In public health, we once devoted the great majority of our disaster preparedness and response efforts to naturally occurring events — floods, fires, earthquakes and the like, especially in Washington state.

On February 28, 2001 when the Nisqually earthquake hit, my agency got a firsthand look at being on both ends of that response. The epicenter was11 miles northeast of our office location at the time in downtown Olympia. Our buildings were damaged.We had to look out for our own, along with other people around the state. It was a long time before I even had a chance to go home and change clothes. Naturally, we responded as a public health agency. We knew the basics to make sure residents were safe, yet it was clear we had a lot to learn.

Less than seven months later, on September 11,the landscape of public health changed completely.Before that time, the only thing public health and Homeland Security had in common were being part of government. When emergency management plans were drawn up to respond to a biological event, public health was largely left out.

Soon after September 11, however, a series of anthrax attacks began around the country. Gary Locke, our governor at the time, asked me to explain what was happening — what anthrax was and what the ramifications could be.

I took an epidemiologist, an environmental health specialist, and a member of my communication team to the meeting. Governor Locke was surprised I had that many people involved.But it quickly became clear we needed diverse skills and talents to fully grasp what was happening,what the biological agent was, and how this might affect people in Washington.

We hadn’t prepared for anything quite like this, so there were no specific emergency plans to coordination between public health and law enforcement.We knew, though, that we didn’t have the resources at our lab to test every white powder sample that someone brought in. With help from the Washington State Patrol and the Federal Bureau of Investigation we built a package screening protocol on the spot. Unlike other labs, we decided law enforcement would determine whether there was a credible threat. I know a lot of my colleagues were inundated and overrun with samples.

Our “white powder protocol” is still in place today.It may be the first example of ongoing collaboration between law enforcement and public health.

Before I was secretary of health, I ran a local health department for 20 years. I know people will first turn to their local health department before looking to the state and national levels. In Washington, we have something known as “meet me calls” — regular conference calls with local health agencies to share and gather information and to answer questions during disasters. We’re fortunate this existed before the attacks; these calls were vital to sharing information and to help prevent public panic.

With the protocols we established, and with the constant flow of information through the “meet me calls,” we ended up testing only a few more than 100 samples. Still, because of how the attacks developed, public health wound up with a permanent seat at the Homeland Security table— and with a prominent role. In short, it changed the landscape of national defense.

We’ve come a long way in the decade since anthrax and September 11. On that day, I had to go to a local hospital in Olympia just to watch a Centers for Disease Control and Prevention presentation because it was the only place with the technology to do it. Now we have video links with many local health agencies and tribal health centers.

In addition to technological advances, we’ve seen big changes in the creation of comprehensive emergency management plans. We now have warning systems throughout the state, and turnkey operations that allow us to anticipate what the public will demand in crises. In the events that followed 2001, we’ve learned to plan,and to make our plans work, instead of waiting to react. The work is far from done, yet Washington state and our national public health system has taken a big step forward we can all be proud of. The people of our nation are safer and healthier because of it.

By Mary C. Selecky, Secretary of Health, Washington State Department of Health

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