Anthrax Medical Emergency:
The Failure of the U.S. Public Health System

Oct 22, 2001

It is not at all clear who is responsible for the mailing of anthrax to the offices of a few different government officials, as well as several large news media organizations. It could, of course, be people associated with the terrorists who carried out the September 11 attacks, but it could as well be a “home grown” terrorist like a Timothy McVeigh, or even some completely crazy individual, like the Unibomber. But one thing this anthrax crisis has clearly revealed is how completely inadequate the health care system is to protect people from the disease.

When the news first broke about anthrax, many people sought to be tested, or to have packages that they feared could contain anthrax spores tested. But it didn’t take long before public health systems across the country were almost completely overwhelmed. They did not have the means to test many of the people who wanted to be tested, nor could they test many of the suspicious materials that people sent their labs. Dr. Norman Crouch, who heads the public health department lab in Minnesota, said that his lab received 600 requests to test suspicious materials and “...obviously, we can’t test them all.” This failure could have been a real catastrophe if the medical emergency had been more widespread.

Politicians pretend that the main problem is that the U.S. is not ready to fight bio-terrorism. But, in fact, as health officials show, the ability to fight the outbreak of anthrax or any other disease from a bio-terrorist attack, is identical to the ability to fight the outbreak of a disease that occurs naturally. The first line of defense in discovering and tracking these diseases is the public health system. The problem is, the public health system has been systematically dismantled, cut back and starved of funds.

The public health system is extremely restricted in being able to test for diseases. Public health authorities do not have the resources needed, that is enough trained staff, as well as sophisticated equipment to rapidly diagnose not just anthrax, but many other diseases, including smallpox, tularaemia or Ebola. When epidemics break out, the public health system has little ability to track it until it’s developed widely. Few public health departments, for example, even have modern computers for monitoring disease trends and outbreaks.

Moreover, if some kind of epidemic does break out, the public health system usually has few means to treat it. After all, there are few if any public hospitals left in this country, not just in the smaller cities, but even the biggest ones as well. Just last year, for example, Washington D.C., that is, the nation’s capital, closed its last remaining public hospital, called D.C. General. And Washington is not alone. Some big cities, like Detroit, haven’t had even one public hospital for over a decade.

No one else can do what a public health service does, that is, coordinate on a wide level all of the different measures to deal with the outbreaks of disease on a local, regional and national level. Certainly, the private health companies, hospitals, insurance companies, pharmaceuticals, are not suited to carry this out. After all, they are driven by profit. They are out to constantly reduce their “costs” by restricting their care to those who are paying customers, that is, those who can afford to pay. They have never been geared to health emergencies on a large scale.

On the contrary, their policies have led in the opposite direction. Since emergency rooms are considered to be unprofitable, private hospitals have closed many of the emergency rooms all over the country. They have also closed even more intensive care units (ICU’s), which means that often people who leave emergency rooms are left stacked up in the hospital corridors. And because stocking medicine for emergencies means tying up their precious capital in inventory, many hospitals have adopted “just in time” policies for vital drugs.

The only medical system whose goal is to fight against public emergencies is public health. But since private health care has always viewed public health as competition, they have pushed to have public health care cut back and dismantled. The U.S. health care system is, by far, the most expensive health care system in the world, with health care spending averaging up to $3,400 per person. But less than one% of that spending goes toward public health, that is, toward some kind of collective protection against medical emergencies.

“I think it is difficult for me to exaggerate the deficiencies of our present public health capabilities,” said Dr. Donald Henderson, a former dean of the Johns Hopkins School of Public Health and an adviser to Health and Human Services Secretary Tommy Thompson. The Bush Administration wants to tell us it is preparing for the eventuality of something like anthrax–that’s a lie. If they were they would right now be pouring money into the public health system. Instead they propose to give more money to the privately run medical industrial complex, one of the largest and most profitable industries in the country.