Don't Homeland Securitize our Public Health Needs

Billions of dollars spent on tougher airline security and border protection proved incapable of stopping a globe-trotting tuberculosis patient from entering the U.S. last week, in large part because public-health issues haven't been treated as national-security issues, according to homeland security officials and experts.

Thus opens the Wall Street Journal's contribution to the latest media blitz over one individual's escapades and why we should stop everything and worry about them. The WSJ article, among others - not to mention the call for a hearing by the Committee on Homeland Security - seem to suggest that the only recourse against the international spread of infectious diseases is yet tighter border security and restrictions on travel of suspected disease carriers. What will they think of next? "Shoes off, laptops out, spit into the Petri dish?"The spread of infectious diseases is rightfully a serious concern of federal officials, including those who monitor the border. But guess what? The cat is out of the bag already. Many of the new diseases that public health officials and the medical community have tangled with in recent decades were imports: West Nile virus, SARS, and of course, HIV/AIDS. These and familiar diseases like malaria and pathogens like E. coli enter the country on packing crates, embedded in consumer products, and certainly in airline passengers. Few people would suggest limiting all those forms of international traffic and those limits would do nothing to stop the homegrown outbreaks that also require a public health and medical community response capacity. Remember, the young Atlanta lawyer in question started his travels in the United States and, had he chosen to get married and honeymoon in the U.S., we probably wouldn't be hearing about him today.If we put transmissible diseases under the umbrella of national security, we are likely to end up with the wrong answers to the wrong questions at the wrong time. There is a lesson to take from the lawyer's antics this week: we need to strengthen and support the responsiveness of public health systems at home and abroad that can (and already do) protect us from most foreseeable risks, and that are the locus of risk control for a future pandemic - whether avian influenza or some as-yet-unknown disease.There are many reasonable and much-needed steps that could be taken to strengthen global public health systems and prevent resistance from developing in the first place - in part by ensuring a more consistent supply of medicine and health products, but also by identifying incentives for healthcare providers and patients to complete a full prescribed course of therapy, which is especially critical in the case of TB where the appearance of drug resistance has magnified the risk to all of us. The groom from Atlanta made some bad decisions about his - and our - health, but it is the public health community that has or must develop the weapons to contain the risk.