world health report 2007 viii global public health security in the 21st century New health threats in the 21st century chapter bioterrism in the form of the antha leers in the nted states in 2001. the emer- gence of SARS in 2003, and the large-scale dumping of toxic chemical waste in Cote Coming only days after the terrorist events of 11 September 2001, the deliberate dissemination of potentially lethal anthrax spores in letters sent through the United States Postal Service added bioterrorism to the realities of life in modern society. In addition to the human toll -five died out of a total of 22 people affected-the anthrax attack had huge economic, public health and security consequences. It prompted renewed international concerns about bioterrorism, provoking countermeasures in many countries and requests for a greater advisory role by wHo led to the updating of the publication Public health response to biological and chemical weapons: WHO guidance The anthrax letters showed the potential of bioterrorism to cause not just death and disability, but enormous social and economic disruption. A simultaneous worry was that smallpox- eradicated as a human disease in 1979-could be used over years later to deadly effect in deliberate acts of violence. Mass smallpox vaccination had been discontinued after eradication, thus leaving unimmunized populations eptible and a new generation of public health practitioners without clinical exper of the disease Since then, WHO has taken part in international discussions and bioterrorism desk op exercises arguing that the surest way to detect a deliberately caused outbreak is by strengthening the systems used for detecting and responding to natural outbreaks, as the epidemiological and laboratory principles are fundamentally the same. Expert discussions on the appropriate response to a biological attack, especially with the smallpox virus, served to test-on a global scale-the outbreak alert and response mechanisms already introduced by WHO In 2003, SARS- the first severe new disease of this century-confirmed fears generated by the bioterrorism threat, that a new or unfamiliar pathogen might have profound national and international implications for public health and economic security. SARS defined the features that would give a disease international significance Is a global public health security threat: it spread from person to person, required no vector, displayed no particular geographical affinity, incubated silently for more than a week, mimicked the symptoms of many other diseases, took its heaviest toll on hospital staff, and killed around 10% of those infected. These features meant that it spread easily along the routes of international air travel, placing every city with an intermational airport at risk of imported cases.New health threats in the 21st century Chapter 3 examines three new health threats that have emerged in the 21st century – bioterrorism in the form of the anthrax letters in the United States in 2001, the emer￾gence of SARS in 2003, and the large-scale dumping of toxic chemical waste in Côte d’Ivoire in 2006. Coming only days after the terrorist events of 11 September 2001, the deliberate dissemination of potentially lethal anthrax spores in letters sent through the United States Postal Service added bioterrorism to the realities of life in modern society. In addition to the human toll − five died out of a total of 22 people affected − the anthrax attack had huge economic, public health and security consequences. It prompted renewed international concerns about bioterrorism, provoking countermeasures in many countries and requests for a greater advisory role by WHO led to the updating of the publication Public health response to biological and chemical weapons: WHO guidance. The anthrax letters showed the potential of bioterrorism to cause not just death and disability, but enormous social and economic disruption. A simultaneous worry was that smallpox – eradicated as a human disease in 1979 – could be used over 20 years later to deadly effect in deliberate acts of violence. Mass smallpox vaccination had been discontinued after eradication, thus leaving unimmunized populations sus￾ceptible and a new generation of public health practitioners without clinical experience of the disease. Since then, WHO has taken part in international discussions and bioterrorism desk￾top exercises arguing that the surest way to detect a deliberately caused outbreak is by strengthening the systems used for detecting and responding to natural outbreaks, as the epidemiological and laboratory principles are fundamentally the same. Expert discussions on the appropriate response to a biological attack, especially with the smallpox virus, served to test – on a global scale – the outbreak alert and response mechanisms already introduced by WHO. In 2003, SARS – the first severe new disease of this century – confirmed fears, generated by the bioterrorism threat, that a new or unfamiliar pathogen might have profound national and international implications for public health and economic security. SARS defined the features that would give a disease international significance as a global public health security threat: it spread from person to person, required no vector, displayed no particular geographical affinity, incubated silently for more than a week, mimicked the symptoms of many other diseases, took its heaviest toll on hospital staff, and killed around 10% of those infected. These features meant that it spread easily along the routes of international air travel, placing every city with an international airport at risk of imported cases. 3 chapter xviii global public health security world health report 2007 in the 21st century