Work remains in preparing nation for bioterrorism risk

WASHINGTON -- A year after the first anthrax-tainted letters were dropped into a New Jersey mailbox, the nation is vastly better prepared to face bioterrorism. Yet experts agree that major holes remain in communications, emergency planning and staffing, and many fear the country's resolve could fade along with memories of the attacks.

There have been no arrests and there are officially no suspects in the criminal investigation into the attacks-by-mail, which killed five and sickened 18. While the investigation appears stalled, efforts to prepare for the next attack have moved steadily forward.

"Public health has always been the poor stepchild. It's never received the dollars, it's never received the attention," said Health and Human Services Secretary Tommy Thompson. "One of the good consequences of 9-11 is we now have the resources available to build the public health system."

Much work remains.

An expanded National Pharmaceutical Stockpile is loaded with medicines, vaccines and supplies, ready to land a cargo plane with 50 tons of material in any city within hours. But many communities have no plan for transporting those supplies to the public.

States have new money to hire public health workers, but there is a dearth of talent for hire.

While cities are now focusing on the threat, experts worry there is still no efficient way to get medical information to the doctors on the front lines.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, described a "mosaic of preparedness."

"In some areas, certain aspects are absolutely gold standard and others have a ways to go, and in a neighboring district it might be just the opposite," she said Wednesday.

Despite the limited scale of the anthrax attacks, the public health system was severely taxed under the weight of investigating hundreds of false alarms, testing more than 120,000 environmental samples and distributing antibiotics to thousands of people who may have been exposed to the bacteria.

"Last fall was a tragic dry run," said Dr. Michael Osterholm of the University of Minnesota, who advises HHS on bioterrorism. "That was horrible but we all know what it could have been had the same amount of anthrax been put into air intake systems."

The long-neglected public health infrastructure -- the people and systems who guard the community's health -- got an unprecedented, rapid infusion of dollars, nearly $1 billion. "I can't remember a time when money went out that quickly," Osterholm said.

Yet he and other experts are concerned states will fail to put up their own money to finish the job or, worse, will cut back existing state spending now that the federal dollars have arrived. Some want Washington to ensure that the states spend the money wisely, something HHS has pledged to do.

But other issues remain:

National Pharmaceutical Stockpile: A year ago, the stockpile had just 15 million doses of smallpox vaccine; soon, there will be enough for every American. But officials worry that many communities do not have plans to get those supplies to distribution and treatment centers. Also of concern: having enough trained workers to handle mass vaccinations, if needed.

Communications. During the anthrax crisis, federal officials failed to communicate accurate information to the public, the media and to state and local counterparts. Lack of clear communication "would be my No. 1, my No. 2 and probably my No. 3" biggest failures, said Steve Ostroff, a CDC epidemiologist.

CDC has lots of work ahead. Gerberding recently called her agency's emergency line and got a recorded message telling her to call another number. When she called that number, she got the same recording. She called communications the most important priority for her office's work on bioterrorism.

Reaching doctors: In a crisis, doctors need up-to-date information about symptoms and treatments, but there is no clear way to disseminate new data quickly. Many doctors do not have e-mail in their offices, and most public health departments do not have an up-to-date list of fax numbers, said Dr. Ed Thompson, director of the Mississippi Department of Health. Mail is too slow and much is never opened.

Research. About $130 million already has been added to the bioterrorism budget to research new vaccines and treatments. But some wonder whether new vaccines will ever be produced, given the questionable market for them. Private manufacturers already balk at producing standard childhood vaccines because their profit margin is so low.

Workers. Even with money to hire more workers, experts worry that there aren't enough trained epidemiologists, lab technicians and other public health experts. "Frankly, the talent isn't out there," said Tara O'Toole, director of the Johns Hopkins Center for Civilian Biodefense Strategies.

Hospitals. The government wants one hospital in each community designated to house contagious smallpox patients, but hospitals fear liability and other consequences of getting that designation.

A small community of experts had long argued that the country was vulnerable to bioterrorism, but their warnings received little attention before last fall. Now experts fear that as memories of the anthrax attacks fade, attention to solving these problems may, too.

Osterholm hopes people stay a little scared. He points to the fire department at the Minneapolis airport. There's never been a fire there.

"But tonight could be the night," he says. "We have to understand today can be the day that the next shoe drops."