Bioterrorism, Fear, and Public Health Reform: Matching a Policy Solution to the Wrong Window

During the 1990s, terrorist actions using biological weapons and the fear that rogue states pos-sessed such weapons placed bioterrorism on the political agenda, a policy window widened by the September 11 attacks. Advocates for improving the U.S. public health infrastructure attempted to use this window to obtain the resources necessary for modernization. This article examines those efforts and identifies significant problems arising from a mismatch between the goals of public health policy entrepreneurs and the policy window used to address them. By defining bioterrorism as a security rather than a public health issue, policy entrepreneurs squander the opportunity to institute broad-based reforms that would improve not only the ability to manage a terrorist incident, but also meet other public health needs. The bioterrorism program proves a useful case study in how the goals of policy entrepreneurs can be displaced by attaching policy preferences to the wrong policy stream. In 1910, M.J. Roseneau argued that fear is the most useful tool of public health because it maintains the public’s respect for the threat of epidemic disease. In the late twen-tieth century, that fear was lost to advances in medicin