"Of all the challenges to homeland security, developing and implementing strategies for dealing with attacks that use 'next-generation' pathogens, including novel or engineered agents, is one of the most important. During these attacks, it can be difficult to discriminate between a natural outbreak and an attack, to identify and characterize the causative agent, and to prioritize interventions. A consequence of not identifying and responding to an attack at an early stage is the increased spread of infection in the population and the associated increases in morbidity, mortality, and cost of quarantine. We examine three prior natural events that allow us to characterize the potential enormity of the impact of an attack that uses next generation pathogens, and to identify R&D [Research and Development] and policy objectives that would significantly reduce the likelihood of severe national scale consequences. Several times in the past century, the world witnessed the emergence of previously unknown pathogens that caused or had the potential for causing widespread deaths. The 1918-19 'Spanish flu' pandemic alone caused as many American deaths as all the wars in this country's history. That pandemic, together with the 2002-03 severe acute respiratory syndrome (SARS) outbreak, and the 1976-77 'swine flu' mass vaccination program, can be used to illustrate the power of a next-generation bioagent, the importance of well-integrated response, and the policy decisions needed for mass intervention."
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