With a new preface assessing leadership responses to the coronavirus pandemic, this text explores leadership problems that can develop during such public health crises as the 2001 anthrax attacks, 2003 SARS epidemic, and Mad Cow Disease epidemic of the 1980s-1990s.A threat to public health, such as a rampaging virus, is no time for a muddled chain of command and contradictory decision-making. Who's In Charge? Leadership during Epidemics, Bioterror Attacks, and Other Public Health Crises, re-issued with a new preface assessing leadership during the COVID-19 outbreak, explores the crucial relationships among political leaders, public health officials, and journalists to see why leadership confusion develops. As the problematic response to COVID-19 has once again shown, the reluctance of politicians to risk alarm can run counter to the public health need to prepare for worse cases.Many leaders will seek high visibility during a public health crisis, but politicians are not medical experts, and the more they speak, the more they risk disseminating harmful information. How to achieve the right balance is the essence of this book. Beginning by looking at the overarching issues of leadership and public health administration, it then examines in depth five emergencies: the 2001 anthrax attacks, the 1993 cryptosporidium outbreaks, the 2003 SARS outbreak, the 2001 foot-and-mouth disease crisis, and the battle against Mad Cow Disease.

PrefaceAcknowledgments1. Understanding LeadershipAn Overview of LeadershipStudying Public Health LeadershipPolitical Leaders and BureaucratsDefining Leadership2. The Long March to Improving the Public's HealthInfectious Disease EpidemicsVaccines: A Fortunate CoincidenceAn Unfortunate Side Effect of HospitalsEarly Public Health Epidemics in the Newly Formed United StatesSweeping Social Changes in EuropeThe Father of EpidemiologyCrossing Borders: European Influences on Early American Public Health EffortsAwakenings: A Long-Awaited BreakthroughThe Germ Theory of DiseaseThe Civil War and the Changing Face of U.S. Public HealthPostwar Public Health DevelopmentsThe Beginnings of International HealthPandemic Influenza in the Early 20th CenturyThe Beginnings of the World Health OrganizationThe HIV/AIDS PandemicPublic Health Past, Present, and Future3. Microbes as WeaponsBiowarfare and Bioterrorism through the AgesAdvances in the 20th CenturyThe Role of the United StatesThe Role of the Soviet UnionTerrorist Acts by Groups and IndividualsEmerging Concerns4. Rising to the OccasionPolitical Leadership during Infectious Disease CrisesAnthrax Attack, Fall 2001, Hamilton Township, New JerseyMayor Glen D. Gilmore, Hamilton Township, New JerseyCryptosporidium Outbreak, Spring 1993, Milwaukee, WisconsinMayor John Norquist, Milwaukee, WisconsinSevere Acute Respiratory Syndrome (SARS), Spring 2003, Toronto, CanadaDeputy Mayor Case Ootes, Toronto, CanadaConclusion5. Success Favors the Prepared Public Health LeaderAnthrax Attacks in New Jersey, Florida, Maryland, and New YorkNew JerseyFloridaMarylandNew York CityCryptosporidium in Milwaukee, WisconsinSARS in Toronto, CanadaConclusion6. Confronting UncertaintyThe 1976-77 Swine Flu DilemmaThe 1997 Avian Flu DilemmaThe 2009 Swine Flu DilemmaLeaders' Responses to Disease ThreatsInformation Required for Decision MakingConclusion7. Part I: The Vital Link between Animal and Human HealthThe Impact of Animal Health CrisesBovine Spongiform Encephalopathy (BSE)Views of the CrisisConclusionPart II: The Vital Link between Animal and Human HealthThe Foot-and-Mouth Disease CrisisViews of the CrisisSumming UpConclusion8. Reaching the MassesRisk Assessment, Perception, and CommunicationSmallpox Outbreak in New York City, 1947The Changing MediaFrom the Media PerspectiveAnthrax Outbreak in New Jersey, 2001Cryptosporidium Outbreak in Wisconsin, 1993SARS Outbreak in Toronto, 2003Conclusion9. All Hands on DeckWorst Case ScenariosLegal Challenges of Public Health and BioterrorismImproving PreparednessA Better ModelExperts' AdvicePublic Health and Emergency ManagementWho's in Charge?Epidemics and Bioterrorist Attacks: Leadership ChallengesPublic Health, the Military, and the National GuardConclusion10. ConclusionCritical Need: Prepared Elected OfficialsRelationships between LeadersWhen Science Does Not Have the AnswersThe Public Communication Roles of Different LeadersLegal and Organizational Structures and Crisis LeadershipTraining Elected OfficialsNotesIndex