In 2001, I was the director of the Florida State Public Health Laboratory in Miami which responded to the first anthrax attack in the history of the United States. In that capacity, I was one of the lead investigators and worked in collaboration with members of the Centers for Disease Control and Prevention (CDC), Federal Bureau of Investigation (FBI), United States Postal Inspection Services (USPIS) and the Palm Beach County Health Department.

As such, I was involved in the entire response to anthrax, from sample collection to testing and aiding the criminal investigation. In addition, I also helped create the process for medical countermeasure dispensation to the employees and visitors of the American Media Inc (AMI) building where anthrax exposure occurred.

During the response, I worked 18-20 hours a day for several weeks with my Assistant Director Dr. Peter Shih and other members who performed shift duties from the laboratory (notably Ms. Jody Dielmann, Ms. Romy Erase, Ms. Rosy Cortes, Ms. Elsa Merlo and Mr. Marc Diamante, Ms. Aurora Garcia, Ms. Christine Pillai (volunteer) and Mr. Dwight Frazier) as well as members from the Miami Dade County Health Department (notably Mr. Pablo Gonzalez, Mr. Walter Livingston, Mr. Gabriel Garcia and Mr. Robert “Sterling” Whisenhunt). We worked tirelessly to ensure the public health mission was met. At times, when I headed back home to catch a nap, I would receive a call a couple of hours later relating to a high priority sample that required immediate testing. After a few instances, I and my Assistant Director Dr. Shih decided to catch little naps when possible at the office. We operated 24/7 because samples were coming in at all times throughout the day and laboratory testing was being conducted as they arrive. My lab processed a total of 14,244samples (12,687 Environmental Samples and1,557 Clinical Samples) over a period of two years between September 2001 and August of 2003 as a result of the 2001 Anthrax attack.

The hardest part of dealing with the anthrax attack in 2001 was the lack of resources and personnel to support the excessive number of samples that ended up in the laboratories. This was due to the challenge for the First Responders to perform appropriate hazard assessments in the field to rule out potential threats. Most of these samples required immediate testing because of the fear associated with a biological threat agent that had a very high mortality and morbidity rate. In addition, the lack of robust laboratory processes and mechanisms to support high volume testing, the lack of appropriately trained laboratory scientists, the lack of available Biosafety Level-3 (BSL-3) laboratory space to conduct high volume select agent testing, the lack of appropriate technology, assays and reagents and the lack of appropriate sample collection and processing methods and procedures to support investigations contributed to the complexity and difficulties to the response.

At the time, laboratory funding was inadequate to support a response — the CDC focus C grants, which help laboratories enhance their preparedness capabilities, had not been created. Under these grants and state funded efforts, we now have fully trained laboratory scientists who can conduct high complexity tests on select agents. The grants also went toward creatingBSL-3 space that support the testing of biological threat agents in a safe and secure manner. In the 10 years since the attack, 160 public health laboratories have become part of the CDC Laboratory Response Network (LRN).

In 2011, we now have the appropriate technology and assays to support rapid detection and high volume testing and have developed sample collection and processing methods that incorporate epidemiological investigation methods.

We’ve also better trained those on the frontlines, including primary care and infectious disease physicians and nurses. I am confident they can recognize a disease associated with select agents rapidly and effectively. In addition, they are able to safely and quickly handle and ship samples to LRN laboratories.

All aspects of the response to a bioterrorism event have been strengthened in the last 10years. In fact, we saw incredible improvements in just two years. In 2003, a joint investigation between FBI and CDC was initiated to understand the level of contamination of the AMI building; this resulted in approximated 6,500 samples. The Florida State Public Health Laboratory in Miami assembled sample collection kits and performed all the testing. The lab operated 24/7 for two weeks to analyze each and every sample. As with the initial anthrax response, there was no compensation for the incurred overtime, but that wasn’t a problem. Those who join the public health community realize that we don’t do what we do in anticipation of compensation. In other words, public health staffs are the unsung national heroes who give time and risk their lives to ensure the safety and security of the public.

The anthrax attacks also brought the public health, medical, law enforcement and first responder communities together. Quite simply, no single agency, office or team is capable of handling, responding or mitigating a biological attack. As such, the success stories of the 2001anthrax attacks are the collaboration and coordination of activities among state and local public health members with law enforcement, first responders and the federal government. Even though we were extremely challenged in 2001,information was shared in a timely manner with all the critical members.

Today, the nation is better prepared to prevent an adversary from acquiring a biological threat agent, protect the critical infrastructure, rapidly detect an attack through robust surveillance and respond and recover from a potential biological attack.

Biological attacks can be devastating. A biological attack can result in high morbidities and mortalities if we are not prepared to handle it effectively and swiftly. The economic impact associated with a biological attack can be significant. We need better methods for decontamination and clearing a facility for reoccupancy. We need better assays and technology to support rapid detection and surveillance. We need better medical countermeasures and better and faster methods for distribution and dispensation of these medical countermeasures to potentially exposed individuals. We need better tools to support laboratory diagnostics to differentiate and identify infected individuals early to initiate rapid clinical interventions. We need better methods to protect the biological select agents so that our adversaries are not able to acquire them. We need to explore innovative approaches to conduct biosurveillance, public health surveillance and biomonitoring to prevent an event or to acquire advance/early warnings about an attack. We need better methods for assessing credible samples versus non-credible samples prior to subjecting to laboratory analysis.

My biggest concern is that the country is getting complacent and we might be losing focus on the importance of being prepared. We, as a nation, invested in building an infrastructure to ensure that the public health program is better prepared to respond to a biological attack. As time passes without an event and the budget continues to shrink, so does our ability to be fully prepared. The failure to maintain the infrastructure we have built can result in reverting us back to where we started. It will cost significantly more to get up to speed if an event were to occur, than it would to maintain the infrastructure we have and continue to build. Terrorists are still out there and they have every intention to attempt to cripple the country again. Although we have made significant progress in comparison to2001, we still have a lot more to do.

By Segaran P. Pillai, Ph.D, MSc, SM (AAM), SM (ASCP), Chief Medical and Science Advisor, Science and Technology Directorate, U.S. Department of Homeland Security

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