When asked to name the seven uniformed services of the United States, most people immediately reply:
- Air Force
Then, after a bit of thought, they remember: Coast Guard
OK. Got five. What are the missing two?
One is the Public Health Service’s Commissioned Corp (PHS). This is why the Surgeon General of the United States always appears in that funky uniform. As the head of the Public Health Service, the Surgeon General holds the rank of Vice Admiral.
I starting thinking about this after seeing the movie Contagion. The movie highlights the Centers for Disease Control and Prevention (who are very proud of that) and the Federal Emergency Management Agency. Except for the easily missed appearances of the Surgeon General, the PHS is not mentioned in the film.
The PHS traces its history back to 1798 when John Adams, second president of the United States, signed into law the Act for the Relief of Sick and Disabled Seamen.
In 1878 the prevalence of major epidemic diseases such as smallpox, yellow fever, and cholera spurred Congress to enact the National Quarantine Act to prevent the introduction of contagious and infectious diseases into the United States. Congress later extended the Act to prevent the spread of disease among the States. The task of controlling epidemic diseases through quarantine and disinfection measures, as well as immunization programs, fell to what later became the Public Health Service.
As vaccines and antibiotics became more prevalent and potent, traditional public health measures seemed passé. Much of the public health infrastructure was dismantled.
Today increased population density, rapid intercontinental travel, human incursion into disease reservoir areas, and misuse of antibiotics giving rise to multiple antibiotic resistant strains all challenge the “modern” disease fighting apparatus. Epidemics are on the rise. A deadly pandemic of the type portrayed in Contagion seems inevitable.
Probably the least realistic aspect of the movie was the speed — 3 months — at which the virus was identified, a vaccine invented and production scaled to commercial quantities. Today we have a well-oiled machine for developing seasonal flu vaccines. The typical development cycle for those vaccines is four months. Developing a vaccine for a never before seen disease will take longer — much longer, if one is even possible. See where we are in developing a vaccine for HIV, for example.
While we wait for a vaccine, it will be old-fashioned public health measures that keep us alive.
Oh, the seventh uniformed service? It is the National Oceanic and Atmospheric Administration’s (NOAA) Commissioned Corp. What, you ask, is that? Weathermen in epaulets? Actually, this service derives from the old US Coast and Geodetic Survey. Seems there was a problem with people being hanged as spies when captured while surveying a battlefield. Put them in uniform and they are protected by the Geneva Convention.