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When the US Centers for Disease Control met a hard wall of political restraint in attempting a full response to the emergency of AIDS in the early 1980s, it was possible to move toward protection of blood and blood products from the legislative branch of government instead - despite resistance from the Red Cross, blood banks, and the Reagan Administration. A Congressional creation, the Office of Technology Assessment (OTA), received a request from the author, made on behalf of his employer, the Chairman of a Congressional Committee and a Member of the OTA Congressional Board. He asked the OTA to assess US blood policy in light of scientific and technological developments - most importantly the new disease, AIDS. The OTA issued its report in January 1985. In 1995, a new Republican majority in both legislative chambers eliminated the OTA - and thus a valuable source of policy analysis of scientific issues independent of the executive branch.

Since the 1988 Institute of Medicine report The Future of Public Health, educators and practitioners have sought to better prepare students for practice. A review of these efforts suggests that they have yet to achieve an adequate synthesis of academic and practice-based education. The authors argue that a fundamental change in the structure of pubic health agencies is required so that all public health students receive practice training in teaching health departments. Academic programs must partner with these agencies but must also continue to teach students about the intellectual framework of public health.

Public health professionals recognize the critical role the law plays in determining the success of public health measures. Even before September 11, 2001, public health experience with tobacco use, HIV, industrial pollution and other potent threats to the health of the public demonstrated that laws can assist or thwart public health efforts. The new focus on infectious threats and bioterrorism, starting with the anthrax attacks through the mail and continuing with SARS, has highlighted the important role of law.For lawyers to serve as effective partners in public health, they should have a basic familiarity with public health: how public health professionals see the world and the key issues they tackle. A practical grasp of public health can be acquired, and often is acquired, “on the job.”

After 25 years of debate about privacy of automated personal health data, the U.S. Congress has set a deadline of August 1999 for enacting health information privacy legislation. The urgency to establish national policy in the United States re-emerges with implementation of a 1996 law mandating a unique identifier for each participant in the U.S. medical care system and the use of a uniform electronic data set for all health information transmitted in financial and administrative transactions. The impact of electronic data storage and transmittal on privacy, health outcomes, and medical care is unclear. A three-step analytic scheme can clarify the issues in the policy debate and for future assessment. The first step is intended to elicit, for the first time, a precise, accurate, and reproducible description of personal health data transactions and chains of transactions, independent of the policy preferences of any interested party. The second step allows the reader to analyze these transactions according to who benefits first and foremost from each. This scrutiny clarifies the reasons why parties to the debate tend to disagree. The third step characterizes how Congress is likely to perceive the policy process and consider its options before enacting any particular set of compromises. Understanding the policy deliberations and potential effects of evolving information technologies and new national privacy rules should aid assessment of results.

The practice of law has changed greatly since the days when judges based decisions on the maxim salus populi suprema lex, and Oliver Wendell Holmes disagreed, noting that “experience” has been the “life of the law.” In the intervening years, the profession has followed Holmes and the legal realists in recognizing that the law does not exist in a vacuum. It is a human endeavor, molded by experiences and filled with human consequences. Today, lawyers, jurists, and legal scholars everywhere on the political spectrum recognize the importance of social context, history, and a variety of non-legal disciplines, and non-legal insights to the intelligent practice of the law Unfortunately, in rejecting the old maxims, the legal profession also lost sight of the fundamental truth of salus populi suprema lex, Latin for “the health of the people is the highest law” - namely, it has lost sight of the truth that a population’s health is a critical part of law’s social context. One of the consequences of this is that the profession has failed to include public health - the study of the causes and prevention of disease, disability, and death in populations - among the non-legal disciplines regularly incorporated into legal analysis and routinely taught to all would-be lawyers. It is time to correct this oversight.

Science is never far from government policymaking. Throughout history, scientists have been rewarded or punished depending on whether their scientific views sup ported the policies preferred by the people in power. When science and the enlightenment that science fosters do not support politically favored policies, science suffers. During the last 4 years, we in the United States have observed a notable clash between science and an administration that believes it can make policy without open scientific debate. Now there are warnings from the White House of retribution against the science community that has challenged this ad ministration. Will the next 4 years be different? Will the Bush administration change its politicized approach to science or will it continue to attack, suppress, and misrepresent science to the public? Will distortion of science for policymaking be limited to domestic decisions, or will it impinge on programs beyond our borders-in other countries and in international organizations? The Bush administration has united the scientific com munity in protest over the way this administration has de meaned the integrity of science and scientists. Scientists' opposition to this administration is, in my memory, unprec edented. Scientists, new to bringing their scientific concerns into the public debate, have proceeded with caution and carefully reasoned analyses. Emanating from every scientific quarter, opposition to the administration's policies departs radically from the usually mild discontent with government science policy that is not uncommon in our country. Perhaps scientists perceive the very integrity of science to be in jeopardy. Surely, it is not surprising that epidemiologists are speaking out early. Epidemiologic research (which, among other things, assesses the human health consequences of exposures) has often experienced nasty political pressure. From the start, the administration opened a broad cam paign against science-based public health and environmental regulation. This administration has reversed science-based policy decisions on global warming,' arsenic in drinking water,2 ergonomics in the workplace,3 and diesel exhaust particulates in underground mines.4 The administration sub stituted policies that offended many advocates (and probably pleased others). More important, the process itself alarmed scientists because of its disregard for science. A more sys tematic attack on science policymaking has followed.

Can the world respond to the demands of the Children's Vaccine Initiative (CVI) to produce large quantities of affordable vaccines that have never been manufactured previously? Vaccines for the world's birth cohort of 150 million will continue to be produced in the countries that use the greatest part of the global vaccine supply. Thus, the CVI will rely on increased self sufficiency in vaccine production in the developing world and "shared development" of new and improved vaccines. The CVI's goal is to direct product development to meet the needs of immunization programs, but it must not neglect production. Thus, from the start, investment at the front end of the development and production sequence requires attention to the ultimate production capacity.The Children's Vaccine Initiative (CVI) will heavily tax the world's vaccine-manufacturing capacity. The success of the program will thus depend upon how people and institutions respond to the challenge of manufacturing unprecedentedly large quantities of affordable vaccines. The CVI aims to direct product development to meet the needs of immunization programs while not neglecting production. Investment at the front end of development and production must be made with a view to ultimate production capacity. This paper based on the history and the current state of vaccine manufacturing attempts to assess how the world can respond to the production requirements of the CVI. Production will be affected by the properties of the vaccines to be manufactured, the volume of doses needed, and affordability reflected in the cost and price of the product. It is recommended that production and supply not be separated from vaccine research, development, clinical testing, and licensure. Given that vaccines for the world's birth cohort of 150 million will be made in countries which use the lion's share of global vaccine production self-sufficiency in developing countries and the shared development of new and improved vaccines.