Preemptive biopreparedness: Can we learn anything from history?

The threat of bioterrorism is in the public eye again, and major public health agencies are urging preparedness efforts and special federal funding. In a sense, we have seen this all before. The Centers for Disease Control and Prevention grew substantially during the Cold War era in large part because Alexander Langmuir, Chief Epidemiologist of the CDC, used an earlier generation's anxieties to revitalize the CDC, create an Epidemic Intelligence Service, and promote epidemiologic "surveillance" as part of the nation's defense. Retrospective investigation suggests that, while Langmuir contributed to efforts promoted by the Department of Defense and the Federal Civil Defense Administration, the United States did not have real cause to fear Communist biological warfare aggression. Given clear historical parallels, it is appropriate to ask, What was gained and what was lost by Langmuir's central role in that first instance of American biopreparedness? Among the conclusions drawn is that biopreparedness efforts fed the Cold War climate, narrowed the scope of public health activities, and failed to achieve sustained benefits for public health programs across the country.