System’s stumbles bode ill for larger bioterror

Few people are closer to the center of the national anthrax investigation than Dr. Donald A. Henderson, one of the world’s leading experts on bioterrorism, whom Health and Human Services Secretary Tommy G. Thompson has called in as a top scientific adviser during the current crisis.

Henderson spent Monday in the “command center” at HHS headquarters in downtown Washington. But in a sign of the communication problems that have marred official response to the first bioterrorism attack in U.S. history, he learned that two Washington postal workers had died from suspected anthrax at exactly the same time as the rest of the nation.

“My knowledge of the deaths came from CNN,” he said Tuesday. “I find it puzzling that the information doesn’t flow better.”

With new reports of anthrax in buildings or people coming every day, the federal Centers for Disease Control and Prevention and other agencies have sometimes put out contradictory, incomplete or dated information to local health officials and the public.

At a Senate hearing yesterday, CDC came under fire for failing to advise treatment of Washington postal workers until some developed symptoms of disease.

“I am very concerned about what CDC is doing and how they are operating,” said Sen. Tom Harkin, an Iowa Democrat. “Maybe I’m wrong, but it just seems to me that something broke down here. People are getting sick and people are dying.”

CDC Director Dr. Jeffrey Koplan said the agency is working as well as possible with the information it receives.

“These are tragedies for us as well and not something we take lightly,” he said. “But you’ve got to know about cases to take action.”

Henderson and others say the problems result from the government’s inadequate preparation for bioterrorism, secrecy surrounding the FBI’s criminal investigation and understandable missteps of overwhelmed public officials.

“There isn’t any national leadership,” said Dr. J. Glenn Morris, chairman of epidemiology and preventive medicine at the University of Maryland School of Medicine. “What we’re seeing is panic at all levels of government.”

Morris pointed to a satellite video hookup organized by CDC Thursday. He was among about 100 doctors and nurses who took an hour out from busy schedules to watch the presentation at an auditorium at the Veteran Affairs Medical Center in Baltimore. But he said most of the hour was occupied by useless, general statements from Thompson and CDC officials.

“The substantive information in that telecast I could have gotten from three minutes scanning a medical textbook,” he said. “The people walking out of that room were saying, ‘Who’s in charge?’”

Some observers, while acknowledging the problems, are more charitable.

“I think CDC faces a real challenge,” said Dr. Margaret A. Hamburg, a former HHS assistant secretary and bioterrorism expert at the Nuclear Threat Initiative in Washington. “They’re dealing with a disease we have very little experience with, delivered by a mechanism we have no experience with. And while they deal with it, there’s been a huge surge of demand on their personnel and their laboratories.”

Henderson, 73, who is renowned for leading the campaign to eradicate smallpox worldwide and now heads the Center for Civilian Biodefense Studies at the Johns Hopkins University, agreed that some glitches are inevitable.

He also said he is “in an awkward position” in critiquing the government response, since Thompson named him Oct. 3 chairman of the HHS bioterror advisory panel.

But he said that CDC got off to a slow start. “What’s clear is that, till a week ago, the organizational structure and how they function was business as usual,” Henderson said. “Now, so they tell me, they’ve created a real operations center” at CDC headquarters in Atlanta.

Henderson said the root of the problem is that CDC had no bioterrorism program at all until three years ago. As an HHS official from 1993 to 1995, he said, he found then-Secretary Donna E. Shalala uninterested in the threat. Only after President Clinton read a novel on bioterror and took an interest in 1998 were significant funds and personnel applied to the subject.

Even before the Sept. 11 terrorist attacks, he said, Thompson showed strong interest. “He puts more energy into this in a week than Shalala did in a year,” he said.

From the beginning of the current investigation, there has been a sharp conflict between the FBI’s traditional secrecy and public health officials’ opposite instincts.

“The FBI doesn’t want to show its hand,” Henderson said. “But in public health, we’ve always done a lot better getting out as much information as we can.”

For example, the scientific analysis of the anthrax powder used in the attacks has been kept within a small circle of officials. As a result, there have been wildly varying press reports on it.

Public health and postal officials want more information on the particle size, virulence and other qualities of the powder so they can better judge who is at risk. But FBI investigators, hoping the powder will give clues about the perpetrators, don’t want details released.

While loath to criticize CDC publicly in the midst of a cooperative effort, some local health officials have felt whipsawed by the federal agency.

As investigators found anthrax in various Capitol Hill locations, for instance, worried employees called local health departments for advice on whether they might have been exposed.

But based on outdated CDC advisories, officials sometimes reassured callers that there was no risk in certain places that turned out to contain anthrax traces.

Despite the extraordinary disruption that they have caused, the current anthrax attacks “are a small-scale test” of the public health system, Henderson said. This offers an opportunity to streamline communications before a larger-scale attack.

“You have to ask,” he said, “is it going to be released in some other way next time?”