Abstract
The end of the cold war between the “psuper powers,” and the subsequent reduction in the probability of a large-scale nuclear war, brought into being a world with new political realities. Governments around the world now have to face the possibility of terrorist attacks on the civilian population, in which biological, chemical, and nuclear agents could be used. Prior to the collapse of the Soviet Union in the early 1990s, planning and preparing responses to large-scale catastrophic infectious disease events among civilian populations, such as a bioterrorist attack, was not an activity to which governments typically devoted many resources.
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Notes
- 1.
*The cost of vaccination is more that just the cost of the vaccine. Vaccination costs, from a societal perspective, include the cost of administrating the vaccine (e.g., nurses time, supervising physician time), cost of completing and processing any paperwork related to vaccination, value of patient time waiting for vaccination, cost of patient transport to and from the place of vaccination, and the cost of treating any vaccine-related side-effects. Furthermore, because many people may never have been exposed to any strain similar to that causing the next influenza pandemic (i.e., be “immune naïve”), it is possible that a large proportion of the population will require two doses of the vaccine — a priming dose and a booster dose. Requiring patients to return to a vaccination clinic for a booster dose will significantly increase the costs of vaccination. See Meltzer et al. (1999) for further details regarding costs of vaccination.
- 2.
†It could be argued that the letter-based anthrax attacks that occurred in the United States in October 2001 exposed thousands of people to anthrax, particularly postal employees. However, since the postal employees were given postexposure prophylactic antibiotics, there is no way to be certain (thankfully) of how many actually were exposed to an infectious dose, sufficient to cause a clinical case of anthrax. Up to 60% of these workers reported that they did not complete the recommended drug regime. Yet, this group of people did not experience any cases of anthrax. This raises the possibility that very few of these employees were actually exposed to an infectious dose of anthrax.
- 3.
‡The categorization and description of all types of mathematical models that could conceivably be used to calculate potential losses due to a bioterrorist attack is a subject for a separate text book. For this chapter, I will concentrate on the two types most commonly used in the published literature: deterministic and stochastic (described in the main text). Detailed descriptions of subsets of models within these two subcategories are also beyond the scope of this chapter. For detailed descriptions of various types of epidemiological models, particularly deterministic models, readers are referred to Anderson and May (1991). See Koopman et al. (2001) for a discussion of the differences between discrete and stochastic mathematical models, how they may be combined, and the problems of such combinations.
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Meltzer, M.I. (2009). The Economics of Planning and Preparing for Bioterrorism. In: Fong, I.W., Alibek, K. (eds) Bioterrorism and Infectious Agents: A New Dilemma for the 21st Century. Emerging Infectious Diseases of the 21st Century. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1266-4_10
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