BMC Public Health 2006, 6:285 http://www.biomedcentral.com/1471-2458/6/285 demic influenza [22], and HIV and other infectious dis- eases of global concern [23]. Yet, as Reich commented in summarizing a Harvard/Global Health Council confer- ence on public-private partnerships for public health in 2000, "We know little about the conditions when partnerships succeed. Partnerships can produce innovative strategies and positive consequences for well-defined public health goals, and they can create powerful mechanisms for addressing difficult problems by leveraging the ideas, resources, and expertise of different partners. At the same time, the rules of the game for public-private partnerships are fluid and ambiguous" [23]. As noted by others at the same conference, "A chief factor encouraging these partnerships is that neither side can achieve its specific goals alone; collaboration is unavoida- ble," and "cross-sector partnerships do not happen; they are built" [24,25]. While these observations arose from an examination of public-private partnerships in public health outside the United States, they are remarkably ger- mane to our observations regarding collaborations between public health and businesses in Georgia. The term "public-private partnership" itself, although widely used, is vague and embraces a spectrum of activi- ties including outsourcing government functions to pri- vate companies, engagement of private consultants to advise governments, the work of philanthropies, and active collaborations [23,26]. The BENS-public health project is an active collaboration involving senior and operations-level staff from businesses and public health agencies in planning, developing, implementing, and test- ing an SNS dispensing model and, more recently, in sup- porting pandemic influenza planning. As such, this is a collaboration that was deliberately built through long- term, sustained efforts of the partners. Building such rela- tionships requires patience and time. People from busi- ness must recognize that governments are usually less nimble than private companies, as learned by Arnold Schwarzenegger, Governor of California, in describing his personal transition from business to government, "You have to have a bit more patience. Coming from the private sector, not having been involved in government, I wanted to do things as quickly as in the private sector, and that doesn't happen" [27]. In building partnerships with business, people from gov- ernments cannot set aside their responsibilities for regula- tion or addressing health threats when they arise from business activities or commercial products, but, at the least, they must learn to view businesses through another lens as collaborators for the public good. This need did not arise with the threat of bioterrorism. For example, in 1992, CDC launched a "Business Responds to AIDS" pro- gram, including outreach to 35,000 corporations to solicit their engagement in addressing the threat of HIV, which affects communities at large and businesses [28]. The ground rules for public-private partnerships in public health are in flux. As noted by Hershey at the Second Annual Partnership Conference on Public Health Law, convened in 2003 by CDC, "A local public health agency and its public health officer are faced with difficult issues regarding public-private partnerships. These include: 1)Congruency of mission and goals – Are the missions and goals of the partnership consistent with that of the local public health agency?; 2) Conflicts of Interest – Is there a perceived or real conflict of interest in the partnership?; 3) Conflicts of Obligation/ Accountability – To whom and to what are local public health agencies accountable?; 4) Balancing Ethical Rules and Values – What ethical rules and values are local public health agencies balancing? Who's [sic] rules and values should they protect? What is the role of the public health professional?; and 5) Allocation Issues – Who decides what gets funded?" [29] These questions may become especially relevant for the BENS-public health partnership in Georgia. The model of collaboration that has been developed for SNS dispensing in Georgia has not been subject to wide-scale public scru- tiny, and, in the absence of an actual emergency requiring SNS dispensing, may never come to that level of public attention. Whether the proposed model is welcomed by the public and media or viewed as an example of govern- ment favoritism to business remains to be seen. If it comes to widespread public attention, this question will be likely resolved in the political arena. In addition, as CDC seeks support from BENS to replicate the Georgia SNS dispens- ing model in other states and as public health in Georgia seeks to expand its portfolio of projects with BENS, it may be necessary to contract with BENS or individual BENS members if the demand for services exceeds their capacity to work pro bono. Possible mixing of volunteer work with activities funded through contracts or other arrangements will change relationships with government agencies, rais- ing potentially difficult ethical and procedural questions for BENS, its members who are both volunteers and potential paid consultants, and governments. Conclusion The partnership between businesses and public health agencies in Georgia to develop SNS dispensing capacity is based on mutual trust and shared objectives: protecting public health in the event of a bioterrorist attack or other major infectious disease emergency and, by extension, contributing to community cohesion in the wake of a Page 11 of 13 (page number not for citation purposes)