The nature of infectious disease outbreaks and their potential for rapid global spread require enhanced preparedness, including a fine-tuned ability to communicate, cooperate, and collaborate, within countries and across international borders on very short notice and with minimal bureaucratic delay. Cooperation must be predicated upon a clear understanding of national and international roles and responsibilities at all phases of a crisis. The importance of communication, collaboration, and cooperation cannot be overemphasized.

The U.S. government continues to improve its plans for protecting civilians and soldiers from attacks with biological weapons. Part of this effort focuses on developing strategies that recognize the difficult choices to be made in using and deploying resources. This paper presents a risk- and decision-based framework-derived from the field of Bayesian statistics-for developing strategies that facilitate managing the risks of biological agents. The framework recognizes the significantly different attributes of potential biological weapons and offers a strategy for improving communication to effectively coordinate national biopreparedness efforts. The framework identifies generic decisions related to routine immunization, response planning, stockpiling vaccines and therapeutic agents, surveillance choices, containment, emergency response training, research, media and communications preparations, information management, and policy development. This paper provides a straw man to be used in wargames, exercises, practices, etc., at all levels of government. Given the attention on anthrax following the 2001 attacks, this paper applies the framework to managing the risks of anthrax to provide an illustrative example. The example demonstrates that by organizing information at this level, decision makers can quickly understand the critical connections between different options (e.g., vaccinating with a new vaccine requires an investment in research; research might increase the opportunities for breaches of containment). With respect to managing the risks of an attack with anthrax, this analysis suggests the need for creation of a comprehensive national management plan that includes quantitative evaluation of resource investments. The authors conclude that the government should adopt a process-based on decision science and using the power of decision trees as an analytical tool-to develop a strategy for managing the risks of bioterrorism. Using this type of approach, the government can better characterize the costs, risks and benefits of different policy options and ensure the integration of policy development. Additionally, confirmed use and refinement of decision trees during exercises will provide analysis of the long-term consequences of decisions made during an event and give policymakers insights to improve initial decisions.

Throughout history, emerging and reemerging infectious disease have plagued human populations. From the earliest recorded epidemics of bubonic plague and smallpox more than 2,500 years ago to the deadly 1918 pandemic of the Spanish Flu, infectious diseases have helped to shape human history. Despite significant advances in medical research and treatment in the past century, infectious diseases remain among the leading causes of death worldwide. These diseases are appearing in places they have never been seen before or were thought to have been eradicated, are spreading faster and more frequently, and are posing an increasing global health threat that will affect national and international security in both the near- and long-term future, even affecting the success of U.S. military missions and operations.