Health Chief Gets Crisis Education on the Job

The day the first case of anthrax was revealed, Tommy G. Thompson stood behind a White House lectern and announced that the dying Florida man had swallowed water from a stream, implying the incident was the work of nature rather than terrorists.

A little more than two weeks later, the number of anthrax exposures has spiraled to at least 43 people in four cities, escalating the nation’s fear that the contamination is out of control and raising concerns that the government’s top health official is out of his depth.

The turn of events proved a rocky start to the crisis for Thompson, a former Wisconsin governor and a career politician who came to his Cabinet post with virtually no medical or scientific expertise. His early missteps--he has also been criticized for asserting that the government was prepared to handle “any kind of bioterrorism attack”--caused some to wonder if Thompson was the best choice for explaining one of the most frightening public health crises in memory.

He was selected as secretary of Health and Human Services for his work on welfare reform, having made Wisconsin the first state to move massive numbers of recipients off the rolls. But almost overnight, the tragedies of Sept. 11 transformed him into the Bush administration’s point man on anthrax, a subject he knew little about even a month ago.

“He’s a politician trying to handle a public health crisis, and the nation doesn’t trust politicians,” said a former high-ranking Clinton administration health official.

His aides contend that he has performed his job well during the anthrax scare.

Though Thompson’s message has at times sounded confused, he is typical of official Washington as it scrambles to explain the source of the bioterrorism and its potential reach. This week, the House shut down while the Senate stayed on. The Justice Department is seeking to determine whether this is the work of terrorists abroad or some deranged chemist at home. And the Bush administration has sounded a well-meaning but schizophrenic call for both normality and vigilance.

If anything, Thompson may have been too eager to reassure the country at the expense of credibility, some critics say. The fact that the Florida man had inhalation anthrax, an extremely rare form of the disease that had not been seen in this country for 25 years, should have set off alarms that Thompson either did not recognize or failed to convey, they say. And many bioterrorism experts dispute Thompson’s assertion that the nation is prepared for any attack.

But whatever he lacks in expertise, he compensates for with a plain-spoken ability to relate to ordinary people. The son of a grocer from a tiny railroad town in Wisconsin, he got his first job at age 5 polishing eggs for his father’s store. In testimony to Congress this week, he summoned the image of that small-town grocery in offering a common-sense explanation--rather than a more alarmist one--for the decision to increase the stock of antibiotics. “It’s like growing up in a grocery family,” he said. “When we sold the groceries, we had to replenish [them.]”

But the no-nonsense demeanor that helped make Thompson the nation’s longest-serving governor may not, by itself, satisfy a nation full of questions about bioterrorism. And some health experts believe he should have shared the podium early on with physicians better qualified to explain the science.

“The most important thing for the secretary, any secretary, to remember: They are political appointees,” said Donna E. Shalala, who served for eight years as Health and Human Services secretary during the Clinton administration and is now president of the University of Miami.

“They have three great scientific organizations that the public trusts, and they ought to put people from those institutions out front to educate the public and to reassure the public,” she said, referring to the brain trust at Thompson’s disposal--the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health.

Still, Thompson’s ability to relate to common folks has served him well. Even his detractors say he has done a good job of assuring people that a government response is in place, reiterating like a mantra that anthrax is not contagious and that there are enough antibiotics to treat 2 million people for 60 days.

“He’s started doing a better job of saying this is where we are, this is where we’re short,” said Chris Jennings, a former health advisor to President Clinton. “The lesson we all need to learn from this is the public is not stupid . . . and the most important thing right now is honesty and credibility.”

Thompson’s aides dispute that he was anything but honest in acknowledging the nation must be ready for a more widespread attack. “From the get-go, Secretary Thompson said we are prepared to respond and we have--quickly, aggressively and effectively--but we need to do more,” said his spokesman, Tony Jewell. “And that’s the part of the message that always gets left off.”

Moreover, Thompson has not kept scientists from the podium, Jewell said, explaining that the department’s best minds were busy in the early days responding to the unfolding crisis: “He seeks out the most qualified people in any given field and encourages them to do their job.”

Even if Thompson had been more inclined to turn to experts in the early days, there were few on hand. Two of the three agencies he oversees--the National Institutes of Health and the FDA--have not had a permanent director appointed, the mark of the notoriously slow Washington bureaucracy that Thompson has soundly criticized.

“The problem he is facing is he has no backup in the department right now,” said Paul Light, who studies government at the Brookings Institution, a nonpartisan Washington think tank. He noted that in addition to the two vacancies, the sitting surgeon general, David Satcher, is a Clinton appointee held in relatively low regard by the Bush White House.

“Thompson is doubly exposed,” Light said. “He is not a scientist. He does not know these issues well and he can be forgiven for the fact that he doesn’t have the troika of aides behind him. Those are arguably the worst of circumstances for him.”

It was only midweek that Satcher and CDC Director Jeffrey Koplan began to assume a higher public profile.

Their early obscurity may have been less Thompson’s burden than his choice, the mark of a former governor accustomed to taking charge. Indeed, before Sept. 11, there were signs that the former chief executive was bridling under the subordinate role he is required to play as a member of the Bush Cabinet.

But when anthrax surfaced, Thompson took the reins, turning the conference room across from his office into a command center that operates around the clock. His staff wakes him up with every late-night development. His office gets 200 media calls a day. His face has been ubiquitous on network television--his day Wednesday began at 6 a.m. with the first of seven talk show appearances.

But keeping the American people informed about a health crisis is hardly Thompson’s only task. He has won praise from some observers for seizing the opportunity to secure resources to prepare for future bioterrorism. On Wednesday he asked for $1.5 billion for bioterrorism preparedness, took steps to increase the supply of drugs to counter anthrax and negotiated with drug companies for enough smallpox vaccine for every American.

“His main job is getting the money and he’s been artful and all over that,” said Drew Altman, president of the nonpartisan Kaiser Family Foundation in Menlo Park, Calif.

Even critics who have long disagreed with Thompson on policy say he has seemed more sure-footed in recent days, yielding the stage to science and preparing for more widespread attacks without exacerbating tensions.

At the end of a long day on Wednesday, during an interview with ABC’s “Nightline,” the harried Thompson even found a place for rueful humor: “Sometimes I wonder why I left the state of Wisconsin.”