Skip Navigation
Explore our COVID-19 Resources and Updates
CHS blue logo square
Home > Our Work > All Publications > 2004


Our publications keep professionals working across the public, private, and academic sectors informed on the most important developments and issues in health security and biosecurity.

Find an article or report by keywords:

Find an article or report or see all by area, author, or year:


Leading During Bioattacks and Epidemics with the Public’s Trust and Help

Working Group on “Governance Dilemmas” in Bioterrorism Response
Date posted:
March 15, 2004
Publication type:

Biosecur Bioterror2004;2(1):25-40

Mary Ann Liebert, Inc.
Available on publisher's website
See also:

Full article as PDF


The prospect of "deliberate epidemics” caused by biological attacks on civilians and the well-chronicled vulnerabilities of human society to large-scale disease outbreaks prompted the Working Group to prepare this report. The document’s purpose is to assist U.S. decision-makers, including governors, mayors, and health officials, in defining what constitutes effective, compassionate leadership in the context of an epidemic or bioattack, and to suggest some means to achieve it. The article sets forth strategic goals that make governing laudably in an epidemic of infectious disease a distinctive challenge. It illustrates special circumstances posed by biological attacks that further complicate efforts to limit the death, suffering, and disruption accompanying large outbreaks. The report identifies specific dilemmas of governing that commonly arise during epidemics and which decision-makers are likely to confront in the event of a bioattack. Lastly, it recommends principles and actions for preventing and/or resolving the apparent and sometimes genuine conflicts of interest, priority, and purpose that emerge in public health crises.

The Working Group contends that governing successfully during large, fast-moving, lethal epidemics requires a dynamic collaboration among members of a community and the community’s leaders. Officials who have realistic expectations about the societal challenges posed by large outbreaks will be better prepared to protect and actively support cooperation and trust between a community and its leaders. In the absence of an engaged 25 public, resolution of the immediate health crisis is rendered far more difficult, and the social and economic resilience of affected communities is diminished. Particularly in the context of bioterrorism, when fear and uncertainty may be significant forces, leaders’ abilities to enlist communities in a collaborative effort to care for the sick and prevent the spread of disease could prove pivotal, not only in terms of implementing an adequate response to the health crisis, but in limiting social and economic losses and in preserving fundamental democratic values and processes.



Our Mission

To protect people’s health from epidemics and disasters and ensure that communities are resilient to major challenges.