Health threats: Who’s in charge?

Government and mixed messages 

Let’s go back some 16 years and see what has changed since the Florida anthrax outbreak in 2001. It’s been indeed almost two decades, but almost a month after doctors diagnosed anthrax in a Florida man, White House officials were still trying to find a leader who can both inspire public trust and answer complex medical questions about a disease that hasn’t been studied thoroughly in humans. So when it comes to health threats: who’s in charge?

Several administration officials are taking turns behind the microphone to brief the nation about the unfolding anthrax crisis. Secretary of Health and Human Services bach then Tommy Thompson has so far served as the Bush administration’s main voice. Later, he would be joined by Homeland Security director Tom Ridge, who announced he would play a much larger role in the effort. He planned to brief reporters three times a week on the unfolding crisis.

But public health experts and others questioned whether Thompson, Ridge or any non-medical expert could provide the answers that the public, media, and doctors seek.

Three prominent scientists — Bruce Alberts, president of the National Academy of Sciences (NAS), William Wulf, president of the National Academy of Engineering, and Kenneth Shine, president of the NAS’ Institute of Medicine — issued a statement that week saying “Americans can ill afford to rely on hearsay or information coming from those outside the scientific and medical communities who may mean well but lack solid data supported by evidence.”

James Curran, dean of the Rollins School of Public Health at Emory University, said that the Sept. 11 attacks and the war on terrorism had heightened the need for leadership. “Things are happening fast,” said Curran, once the government’s point person on AIDS. “They’re happening on multiple fronts, involving multiple people. Single, coordinated leadership is important.”

The Centers for Disease Control and Prevention, which took prominent public roles in explaining outbreaks such as AIDS and hepatitis C to the public, took a backseat this time to the FBI and state and local health officials.

The agency said it had been reluctant to speak out for two reasons. First, the CDC was hesitant to upstage state and local authorities, who, by law, are responsible for public health in their communities. The CDC cannot investigate any outbreak without a state invitation, and CDC officials were afraid they wouldn’t be invited to assist if they would alienate their local colleagues.

Second, officials said the CDC had frequently deferred to the FBI, which is handling the criminal investigation into the anthrax crisis.

“What we are attempting to do is work in a complementary way,” CDC director Jeffrey Koplan said as the agencies first looked into the South Florida cases some 16 years ago today. But public health officials said the public suffered from the lack of reliable information, a vacuum that was ultimately filled by the rumors and conjectures that concerned Shine and his colleagues. Some information was deliberately withheld, and other statements were misleading or confusing.

For example, congressional leaders were reportedly briefed Oct. 20, 2001, on the lethal potential of anthrax in the letter sent to then-Senate Majority Leader Tom Daschle. Daschle said the anthrax bore the earmarks of a sophisticated weapon, yet Ridge said the same day that the anthrax in the Daschle letter was “indistinguishable” from the other anthrax mailings.

“CDC needs, it seems to me, to step forward as the source of information that the public can rely on,” said Tara O’Toole of the Johns Hopkins University Center for Civilian Biodefense Studies.

Government officials said privately that some of the blame for the leadership vacuum lies in the White House and HHS, where administration press officers insisted on approving all interview requests from national newspapers and network news shows. Even Thompson expressed frustration with the situation.

“I have been frustrated at times at not getting out information as fast as I would like,” he said. “We’re constantly making changes to get information out faster.”

Two weeks later, CDC director Koplan and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, broke their relative silence and began appearing on talk shows and in newspaper stories. Fauci attributed much faster turnaround of interview requests either by HHS or the White House.

The public wasn’t the only group left with unanswered questions. Infectious-disease specialists said those on the front lines of medical care in America were and still are struggling to answer the urgent questions of patients regarding their risks from anthrax or other biowarfare germs.

Craig Smith, director of infectious diseases at Phoebe Putney hospital in Albany, Ga., said communication doesn’t trickle down very swiftly from the federal level to the doctor in the office. “Every doctor in the U.S. knows as soon as something is discussed on CNN, their phones will start to ring,” he says. “Physicians should not have to rely on news media for information that should be communicated to them (directly), in real time.”


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