The events of Sept. 11, 2001, when terrorists attacked New York and Washington, and the subsequent mailing of anthrax-contaminated letters to public figures, will have profound repercussions on the practice and priorities of public health, not to mention international relations and the role of international organizations.

Like all of you, I was deeply shocked by these terrorist attacks. I could see from our office the immolation of those who died in the Pentagon. The Pan American Health Organization (PAHO) was quick to offer assistance to the United States after this enormous disaster, in which some 3,500 innocent people from 80 countries were killed in a barbaric act without precedent. Terrorism may be regarded as a disease for which no vaccine or drug exists except the confidence and the good will of men and women; its detection and prevention depend on our eternal vigilance.

How further events develop, and how authorities continue to react, remain to be seen. But several things are clear. One is that the role and fundamentals of public health have never been more important. The fear of terrorist attacks using biological, chemical, or radiological weapons will not go away quickly, and public health authorities must increase their preparedness to respond.

Another is that countries must continue to act in a collaborative manner. As U.S. Secretary of Health and Human Services Tommy Thompson told our ministers of health at PAHO in September, just days after the terrorist attacks, "The need to build partnerships and alliances has never been more compelling." The importance of international collaboration to combat disease, lengthen life, and improve the living standards of all people has never been greater. We must join together even more closely in working for this collaboration that is among the fundamental aims of the Pan American Health Organization. But we must also take into account new realities.

Because of the evolution of technology, humanity's fate is increasingly a common one. Political theorist Robert Keohane argued that international institutions can overcome obstacles to cooperation that arise from anarchy, even when no coercive power exists. He said that countries seek cooperation if there is national political support to do so. Today it is clear that global terrorism, like global warming, AIDS, and other international issues, has placed countries in a position where they must cooperate.

After Sept. 11, it became clear that some misguided, evil persons would stop at nothing to gain their political objectives. It is no longer beyond imagination that terrorists would unleash as an act of terror one of humanity's ancient plagues, smallpox, which we fought so long to conquer. It is our duty to work with our Member Countries to help them prepare for such an eventuality, however hideous that might be.

Only an effective, well-coordinated public health response can guard against the threat from intentional infections with anthrax, smallpox, plague, botulism, or even genetically altered versions of these or other agents. Plans that include rapid detection, diagnosis, and response can help protect against these horrors. Thorough training of health care providers in diagnosis and reporting of clinical presentations consistent with man-made epidemics can give our countries an edge in preparation. Improvements in laboratory capacity and security are also crucial. Research can help us combat the prospect of these infections and find new ways to discern their deliberate use. Our countries must appreciate the need for ample communication to inform the public adequately.

For 25 of our 100 years of existence, we have worked closely on emergency preparedness with many countries in the Americas, providing technical expertise in disaster mitigation, preparedness, response, casualty management, and related issues. Now, we must add combating bioterrorism to our armory. We will promote the involvement of national civil defense, disaster management, medical, and public health professionals in the challenge to prepare against not only biological attacks, but also chemical and radiological attacks.

The silver lining in the cloud of dust and death raised by the collapse of the World Trade Center must be the aspiration that nations will succeed in preventing bioterrorism. The immediate efforts we must make in establishing more effective national and regional strategies against bioterrorism will have additional benefits. We will improve response to natural infectious disease outbreaks and to new or emerging diseases.

As we move into PAHO's centennial year in 2002, we will not forget the wanton, useless killing of Sept. 11, which goes against everything we stand for. But we will use its lessons and our newfound unity in revulsion to terror to draw together, to draw strength from each other, and to strengthen our continuing effort to make life better for all peoples of the Americas.

To your health,

Dr. George A.O. Alleyne
Director, PAHO