, we clearly are champions of a broader social
agenda that insists that everyone in this nation have access to basic health
care services, including being treated for bioterrorism. A terrorist event does
not discriminate between the insured and the uninsured, the citizen and the
undocumented immigrant. If anything, the threat of bioterrorism should be a
reminder of the injustice found in our current national policy.
As for capacity building, our understanding of the social nature of
the human person, the importance of community, and the demands of the common
good prompts us to pay particular attention to our public health system. In
recent years, a once effective and critically important public service has been
allowed to deteriorate along with other vital parts of our nation's social infrastructure.
As the Pew Environmental Commission pointed out, the absence
of a national system for monitoring public health problems linked
to environmental toxins has limited our ability significantly
to respond adequately to health crises such as childhood asthma.3
If we should similarly fail to develop public health tracking
systems to collect and report data about bioterrorist events
and the health and mental health consequences of terrorism on
victims, responders, and communities, we will be unable to plan
and execute a comprehensive and effective response. I would
suggest that supporting a robust public health system is a Catholic
priority.
Finally, turning to immediate action steps,
I will note that participants at CHA's recent Physicians Forum in Amelia Island,
FL, raised several ethical issues during a discussion of last fall's anthrax
events. Although these issues are not new — and have, in fact, occasioned significant
theological, ethical, and legal reflection over the years — they could take on
a new immediacy in the event of a bioterrorism attack that affected a large
number of people.
By what ethical criteria, for example, would we triage emergency treatment
of those with symptoms, or — an even more complex question — allocate potentially
limited supplies of antibiotics among people who have been exposed but are asymptomatic?
What ethical guidelines should influence a strategy to contain an outbreak of
smallpox in a large population? Can the common good require enforced vaccinations
even if they put some people at substantial risk? Catholic clinicians and ethicists
must not just be prepared for these conversations; they must play an active
role in them.
A Silver Lining?
The threat of bioterrorism is no longer the stuff of spy novels — it is now a
very real part of our daily life. The question, many would say, is no longer
whether but when another terrorist attack will occur.
Although we must be diligently attentive to our responsibility to be institutionally
prepared, and work together to ensure a fair and equitable provision of financial
resources so that we can finance that preparedness without doing harm to other
aspects of our service, we should attend also to the other issues noted above.
Perhaps the silver lining in this dangerous situation is that it will force
us to realize the broken nature of our nation's entire health care delivery
system. Our desire to be prepared for all of the aspects of bioterrorism could
become an invitation to craft the policies and develop the systems and structures
for truly effective health care of people and communities. Without these changes,
we will never be really prepared.
NOTES
- U.S. Commission on National Security in the 21st Century,
New World Coming: American Security in the 21st Century:
Major Themes and implications, Washington, DC, 1999, p.
8 (available at www.nssg.gov/Reports/NWC.pdf).
- U.S. Conference of Catholic Bishops, "Living with Faith
and Hope after Sept. 11," Origins, November 29, 2001,
pp. 413-420.
- See Michael D. Place, "Needed: A Warning System for Environmental
Health Risks," Health Progress, September-October 1999,
pp. 8-9.
Copyright © 2002 by the Catholic Health Association of the United States
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