Public Health Officials Weigh Bioterror Risks

The latest in a series of events elevating the public health system from the distant backwater of American medicine to a central role in the nation’s defense against terrorism is unfolding here this week in a cavernous hotel ballroom.

But none of the officials attending the first meeting of a new advisory council on public health preparedness, which concludes today, is gloating about the new respect--not to mention $3 billion in federal funding--they’ve gained since last year’s anthrax attacks.

If anything, the potentially overwhelming challenge of helping to prepare the nation for a smallpox, botulism, plague or other bioterrorism attack energized the council’s 21 members and a corps of public health officials to use their new status and resources also to address their more traditional concerns: controlling infectious disease epidemics, immunizing children and, most recently, guiding state and local responses to the West Nile virus.

“Bioterrorism creates enormous challenges and risks to the system,” Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention in Atlanta, said Monday. “If there is a silver lining” from the anthrax attacks, “it is that we do have renewed attention. But we have to make people realize that it’s part of providing care all the time.”

The formation of the committee--21 epidemiologists, health school deans and other public health experts who report to Tommy G. Thompson, secretary of Health and Human Services--is the Bush administration’s latest affirmation of the public health system’s role in bioterrorism preparedness.

Jerome M. Hauer, director of the Office of Public Health Preparedness, itself less than a year old, said he knew of “no other time in federal government history when so much money has gone out so quickly.”

It was in January that President Bush signed legislation passed by Congress providing $3 billion for public health preparedness. By the end of that month, $1.1 billion had been awarded to states and major cities, and 20% of that was made available immediately. By early June, after state plans for the money had been approved by federal officials, virtually all the state and city funds had been distributed.

Explaining that federal officials had a “low threshold for bureaucratic nonsense,” Hauer said they “wanted to ensure the money was used to build a system, not to buy toys.”

The funds are being used to renovate laboratories and increase their capacity, to improve the detection of bioterrorism and other infectious disease outbreaks, for health worker training, bioterrorism response facilities and equipment and the development of so-called surge capacity, making sure that at least 500 hospital beds are available to handle a sudden influx of bioterrorism victims.

While state and local health departments are just now beginning to recover from years of under-investment, they must provide the first and most critical response to both bioterrorism and more mundane health matters, like who should get flu shots.

Gerberding traveled recently to Louisiana, where she praised laboratory workers for their “heroic” response to the outbreak of West Nile virus, which is carried by infected mosquitoes and has killed at least 16 people across the country in recent weeks.

But the laboratory itself is “archaic,” she said, adding that it is “a classic example” of the many public health labs around the country that need to be upgraded.

“All terrorism is local,” said Hauer, whose office is part of HHS. But as the U.S. prepares for terrorism, he added, “we can rebuild public health infrastructure to be prepared for other crises too.”

However, a critical part of that local response--the habits and systems connecting private health-care providers to the local health department--has often been weak or missing, officials said.

The most important element of infectious disease detection is the “alert clinician who picks up the phone and tells the public health department something strange is going on,” said Dr. D.A. Henderson, chairman of the committee whose status in the public health world is almost legendary because of his role in eradicating smallpox.

Several speakers noted that the first indication of a rare anthrax case came in October when a physician called the Palm County, Fla., public health department. Anthrax spores sent through the mail ultimately killed five people, sickened 17 and prompted more than 30,000 people to take preventive antibiotics.

The routine reporting of strange symptoms, a surge in emergency 911 calls or an uptick in prescriptions for antibiotics cannot occur if there aren’t quick, easy and readily identifiable ways for doctors and nurse practitioners to reach public health officials.

Henderson and several committee members recounted instances in which even they had been unable to find emergency telephone numbers for the CDC or local health agencies. Some of the bio-terrorism funds are being used to develop better, more coordinated public health communication systems.

The public health system has another need, however, that money alone cannot fill. Several committee members and public officials bemoaned the severe shortage of epidemiologists, microbiologists and public health nurses.

Although $20 million has been funneled to training programs in public health schools, “we’re going to be short of staff for some time,” Henderson said.