Senator Bill Frist?s speech, ?The Manhattan Project for the 21st Century,? delivered as Department of Healthcare Policy Lecture at Harvard Medical School, may have a slightly misleading title, but the importance of its content should have the ear of US government and, indeed, governments worldwide. While bio-terrorism is the threat that many fear will become the weapon of choice for terrorism, it seems that with almost all the focus being on security issues, the threat from naturally and/or mutating disease phenomena is subsumed. The reality is that naturally occurring infectious disease poses a similar threat that should also be considered a threat to security. In order to combat this threat, an all hazards approach is needed in order to combat the biological threat in a holistic rather than a piecemeal approach. While Frist indicates this needs to be a national effort, in reality it must be an international effort, as many disease outbreaks start elsewhere and are spread transnationally. In such an interconnected system with advances in travel and commerce, while some diseases are endemic to certain regions, borders should not be taken as a safe haven from the spread of disease. Viruses can also mutate, be spread by animal contact, and zoonotic diseases can jump to humans. In addition, with the internationalization of the bio-technology industry and proliferation of knowledge, deliberately introduced biological agents are also a threat.

On one hand, it seems that in the latter half of the 20th century, the world, for the most part, had gotten rid of major epidemics like the Spanish Flu in 1918 and various plagues that decimated populations in the last few centuries. This does not mean that worldwide pandemics and infectious diseases are vestiges of the past; in fact, we may be overdue for an epidemic. Certainly, advanced societies and advances in science and medicine have wiped out, tempered, or cured many diseases that used to devastate populations in the past. Better hygiene and sanitation has also contributed to this state of affairs. Yet, many infectious diseases remain pervasive in many less developed parts of the world, especially Africa and parts of Asia. Extremely lethal and unusual diseases, such as Ebola and Marburg fever, seem to have broken out more frequently recently in parts of Africa. In addition, the last few years has seen an increase in new diseases like SARS, the West Nile Virus, new strains of drug resistant AIDS virus, and Avian flu outbreaks. Fears that these viruses could mutate or further mutate and spread to humans is also of concern.

<