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Book Review
Public Health Response to
Biological and Chemical Weapons: WHO Guidance
World Health Organization
ISBN: 92-4-154615-8
Pages: 357; Price: U.S.$34.20
Suggested
citation for this article
In this manual, the World Health Organization (WHO) updates its guidance
for governments in preparing for a possible terrorist attack with biological
or chemical weapons. The book has something for virtually everyone who
may have an interest in this topic, from government officials to clinicians,
including information about the history of biological and chemical warfare,
applicable international treaties, procedures for requesting WHO technical
consultation, fundamentals of public health emergency response, basics
of infectious diseases, treatment of patients with specific infectious
or toxic exposures, physical properties of various agents, the utility
of reconnaissance satellites for detecting weapons development, the management
of food and water safety programs, etc.
This ubiquity and ambitiousness underlie the manual's limitations and
strengths. At times the guidance is so general that is almost an inventory
of truisms (e.g., "If it is found that the [emergency] control measures
are not effective, they must be changed or modified."); elsewhere,
the manual is a detailed resource. Its utility for different users will
depend on their backgrounds and information needs. The core chapter, Public
Health Preparedness and Response, may disappoint those seeking more than
general principles. Yet these principles merit articulation.
Descriptions of the sarin attack in Tokyo in 1995 and the anthrax attacks
in the United States in 2001 illustrate lessons from governments' recent
experiences with chemical and biological terrorism. Both episodes demonstrate
that relatively small attacks can have a profound impact and expose weaknesses
in public health systems. The anthrax case study lauds the success of
laboratory preparations but does not sufficiently address three essential
questions: Why did clinicians caring for the initial patients with cutaneous
anthrax not establish and report the diagnosis sooner? Why did the Centers
for Disease Control and Prevention not recognize earlier that anthrax
spores could escape from sealed letters? Why did the federal government
stumble initially in its efforts to communicate with the public? For each
question, an assessment of systemic hurdles would benefit readers seeking
to improve the functioning of the public health system.
The manual generally, but not consistently, avoids bureaucratic lingo.
While clearly organized, the book lacks an index, complicating efforts
to find information quickly. The appendices on chemical and biological
agents offer concise, formatted summaries similar to those available through
other resources, but ironically provide relatively little information
about the agents' potential as weapons.
This manual will find a home on bookshelves worldwide among government
officials and others concerned about the threat of biological and chemical
terrorism. For those in countries most in need of this guidance, its scope
may be overwhelming. But the book's underlying theme—that public health
preparedness for biological or chemical terrorism depends on fundamental
capacities to respond to more common health threats—is its most salient
message, no matter where the user resides.
James W. Buehler*
*Emory University, Atlanta, Georgia, USA
Suggested citation
for this article:
Buehler JW. Public
health response to biological and chemical weapons: WHO guidance [book
review]. Emerg Infect Dis [serial on the Internet] 2005 Jan [date cited].
Available from http://www.cdc.gov/ncidod/EID/vol11no01/04-0927.htm
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