On March 11, 2011, I watched, horrified, as the news of the Japan earthquake and tsunami unfolded. Within days, the potential radiation exposure escalated to the point that, in Washington State, 5,000 miles from the nuclear reactor, we were fielding calls from citizens, health care professionals and the media.

The events in Japan left me feeling the same as the anthrax incidents on the east coast in 2001.Both incidents posed a true human health threat, not for Washington residents, but for individuals far away. In both instances, the community concern was elevated and internet information was readily accessible and not always accurate. It was our responsibility to develop and coordinate a local and statewide response quickly — doing so before the federal government was able to provide guidelines.

Emergency preparedness requires careful planning before an incident occurs. Having written plans agreed upon by partners in preparedness helps ensure a more controlled rather than a chaotic response. As the public health officer for Thurston County, Washington, which includes Olympia and the State Capitol, I worked to build plans and protocols to respond to bioterrorism with some of our response partners for a number of years. However, until October11, 2001, many of us did not believe that a bioterrorist event would really happen.

The news about possible mail exposure to anthrax spurred me into developing mail handling guidelines, which included input from the Federal Bureau of Investigation (FBI), community physicians, citizens, and public health department staff. After 12 years of being the health officer of this community, I was able to anticipate some citizen concerns. My main fear was that our staff alone would not have the resources to handle all the “what if” situations.

After meeting with the disaster management group and the unified law enforcement group, which included all city police chiefs, sheriffs and state patrols, I refined the guidelines for handling suspicious mail. This was used as a template for a triage protocol for our local 911 center so that the entire community would have a unified response. The information was discussed, agreed to, widely distributed and shared with all crisis lines and hospital consultation lines.

With everyone on the same page, our response was clear and consistent. Still, we encountered problems — some expected and some that seemingly came out of nowhere. For the most part, suspicious mail was not accompanied by a credible threat. It quickly became apparent that potentially contaminated mail was going to be turned in by the hundreds and we would not have the capacity to deal with all of the samples. On the rare occasion when we did encounter a credible threat, there was a clear lack of personnel trained to handle hazardous materials.

In addition, some members of the public were disappointed with our response because we used “threat assessment” to triage which items were tested and which were discarded. With Olympia being the seat of state government, the guidelines included “persons of importance” in government as potential targets for threat. To some, this implied that citizens were not as important as government officials. The situation worsened after deaths in New York and Connecticut were published in the media, because their source of exposure was never really determined. So, the risk of casual or accidental exposure became more of a concern.

For some reason, calling this bioterrorism instead of communicable disease control gave the impression that this was something new and exotic. The reality is that epidemiology is a cornerstone of public health practice. Disease control and surveillance are part of everyday public health functions. Some doctors and hospital practitioners responded with an “I don’t know what to do” even when they had handled similar situations in the past.

While our guidelines were not perfect and we faced problems, our response was successful because we established relationships in the community, created mutual aid agreements and had a history of working cooperatively with all stakeholders. It definitely helped to have all agencies deal with situations in similar ways. In reviewing the guidelines we developed, and comparing those to subsequent published guidelines, it is clear that our information was good and our guidelines were written in a more “prescriptive” manner to fit our community needs.

Over the last 10 years, our public health emergency preparedness response has been fine tuned. Public health leaders have emerged as very credible sources of information. We have also become excellent risk communicators, understanding the needs of our individual communities, so that we can tailor messages locally. The public health, health care, law enforcement and emergency management systems are closely linked and work well together.

That said, the biggest threat to bioterrorism preparedness is the lack of stable funding for the public health system. Preparing to handle a disease outbreak is one of the fundamental day-to-day activities of a local public health agency. As funding has gotten tighter, the cutbacks in the public health workforce remove a huge number of people who have experience and expertise in dealing with disease outbreaks. A bioterrorist threat is one we are capable of recognizing and responding to, but we may soon reach a point where we will have no capacity (in terms of resources and staff) to do so.

Responding to bioterrorism is a public health responsibility. We need a constant stream of resources to remain vigilant in our preparation.

By Diana T. Yu, M.D., M.S.P.H., Health Officer, Thurston and Mason County, Washington

You can download a PDF of the story here, including a timeline that was in the report that was not reproduced above.