For Immediate Release: September 29, 2011
TFAH Statement on the 10 Year Anniversary of the Anthrax Attacks: Progress and Gaps in Public Health Preparedness
Washington, D.C., September 29, 2011 – October 2011 marks the 10 year anniversary of the anthrax attacks in the United States. The following is a statement from Jeff Levi, PhD, Executive Director of the Trust for America’s Health (TFAH):
“All of us at the Trust for America’s Health want to take this anniversary to remember those we lost and their loved ones and to commemorate the public health community and other responders who worked tirelessly and heroically to respond and protect us.
Public health officials were at the lead of the anthrax response – diagnosing and treating victims and running more than a million tests on 125,000 potentially life-threatening samples around the country in a short period of time. These officials were often working without adequate resources or training to respond to these types of attacks and had limited knowledge of the science involved in weaponized anthrax and how widely it was dispersed through the U.S. mail system. This was truly the first time public health came to be viewed as central to emergency response and national security on a wide-scale basis.
Over the past decade, we made a lot of strategic, smart investments to improve preparedness in the United States. However, recent federal, state and local budget cuts threaten to put that progress into jeopardy. The most important way we can honor the past is to make sure we sustain enough resources to support the field of public health so they have the tools and expertise they need to do their jobs -- so we can prevent what we can and respond when we have to.”
On September 1, 2011, Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) released Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense, which examined 10 years of progress and gaps in public health preparedness and included firsthand accounts from public health officials, laboratorians, clinicians and doctors who were on the frontlines in the response to anthrax. The report also features a timeline of the anthrax events and a summary of the lengthy criminal investigation to identify the perpetrator.
Some key areas of progress over the past decade include significant improvements in: preparedness planning and coordination; public health laboratories; vaccine manufacturing; the Strategic National Stockpile; pharmaceutical and medical equipment distribution; surveillance; communications; legal and liability protections; increasing and upgrading staff and surge capacity.
Some ongoing gaps a decade later include: major recent budget cuts; a gap in trained public health workers; a gap in surge capacity for mass care during emergencies; a lack of an integrated, national approach to biosurveillance; gaps in supporting the way communities cope and recover from disasters; and gaps in vaccine and pharmaceutical research, development and manufacturing.
Example excerpts of reflections include:
- “What stands out most to me about the 2001 anthrax attacks is the notion that from that point on, bioterror was a reality and no longer an abstract concept…. Today, we know and can dispassionately describe exactly what happened. We know that of the people potentially exposed to anthrax in 2001, 22 people were infected, five of whom died. We know now that the attacks were unlikely a concerted effort by a group or organization intended to broadly affect our society and large numbers of people. We know that the attacks likely stemmed from the actions of a single individual who was probably mentally unstable. Today we know the anthrax attacks had a relatively limited and short-lived impact in terms of morbidity and mortality. However, at the time the entire event was surrounded by uncertainty.” -- Anthony S. Fauci, M.D., Director, NIAID/NIH
- “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.” -- Dr. Segaran Pillai, Chief Medical and Science Advisor, Ph.D. MSc, SM (AAM), SM (ASCP), Science and Technology Directorate, Department of Homeland Security, who was in Florida during anthrax when anthrax was first detected
Some contributors include Anthony Fauci, M.D., Director NIAID/NIH; Senator Tom Daschle, former U.S. Senator from South Dakota and former U.S. Senate Majority Leader; Isaac Weisfuse; M.D. MPH, Deputy Commissioner of the Division of Disease Control of the New York City Department of Health and Mental Hygiene; John R. Lumpkin, Senior Vice President and Director, Health Care Group, the Robert Wood Johnson Foundation and former Director of the Illinois Department of Public Health; Sara T. Beatrice, PhD., New York City Public Health Laboratory; Georges Benjamin, M.D., FACP, FACEP (E), FNAPA, Hon FRSPH, executive director of the American Public Health Association and former Secretary of the Maryland Department of Health and Mental Hygiene; and stories from a range of officials at the U.S. Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and state and local public health officials in New York, Washington, D.C., Virginia, Florida, Connecticut, New Jersey, Arizona, Maryland, Missouri, North Carolina, and Washington State. There are excerpts and highlights of the stories included at the end of the release.
The report is available on TFAH’s website at www.healthyamericans.org.
Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org.
The Robert Wood Johnson Foundation (RWJF) focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need—the Foundation expects to make a difference in our lifetime. For more information, visit www.rwjf.org.
The following includes a series of excerpts and highlight from the stories
Anthrax in Florida
“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…. 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 laboratories.” -- Segaran Pillai, Chief Medical and Science Advisor, Ph.D. MSc, SM (AAM), SM (ASCP), Science and Technology Directorate, Department of Homeland Security
“I received that specimen around noon on October 3, 2001. I immediately started the analyses that I had been taught at CDC…. Following a press release, on October 8, 1,114 people who worked in or had visited the [American Media Inc.] building during the previous 60 days presented at the Palm Beach County Health Department…” -- Phil Lee, Biological Defense Coordinator, Molecular Biology, Florida Department of Health Bureau of Laboratories
“Ready or not, the Florida anthrax event thrust public health and bioterrorism to the front of the line.... CDC and public health as a whole had limited science or past bioterrorism experience to draw upon beyond basic laboratory and epidemiological understanding.” -- Q&A from CDC
Anthrax in New York
“On October 12, 2001, we received our first Anthrax laden letter which was mailed to the office of NBC News here in NYC. The ensuing investigation and media coverage resulted in our Public Health Laboratory receiving thousands of clinical specimens and environmental samples for testing… coffee tables from a department store, suitcases from the airport, dollar bills that had been rolled up, you name it.” -- Sara T. Beatrice, Ph.D., Assistant Commissioner, New York City Public Health Laboratory
Anthrax in Washington, D.C. Metro Area
“The patient said he delivered mail from the Brentwood postal facility. At the time, Brentwood had no special meaning to anyone…. [the doctor] did an X-ray which just didn’t look right, and then followed that with a chest CT Scan that was demonstrable for the telltale sign of inhalation anthrax… Later that same night, another of our emergency department physicians… took care of another postal worker from Brentwood. He came in because he said he had the worst headache of his life.” -- Dan Hanfling, Special Advisor on Emergency Preparedness and Disaster Response to the Inova Health System and Board Certified Emergency Physician
“I vividly remember the first report to me by my Chief of Staff, Pete Rouse, and my grave concern for each of the affected staff. I remember the agony of calling parents, spouses and families of the exposed staff to inform them of what had happened and to share what little I knew about how we would address the situation.” -- Former U.S. Senator Tom Daschle
“We realized there was no cavalry coming to sort things out, we would have to manage most of this ourselves.” -- Dan Hanfling, Special Advisor on Emergency Preparedness and Disaster Response to the Inova Health System and Board Certified Emergency Physician
“The people in Virginia who contracted anthrax survived. Part of the reason for the positive outcome was the responsive infrastructure developed through the Laboratory Response Network (LRN). One patient went to the emergency room and was discharged after having a blood sample drawn for culture…. Within forty minutes of receiving the specimen… the patient returned to the hospital and was successfully treated with the appropriate antibiotics.” -- Jim Pearson, Virginia DGS Deputy Director for Laboratories, Director of the Division of Consolidated Laboratory Services
Anthrax in New Jersey
“Two perceptive local New Jersey physicians, having read news reports of the NYC cases, and the NJ postal center of origin, called our phone banks to report unusual, persistent skin illnesses in two postal workers…. It turned out it was over three years before [the Hamilton postal building] was deemed safe to reopen.” George DiFerdinando, Jr., M.D., M.P.H., FACP, Director, New Jersey Center for Public Health Preparedness at UMDNJ-SPH Co-PI, New York-New Jersey Preparedness and Emergency Response Learning Center Adjunct Professor of Epidemiology, UMDNJ-SPH
Anthrax in Connecticut
“In March of 2001, I joined the State of Connecticut Department of Public Health as a Bioterrorism Coordinator in the Public Health Laboratory…. My role would drastically change in a matter of a few months, after Ottilie Lundgren, a citizen of Oxford, Connecticut, became the last known victim of the anthrax attacks.” -- Diane Barden, Bioterrorism Response Laboratory Supervisor, Connecticut Department of Health Public Health Laboratory
Thousands of Scares around the Country
“At the outset of the anthrax response, we were basically operating out of a closet. We built a makeshift lab in an unoccupied office – this became our BioEmergency Response Lab.” -- Victor Waddell, PhD, Bureau Chief, Arizona State Public Health Laboratory, Arizona Department of Health Services
“Here was a typical scenario: a jittery and unnerved town resident would discover ‘suspicious’ white powder in his community. Immediate notification of the local police or fire department would trigger both the closing of the local post office and the sudden arrival of HAZMAT teams, bedecked in imposing space- suit paraphernalia. The teams would delicately handle the samples under the watchful eye of local media and news cameras. Then, those samples would be delivered to the M.D.PH state laboratory for analysis. A hastily-arranged press conference would feature harried state and local officials trying to explain the unfolding developments to an increasingly anxious public. And when testing in the laboratory subsequently yielded negative results for anthrax, that finding would prompt yet another round of news announcements as well. Multiply this situation by several thousand --and that was the Fall of 2001 in our state, and indeed, around the country.” -- Howard K. Koh, M.D., M.P.H., U.S. Assistant Secretary for Health, U.S. Department of Health and Human Services, Massachusetts Commissioner of Public Health, Commonwealth of Massachusetts
“The types of environmental samples received were variable to say the least. From the obvious bulk mail from post offices, suspicious mail from homeowners and powder samples (including powdered doughnuts), to the more obscure airline seat covers, dead birds, body bags, teddy bears, disposable underpants, a Marilyn Monroe effigy and residential mail boxes together with post and concrete anchor… each presented a new challenge.” -- Phil Lee, Biological Defense Coordinator, Molecular Biology, Florida Department of Health Bureau of Laboratories
Legacy of the Tragedies for Public Health
“What stands out most to me about the 2001 anthrax attacks is the notion that from that point on, bioterror was a reality and no longer an abstract concept…. Today, we know and can dispassionately describe exactly what happened. We know that of the people potentially exposed to anthrax in 2001, 22 people were infected, five of whom died. We know now that the attacks were unlikely a concerted effort by a group or organization intended to broadly affect our society and large numbers of people. We know that the attacks likely stemmed from the actions of a single individual who was probably mentally unstable. Today we know the anthrax attacks had a relatively limited and short-lived impact in terms of morbidity and mortality.
However, at the time the entire event was surrounded by uncertainty.” -- Anthony S. Fauci, M.D., Director, NIAID/NIH
“The events were highly transformational – something had fundamentally changed in the field of public health after 9/11…. This was nailed home when the anthrax attacks occurred. Quite simply, never in the history of public health had diseases we thought were in the past been reintroduced as a weapon.” -- Alonzo Plough, M.A., M.P.H., Ph.D., Director of Emergency Preparedness and Response, Los Angeles County Department of Public Health; Board of Director, Trust for America’s Health
“On this, the impending 10 year anniversary, it has left us reflecting on where we were at the time, what contribution we made to helping those directly impacted by this tragic event, and wondering what would happen if something similar happened again. For those of us who are disaster response leaders, it reinforces the importance of building a robust and prepared nation--recruiting, training, and sustaining a workforce, both volunteer and paid, that has the capability to be at the right place, doing the right things, at the right time.” -- Jack Herrmann, Senior Advisor, Public Health Preparedness, National Association of County and City Health Officials (NACCHO)