Anthrax: Public Health System Learns Lessons

By Sydney J. Freedberg Jr. and Marilyn Werber Serafini

From the National Journal, Nov. 10

In a way that the far bloodier September 11 attacks did not, the anthrax assault has required unprecedented collaboration: among law enforcement, emergency management, and public health officials; among federal, state, and local government; and between government at all levels and the medical community. If the attacks-by-mail did America any kind of favor, it was to highlight how many weak links there are in the chains that bind these agencies to each other in a crisis-links that must be strengthened before a far heavier blow breaks them apart completely.

Consider Clifford Ong, Indiana's new statewide counter-terrorism coordinator, appointed two weeks into the crisis as the Hoosier version of national Homeland Security chief Tom Ridge. Ong's office, intended to be the state's central clearinghouse for anthrax information, first learned about Indiana's most serious anthrax scare, not through official channels, but from the media. Although about 600 miles from any confirmed case of anthrax, Indianapolis happens to have one of the only two facilities nationwide that repair and recycle post office sorting machines-including a tainted printer from Trenton, N.J. State authorities did not even know the repair plant was there until a subcontractor called asking for advice about how to handle machinery possibly exposed to anthrax. The state then tested for anthrax at the repair plant, and the report came back negative. Ong relaxed. But he didn't know that the main contractor at the plant had asked the U.S. Postal Service to come and do its own test. This second test, performed by an out-of-state lab, came back positive. Suddenly, there was anthrax in Indiana, and yet state authorities weren't told. Reporters in Washington were. Ong had to field the frantic calls.

"Our problem isn't locally," said Ong, who has long worked with the local U.S. district attorney and the FBI field office. "Washington seems to respond within the Beltway to national media without any concern that we have local media.... It puts us in somewhat of a defensive position."

This snafu-just one of many-shows how vital information can fall into the cracks between organizations, into blind spots where fear can flourish like mold inside a wall. Considering that just four people died of anthrax in one month, the average American was far more likely to be struck by lightning, which kills 80 to 100 people every year, than to contract the disease. The point is that anthrax is not contagious-but fear is. "The medical problem was actually pretty small," said Jack Harrald, the director of the Institute for Crisis, Disaster, and Risk Management at George Washington University in Washington. "The terror problem, in terms of managing people's fear, was pretty huge-and not very well managed."

The failure of government, medicine, and media to respond to fears and ignorance about anthrax with real understanding led to millions of dollars in losses-to businesses that had to find substitute mail carriers or evacuate their workplaces for testing, as well as to local governments that had to respond to every emergency anthrax scare. In Los Angeles, where hazardous-materials responses increased 300 percent in mid-October, "we received a call from an employee at a doughnut shop that there's a white, powdery substance on the floor," said Deputy Chief Darrell Higuchi, of the Los Angeles County Fire Department. The shop, of course, sold doughnuts with powdered sugar. "Yet," said Higuchi, "you feel for the callers, because they are scared."

Fear thrives on ignorance. But there is no effective, authoritative, nationwide system to communicate information about bioterror. Nor is there a single national spokesperson for the public's health. Indeed, some have criticized the Bush Administration for failing to designate someone as the voice of the anthrax crisis, even acknowledging White House reluctance to call on Surgeon General David Satcher, a leftover Clinton Administration appointee. Instead, information has moved through dozens of parallel and poorly coordinated channels of communication: The Centers for Disease Control and Prevention talks to state health officers, the FBI to local sheriffs, the Federal Emergency Management Agency to disaster officials, medical associations to their members. But when people in different fields, such as police and physicians, must work together, or when there simply is no state or local counterpart to a federal agency, the channels are less clear-as Ong found out in dealing with the Postal Service. The system simply isn't set up to share information.

In fact, civil liberties laws often forbid necessary communication. Said Lawrence Gostin, the director of the Center for Law and the Public's Health, a joint project of Georgetown University and Johns Hopkins University: "The law thwarts vital information-sharing vertically from federal to state, and horizontally between law enforcement, emergency management, and public health."

The biggest gap is between government and the medical community. A CDC alert on bioterrorism, sent to state health officials just after September 11, had still not reached many local emergency rooms a week later. And the crucial linchpins between doctors and officials-local public health offices-are notoriously overworked and short of funds. As many as one in five public health offices do not even have e-mail, said Sen. Bill Frist, R-Tenn., a physician. Many localities still collect epidemiological data on disease outbreaks only by asking doctors to send postcards through the mail-hardly an ideal approach in any fast-moving outbreak, let alone one that strikes at the postal system.

Anthrax has finally kick-started efforts to revive public health systems, after decades of neglect. In North Carolina, for example, the Legislature is about to allocate millions of dollars to replace reporting by postcard with high-speed, highly secure electronic links. Ultimately, the network will connect not only local officials, but also every hospital, pharmacy, and doctor's office in the state.

New funding and new networks are essential first steps. But in a country where almost all health care is provided by the private sector-indeed, where most critical terrorist targets, from Internet servers to nuclear plants to sports arenas, are privately owned-defense against terrorism probably cannot be achieved by a new agency, a new program, or a new technology. True "homeland security," most experts say, will require an overarching system that links not just every level and agency of government, but also the private sector, nonprofit groups, and the general public. Computers and the Internet will be vital in helping to set up this new national network, but it will be the intangible connections between people working together in a common cause that will really make the new system work.

The Broken Linchpin

If it sometimes seems as if the world has turned upside down since September 11, that's because it has. Terrorism has upset the traditional pyramid of who protects whom. No longer do the Pentagon's armed troops bear the brunt of foreign blows. Whether the danger comes from airliners-as-bombs or from anthrax envelopes, local firefighters, medics, and police respond long before Washington can act. But even the local emergency teams come second to the scene. In a terrorist attack, the first responder is the ordinary citizen-the airline passenger who decides to rush the hijackers, the mailroom clerk who notices a suspicious package, or anyone who wonders whether these flu-like symptoms they're feeling might be anthrax. It is their decisions, prudent or paranoid, that trigger the government response. Said Peter Probst, a former Pentagon and CIA official, "The first line of defense is an educated, engaged public."

That word, "educated," signals where things start breaking down. Even those officials who should be best equipped to inform have stumbled over their own statements, and each other's-and that includes Surgeon General Satcher and Health and Human Services Secretary Tommy G. Thompson.

"You've got Satcher saying one thing, Tommy Thompson saying another, and the CDC saying a third," fumed one local official who spoke with National Journal. One day the word is to put everyone on Cipro, the next day not, the third day it's another antibiotic altogether. "There isn't a consistent message."

With that confusion at the top, many officials, never mind ordinary citizens, admit turning to the news media as their first source of knowledge. But as reporters themselves grope in the dark for information, and constantly face the pressure for round-the-clock, up-to-the-minute coverage, they may magnify inconclusive clues, or even outright rumors, into major scare stories. There was so much misinformation about anthrax early on, said one congressional staffer well versed in bioterror, "the first few days, I was kicking the television a lot."

Many confused citizens dialed 911, just to be sure. Far more fell back on the second line of defense: their doctors. Physicians are still trusted more than most other professionals. And even though only a handful of American doctors have ever seen a case of inhalation anthrax (the last U.S. case was in 1978), most rushed to learn what they could. Until recently, medical education on bioweapons has been minimal. But after September 11, well before the first anthrax case in Florida, sensitivity to terror of all kinds was so high that the major medical associations quickly rallied to upload data to their Web sites and downlink teleconferences to their members.

That information probably saved lives. Had Florida photo editor Bob Stevens died in August, said Randall Larsen, director of the Anser Institute for Homeland Security, a consulting group in Northern Virginia, "it's highly unlikely he would have been diagnosed as dying with anthrax, because they weren't looking for it." Before September 11, when authorities sent anthrax samples to four medical laboratories as a test of their bioterrorism alertness, three of the labs just threw the samples out, mistaking the anthrax bacteria for contamination on the slides. In another test, out of a roomful of doctors at Johns Hopkins medical center, just one recognized an X-ray of a strange chest inflammation as characteristic of anthrax. Even after the September 11 attacks, HHS Secretary Thompson initially suggested that Stevens's death was due to a freak natural cause. But doctors were on high enough alert by then to spot the symptoms.

Although the professional medical associations could deluge their members with basic references on anthrax, they lacked the quick communications systems to collect and broadcast up-to-date data on the ever-changing outbreak. In fact, since most associations serve only a single medical specialty-and even the mighty American Medical Association serves fewer than half of all doctors-they could not even help share information among different types of doctors in a given community.

The painstaking, county-by-county collation of data gathered from individual physicians has always fallen to local public health offices-the traditional American defensive line against disease. But emergency officials, medical associations, and independent experts alike all agree that the public health infrastructure has long been, to quote one congressional staffer, "the forgotten stepchild." These local offices are perpetually short on funds, technology, and-above all-personnel. They are burdened with laws written to guard against 19th-century scourges such as syphilis and tuberculosis, and few of these laws even require doctors to report outbreaks of likely bioweapons such as anthrax, much less the subtler indications of spreading disease.

"Suppose there's a run on anti-diarrhea medication. How would we know that? If there are a lot of absences from school or work, how would we know that?" said Georgetown University's Gostin. "We need a public health agency to be able to get information from the private sector."

New York City, considered a national model, does keep hourly tabs on such things as sales of the anti-diarrheal Kaopectate. Los Angeles hospitals are linked by computer to share diagnosis data. But most areas lack such sophisticated "disease surveillance" systems, even in states that have really tried. Virginia, for example, connects its local health offices across the state by computer, said George Foresman, a Virginia emergency management official, but the state's effort to bring private practices into the network stalled because "we just had not been able to secure the funding."

The problems are not only fiscal. Even with a $1.4 million federal grant, Michigan found the private sector deeply reluctant to share information. "We've asked pharmacies if we could monitor what antibiotics are going out," said Dr. Sandro Cinti, of the University of Michigan medical center, "but they didn't want to give away that information."

In the absence of even such imperfect electronic systems, most public health officials collect data the old-fashioned way: slowly. In some places, doctors' offices fill out and mail in forms to health agencies; in other places, they call in, and local officials must laboriously enter the information by hand, and then in turn mail another piece of paper to the state health office. Conversely, when Illinois authorities, who have invested heavily in linking public health offices to local hospitals, wanted to send every physician in the state advice on anthrax, they had to take the licensing board's master list of addresses and mail every one of them a letter. There was no comprehensive e-mail or electronic system.

"The information-gathering and decision-making loop isn't fast enough," said Clark Staten, the executive director of the Emergency Response & Research Institute in Chicago. "The bad guys can move faster than the good guys-at the present time." And during that lag, fear can spread, and people can die.

More Than Medical

Even in a better-than-average flu season, doctors may run out of vaccine and hospitals out of beds. In some cities last year, said Sen. Edward Kennedy, D-Mass., "they had sick patients that couldn't even be treated in the emergency rooms-they were out in cars."

Any major natural disease outbreak overtaxes American medicine. But biological terrorism takes the complexity an octave higher. Each scattering of spores is obviously a public health problem. But it is also evidence of a crime-and of a hazardous material in the environment. Anthrax not only requires close "vertical" cooperation among federal, state, local, and private medical organizations, it also cuts horizontally across functional lines. Ordinary disease can be dropped neatly into an organizational box marked "medical." Bioterrorism requires out-of-the-box cooperation among public health professionals, private doctors, law enforcement agencies, firefighters, emergency management systems, and even foreign intelligence agencies.

This kind of jurisdiction-crossing is so alien to American government that it is often outright illegal. If the Central Intelligence Agency had somehow found out beforehand about the anthrax-laced letter addressed to Senate Majority Leader Thomas A. Daschle, for example, it may not have been allowed to warn health officials until after it was sent, according to James Hodge, the project director of the Center for Law and Public's Health. To protect civil liberties, said Hodge, "there's a firewall between intelligence agencies and public health."

Even when there's no legal obstacle to collaboration, many of the various agencies lack the experience, the contacts, or the procedures to work together. Both the U.S. Postal Inspection Service and the Centers for Disease Control are trying to track the anthrax letters to their source. The two agencies share information, but they don't share people: Instead of combining forces, detectives and doctors are on two separate teams following different methods to reach the same goal.

Sometimes, the lack of coordination could have even worse consequences. "When I was the health commissioner of New York, I had no clue who was the head of the FBI office, and he had no clue who I was," said Margaret Hamburg, who went on to become HHS's top bioterror official under President Clinton. "The last thing they want to be doing is exchanging business cards in the middle of a crisis." Yet, that is just what often happened with the anthrax scare.

In the District of Columbia, for instance, where traditional federal-local complications compounded all the other problems, the initial confusion and inconsistencies in testing and treatment for Capitol Hill staff versus postal workers boiled over into racially tinged fury. One community forum turned, unfairly, into a pillorying of D.C. public health chief Ivan Walks. Soon Dr. Walks and Mayor Anthony Williams were holding joint press conferences with Postal Service officials and the CDC. But those relationships had to be set up on the spot-and the public health office still does not have a full-time representative in the District's interagency Emergency Operations Center.

D.C.'s problem is not uncommon. "We somehow managed to leave the public health system ... outside the emergency system," said Harrald, at D.C.'s George Washington University. Emergency managers, firefighters, and police have largely overcome past problems of coordination by planning and training together before disasters, and by jointly staffing command posts during times of crisis. Such a combined system cranked into action in New York City on September 11. "The federal government had thousands of people moving in the right direction 20 minutes after the second tower was hit," Harrald said. "We know how to do this. That's the good news."

The bad news is that, in most places, no one told public health officials the good news. In D.C., "it took a long time before the emergency room at [George Washington University] hospital and the emergency room at Children's Hospital and the attending physician of the Capitol and the CDC had the same picture of what they were dealing with," Harrald said. "I'm not throwing stones at individuals. The problem is that we didn't set the systems up before the event."

The American Answer

In the first month of anthrax attacks, the country's system of defenses against bioterror often seemed to be no system at all, only chaos. Fortunately, reality is more nuanced, and more heartening, than that. True, there is no one coherent national system. But there are systems-all partial, all imperfect, but needing mainly to be strengthened and brought into an overarching structure. Senate Health, Education, Labor, and Pensions Committee Chairman Kennedy and panel member Frist last year co-sponsored the Public Health Threats and Emergencies Act of 2000, which authorized $540 million a year to strengthen the public health infrastructure and to better recognize and respond to bioterrorism attacks. Congress has not yet funded the new law, but already the two Senators have upped their request to $1.4 billion a year.

The final sum needed for homeland security will surely be much higher. But "we're not going to create a whole new Department of Defense," with a $350 billion budget and staff of 3 million, said David McIntyre of the Anser Institute. "We're going to play with the chips that are on the table."

"The pieces are there," said Frist. The task is taking the pieces that exist-federal, state, local, and private-"and coordinating them in a seamless way. It can be done." In Frist's own field, transplant surgery, moving precious organs quickly across the country and then ensuring that patients' bodies do not reject the new tissue require far-flung hospitals and diverse disciplines to work closely together-and they do it, every day.

High on Capitol Hill's agenda is a massive reinvestment in the nation's long-neglected public health system. Top priority is a secure, high-speed electronic data-link for doctors and public health officials who are now scrawling disease reports on postcards. The CDC already has an electronic Epidemic Information Exchange system to share outbreak alerts among federal, state, and local public health officials, as well as the military. And long before September 11, the CDC had given all 50 states seed money to start work on a National Electronic Disease Surveillance System to link all 2,000-plus local health offices around the country. This network could automatically and swiftly share, for example, the results of a crucial diagnostic test. Ultimately, it could also tap into hospitals and even private practices. But for now, the surveillance network does not actually exist. A bare-bones "base system" is scheduled to begin in 20 states in 2002. That seemed plenty fast-before September 11. Now, lawmakers are likely to hit the gas.

But strengthening public health is only half the battle, because public health officials will still get their information from the private sector. The real challenge is to track-from every hospital, every doctor's office, and every pharmacy around the country-the telltale upticks in certain symptoms, or prescriptions, that although seemingly innocuous in isolation, could signal an impending crisis. It is a daunting task.

Yet it is also mostly done already. Insurance companies routinely require doctors to code each diagnosis and report it electronically for reimbursement, keeping electronic tabs on everything from pharmaceutical sales to major surgeries. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) made such reporting systems mandatory nationwide, though a significant 43 percent of doctors are not yet hooked up. In its patient-privacy rules, the act also has a little-known exception that requires doctors to share data on threats to public health.

Medical information companies are already on the Hill touting software solutions. A properly designed system could tap into the existing streams of data, strip off names and other individual identifiers, and crunch the numbers into trends. To be sure, such an early-warning system might well find false patterns. An upsurge in sales of certain drugs might indicate an outbreak of disease, or it could simply reflect effective advertising. Conversely, the system might miss a real outbreak if doctors consistently misdiagnosed as flu the ambiguous early symptoms of, say, anthrax-the reason why D.C.'s Walks is currently working on a system that codes not just final diagnoses but actual symptoms as well.

Still, the most sophisticated computer is only a tool. The most important linkages are among people. And in small ways, that linking process has already begun, too. Tom Ridge has held teleconferences with all 50 state governors. Local officials and medical associations are reaching out to one another, often through e-mail. And a FEMA program called "Project Impact" gives local governments grants and training to bring together different agencies, businesses, and community groups for disaster planning. Mayor Susan Savage of tornado-prone Tulsa, Okla., says that Project Impact simply but systematically asks, "What does the private sector bring to the table that can complement public resources?" On September 11, for example, when 800 airline passengers were stranded at the Tulsa airport, the city mobilized everything from public buses for transportation to local preachers for counseling, pulling resources freely from the public, private, and nonprofit sectors.

Officials, legislators, and experts increasingly agree that such bottom-up approaches are the model for homeland security. Imposing a single national system from the top down is not only impractical, it is probably unwise. What makes more sense is a "network of networks," an overarching system that lets each local government or private group tailor its approach to its own unique needs-within the overall framework.

A prototype nationwide network of networks has actually already been built. Unfortunately, it was promptly taken apart soon after. Late in 1999, when the public and private sectors alike were fretting that their computers might crash once the year hit "00," then-Secretary of State Madeleine K. Albright visited the national Y2K crisis center and exclaimed, "You could really run the world from here."

Like a terrorist, the Y2K bug threatened to strike unpredictably at any target: federal, state, local, or, in the vast majority of cases, private. Imposing a top-down structure to address the potential threat was impossible, recalled John Koskinen, Clinton's Y2K coordinator: "You need to build off existing structures, and not create new ones." So Koskinen pulled together existing networks-government agencies, corporations, trade associations, and industry groups-in a loose but comprehensive confederation that reached into every threatened sector, with himself as the lead spokesman.

"The year-2000 preparations were a pretty good dress rehearsal" for the kind of coordination required since September 11, said David Vaughan, a Texas public health official. JoAnne Moreau, the emergency preparedness director of Baton Rouge, La., agreed: "We developed relationships with agencies and companies and factions that we never knew would have some kind of role."

The lesson that Y2K holds for homeland defense is that the federal government cannot, need not, and probably should not, do everything. Of course, without strong guidance from Washington, the thousands of private and local-government responses could create an irrational tangle, like an ill-tended garden. The federal role is to fertilize the growth and, when necessary, prune it back. "There are 1,800 separate legal jurisdictions in the United States, and the American people and the Constitution like it that way," said David Siegrist of the Potomac Institute for Policy Studies think tank. "The federal government needs to offer incentives ... and set standards."

In a shadow war with an amorphous foe, America can prevail only by empowering individuals and small groups to innovate-because it is they, and not any federal official, who will be on the front lines. Thirty years ago, noted McIntyre, if a child showed up at school beaten black and blue, teachers might think, "Tough parents," and move on. Today, they would report the possible abuse-and thereby set various responses in motion. A public similarly well-educated to watch for something genuinely wrong in their world would go a long way, not just toward calming panic, but toward stopping terrorists before they strike.

"We don't want to be people who watch each other. We want to be people who watch out for each other," said McIntyre. "It's the distinction between a controlled society and a civil society. A civil society requires citizens. And in good times, maybe we forgot that."

We have certainly been reminded now.

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Anthrax: Threats Sent to Abortion Clinics

A new wave of suspicious powder and anthrax threats arrived yesterday at U.S. abortion clinics via Federal Express, according to reports.  Meanwhile, the investigation into the recent anthrax incidents has come under criticism, the New York Times reported.

Letters containing white powder and threatening notes were shipped to abortion clinics in Philadelphia, Washington, New York state, Ohio, Florida and Michigan by FedEx, according to the Philadelphia Inquirer.  Preliminary tests on one letter found no trace of anthrax, said FedEx spokeswoman Sally Davenport.  For the first time, abortion rights organizations, such as Catholics for a Free Choice, were also targeted, the Inquirer reported. 

The “Virginia Dare Cell,” of the domestic terrorist group the Army of God (see GSN, Oct. 29), signed the notes.   Similar threats mailed to abortion clinics last month were signed “Virginia Dare Chapter,” instead of “Virginia Dare Cell,” said Ann Glazier, Planned Parenthood Federation’s security director.  “The word ‘cell’ is new,” Glazier said.  “I’d say it’s a blatant attempt to convey that they are terrorists.”

The letters were sent using the FedEx billing account number for Planned Parenthood and the National Abortion Federation, which were falsely listed as the senders, according to the Inquirer.  FedEx is working with the FBI to determine who was responsible, Davenport said (Marie McCullough, Philadelphia Inquirer, Nov. 9).

Planned Parenthood President Gloria Feldt said she sent a letter yesterday to Attorney General John Ashcroft and Office of Homeland Security Director Tom Ridge asking that they meet with leaders of organizations representing abortion providers.  “One of the most important things in stopping terrorism is for leaders to stand up and stand together and say ‘we will not tolerate this,’” Feldt said (Rita Rubin, USA Today, Nov. 9).

Anthrax Investigation Criticized

The FBI’s initial unfamiliarity with anthrax contributed to errors in their investigation, government officials, scientists, and investigators said.  “It’s just unrealistic to ask 7,000 agents to overnight become sufficiently knowledgeable about bioterrorist agents and possible means of theft of those items and how they might be disseminated lethally to an American populace” said Bill Tobin, who worked in the FBI chemical laboratory.  FBI officials said they had relied on outside experts for advice on anthrax, but that the investigation was following a logical strategy (see GSN, Nov. 7). 

Soon after the first reported cases of anthrax, the FBI said it had no objections to the destruction of anthrax samples at Iowa State University, according to the New York Times.  Scientists involved in the investigation, however, said that the university collection might have contained important genetic clues. 

A precise match between the anthrax used in the recent incidents and a specific strain in the Iowa State collection might have provided information as to when the bacteria had been isolated and how widely it had been distributed to researchers, according to the Times.  “If those cultures were still alive,” said Martin Hugh-Jones, an anthrax expert at Louisiana State University, they could have helped in “clearing up the muddy history.”

Another flaw seen in the investigation is that few visits have been made to companies, laboratories and academic institutions with the capability to make the kind of potent anthrax mailed in the letter to Senate Majority Leader Tom Daschle (D-S.D.), the Times reported.  When investigators have conducted interviews, only general questions are often asked, several laboratory directors said.

In New Jersey, where the anthrax-tainted letters are believed to have originated, investigators asked Waksman Institute of Microbiology Director Joachim Messing only a few general questions about growing bacteria and did not mention specifically what kind of information they wanted, according to the Times.  Messing said he felt obligated to volunteer that his laboratory did not handle anthrax. 

“I couldn’t give you a clue what they were after,” Messing said.  “I asked the person from the FBI if he knows anything about bacteria, some very simple questions, and it was very clear that he didn’t have the background to make evaluations.”

FBI officials also appeared unaware of ChemShow, an international chemical and pharmaceutical convention that was held last month in New York, according to the Times.  Hundreds of chemical and pharmaceutical equipment manufacturers, engineers and technicians attended the show.  “If [investigators] weren’t crawling around that show, they should have been, said Richard Barbini, a chemical engineer and salesman for Arde Barinco Inc.  “There’s all kinds of people there from many different companies, a lot of people who know a lot” about how to make anthrax.

The FBI and other sections of the Justice Department would be reformed to better prevent terrorist attacks in a plan announced yesterday by Attorney General John Ashcroft (New York Times, Nov. 9)   

First Anthrax Death in Medical Journal

The letter sent to Bob Stevens, the Florida man who was the first to die from anthrax (see GSN, Oct. 5), was likely mailed within a few days after the Sept. 11 terrorist attacks, according to a recent article in the New England Journal of Medicine. 

Stevens became infected with anthrax Sept. 19, according to the doctors who treated him.  He had “closely examined a suspicious letter containing powder” that day, coworkers at American Media Inc. said and the Journal reported.  Stevens became ill around Sep. 27 and died Oct. 5, according to USA Today.  The incubation period—the time between Steven’s exposure and the onset of his illness—is “highly plausible” when compared with earlier anthrax research, said Larry Bush, one of the author’s of the Journal article (Parker/Sternberg, USA Today, Nov. 9).

Click here to read the article in the Journal.

About 32,000 people are taking antibiotics in wake of the recent anthrax incidents, the U.S. Centers for Disease Control and Prevention said.  Of those, 5,000 are on the full 60-day treatment. A recent study has shown only 20 percent of people on Cipro, a common anthrax antibiotic, have reported minor side effects.  The Food and Drug Administration planned to contact all 32,000 people on antibiotics to count incidents of side effects and to make sure there are no relapses after ending treatment, according to the Associated Press.

New guidelines report that finding traces of anthrax spores on surfaces does not warrant closing buildings or prescribing antibiotics, medical authorities said (Lauran Neergaard, Associated Press/Atlanta Journal-Constitution, Nov. 9).  

Postal Service Developments

The Bellmawr postal facility in New Jersey was ordered to reopen last night (see GSN, Nov. 8) by a federal judge, according to CNN.  The facility had been closed twice over disputes between management and postal workers over anthrax decontamination. 

Management of the facility and local postal worker union officials worked out an agreement under which the facility would open, contingent upon “systematic anthrax testing” to be conducted through February 2002, U.S. District Judge Jerome Simandle said. 

“We are very pleased with the mutual agreement and look forward to working with union officials,” said Postal Service spokesman Paul Smith (CNN.com, Nov. 8).

Postmaster General John Potter asked Congress yesterday for $5 billion to help improve mail safety (see GSN, Oct. 31).  “We urge Congress to recognize that emergency funding is required as part of the effort in defending homeland security,” Potter said.  “Users of the mail should not be burdened with these extra costs through the price of the postage.”

Between $3 billion and $4 billion will be spent on security efforts, such as cleaning postal facilities and buying equipment to sanitize mail, according to Potter.  Already, the Postal Service has cut more than 11 million hours from employees’ shifts to ease costs, Potter said.  Without the funding, further job cuts and higher postal rates could jeopardize the Postal Service’s future, he said.

Some members of the Senate Appropriations Subcommittee on Treasury and General Government, which oversees the Postal Service, seemed open to Potter’s request, according to the Atlanta Journal-Constitution.  “A direct appropriation to the Postal Service would be extremely unusual, but these are unusual times,” Subcommittee Chairman Byron Dorgan (D-N.D.) said. 

“I don’t know that there is much enthusiasm for bailing out, quote unquote, the Postal Service,” however, Majority Leader Daschle said yesterday.  “They have their ways of addressing their need for resources, and they ought to use them” (Kim/Hopgood, Atlanta Journal-Constitution, Nov. 9).   

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Smallpox: CDC Prepares Smallpox Response

The U.S. Centers for Disease Control and Prevention plans to create mobile teams staffed with eight people each to respond to potential smallpox outbreaks, according to yesterday’s Boston Globe.  The CDC plans to release a full smallpox response plan in two or three weeks as part of national efforts to prepare for potential terrorist attacks. 

Under an outline of the plan, eight-person teams would respond to any reported smallpox cases, isolate the patient, vaccinate everyone who had recent contact with the patient and then vaccinate a second ring of people who were exposed to those who had contact with the patient, the Globe reported. 

Several experts said that despite the enormous amount of work required to track down and vaccinate that many people, the move was necessary.  “I think you have to do the secondary ring.  You have to assume that … those people still might get sick.  The wider you take that second ring, the wider the insurance policy you have,” said Walter Orenstein, director of the CDC’s National Immunization Program. 

The response teams would include a physician leader, a senior public health adviser, two epidemiologists, a lab specialist, a communications specialist, a community liaison and a technical support worker.  The teams would cooperate with state and local officials. 

The CDC has already vaccinated 140 first-responders (see GSN, Nov. 6) against smallpox (John Donnelly, Boston Globe, Nov. 8).

U.S. to Choose Smallpox Vaccine Producer

Meanwhile, U.S. Health and Human Services Secretary Tommy Thompson could award a contract today to one or more of the companies remaining in negotiations to produce enough smallpox vaccine for the U.S. population (see GSN, Nov. 8).  Thompson said he could announce the contract winner or winners shortly after a meeting with company representatives today.

Issues of liability and antitrust laws must still be negotiated, Thompson said. 

The proposed vaccine would be made from live vaccinia virus (see GSN, Oct. 24) and would be purer than the old vaccine, although it would have the same risk of negative side effects (Linda Lloyd, Philadelphia Inquirer, Nov. 9).

Will the U.S. Vaccinate All Americans?

U.S. President George W. Bush said yesterday that he was discussing with Thompson the possibility of requiring all Americans to receive a smallpox vaccination.  He expressed concern that a mass vaccination program could kill people due to the vaccine’s side effects.  “One of my concerns is if we were to have universal vaccination, some might lose their life.  And I would be deeply concerned about a vaccination program that would cause people to lose their life … but I’m looking at all options,” he said (Federal News Transcript, Nov.8).

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U.S. Response: Military Lacks Medical Personnel, GAO Says

The U.S. military does not have the medical personnel needed to respond to a biological or chemical warfare attack, said a congressional report released Tuesday.

The Defense Department does not have the specialists needed in the event of a chemical or biological warfare attack and has not adopted its medical plans to chemical or biological warfare, said a report from the General Accounting Office.  The shortcomings in the military’s planning can be attributed to several factors, including failure to establish it as a medical priority and pessimism over being able to treat large numbers of casualties from such an attack, the report said.

The GAO found that less than 20 percent of the military’s medical personnel had completed any specialized chemical and biological military medical training.  “While progress has been made since the Gulf War in increasing the ability of such specialized training, these courses are essentially voluntary,” the report said.  

Military medical planners said that no “realistic” field exercises of medical support for chemical or biological warfare had been conducted, according to the report.  Only two joint military exercises since 1993 had included medical responses to a chemical or biological weapons attack (GAO report, October 2001).

“The GAO findings indicate the [military] has some efforts underway, but has yet to succeed in reshaping conventional medical planning to address the unique challenges of chemical and biological warfare,” said Christopher Shays (R-Conn.), chairman of the House of Representatives Subcommittee on National Security, Veterans Affairs and International Relations.

Before the Sept. 11 terrorist attacks the military believed the possibility of a chemical or biological weapons attack was low, said GAO Senior Analyst Nancy Kingsbury.  “Relative to being shot at, [being attacked with chemical or biological weapons] is a low probability event,” Kingsbury said. 

“The GAO report is helpful and I believe it provides a roadmap [for making future changes],” said Assistant Defense Secretary for Health Affairs William Winkenwerder.  “Since Sept. 11 and the multiple anthrax attacks, terrorism’s potential to cause loss of life, disrupt missions or activities and install fear in daily life has been clearly demonstrated” (Eun-Kyung Kim, Associated Press, Nov. 7).

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U.S. Response:  CDC Wants Quarantine Powers

The U.S. Centers for Disease Control and Prevention wants to allow states to enact quarantines in the event of a biological warfare attack, Health and Human Services Secretary Tommy Thompson said Tuesday. 

“If we did have an outbreak of smallpox, that would be, certainly, one of the avenues that we would have to quickly explore,” Thompson said.  A biological warfare attack would force the government to create “concentric circles” of containment in order to inoculate people and prevent the spread of disease, he said.

The CDC’s proposed emergency health powers act, developed with the National Governors Association and other groups, states that a person under quarantine would “obey the public health authority’s rules and orders.”  Failure to obey would be a misdemeanor.  The plan also would allow states to commandeer “appropriate property as necessary for the care, treatment and housing of patients” (Eunice Moscoso, Atlanta Journal-Constitution, Nov. 7).  Other features of the plan would require pharmacies to report surges in prescriptions that might indicate a bioterrorism attack was underway and allow states to access health data and order medical examinations.

Governors in many states already have limited quarantine powers, according to USA Today.  The proposed act would broaden their authority into other areas, such as compulsory vaccinations.  “Every state’s government needs to go back and make sure they have the necessary legal framework to address properly a large scale bioterrorism attack,” said Maryland’s Secretary of Health and Mental Hygiene Georges Benjamin (Larry Copeland, USA Today, Nov. 8).  

Mobilized National Guard units would enforce the CDC’s authority, said former Federal Emergency Management Agency Director James Witt.  “If you look at something that’s really contagious, you can try to limit the area that it would be in as much as possible,” Witt said.  He added that the real question, however, was: “How far would you go in containing it?”

It is likely that people would attempt to evade restrictions in the event of quarantine, experts said.  “What are your rules of engagement?” asked ANSER Institute of Homeland Defense Director Randy Larsen.  Would a National Guard soldier, Larsen asked, shoot a grandmother trying to evade the quarantine?  “You have to use all reasonable force to exercise that power,” said Lawrence Gostin, director of Georgetown University and Johns Hopkins University Center for Law and the Public Health.  That could include lethal force, Gostin said (Seth Borenstein, Knight-Ridder/RealCities.com, Nov. 7). 

CDC Flush With Funds

It’s never been easier for the CDC to obtain funding, said Georgia’s Senators Max Cleland (D) and Zell Miller (D).  “It’s on the front burner big time because people realize the CDC is a national security agency now,” Cleland said.  “It doesn’t just track flu in Philadelphia or diseases in Africa.  It now is going to help us prevent major loss of life, but it’s got to be dramatically upgraded.”

One of those upgrades is a new CDC headquarters, to which a Senate spending panel has allocated $250 million.  President George W. Bush’s request was for $150 million, which would have finished construction in 10 years.  The new money is expected to cut the construction time in half, according to TB & Outbreaks Week. 

The full Senate and House of Representatives must approve the additional funding and Bush must sign it, but Georgia’s senators said they are not worried.  “There’s always been a small group in both the Senate and the House, and also those in federal agencies, who understood how important the CDC is, Miller said.  “But I would say your average congressman did not.  Now they do.”

The CDC’s fiscal 2002 budget will total $4.4 million if all funding requests are approved, according to TB & Outbreaks Week.  “We would have limped along, business as usual,” Cleland said.  “Now four weeks later, we’ve got a record budget passed” (TB & Outbreaks Week, Nov. 6).

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Anthrax:  Washington Postal Worker Called 911 Before Dying

A Washington postal worker called 911 to contact emergency personnel on the day he died from inhalation anthrax and told the operator he had been near a letter that contained a suspicious powder, the Washington Post reported today.  Meanwhile, government officials said the United States should remain on alert as the investigation into the recent U.S. anthrax incidents continued (see GSN, Nov. 8).

Thomas Morris, who worked at the anthrax-tainted Brentwood Road mail facility (see GSN, Oct. 23), told 911 operators he believed he had been exposed to a suspicious powder that contained anthrax when he was in the vicinity of a fellow worker who handled an envelope with the powder inside a week earlier.  He started to feel ill on Oct. 16 and went to the doctor two days later, he said, but the doctor said he was suffering from a virus and recommended Tylenol. 

Postal officials had told him that tests results on the powder for anthrax had come back negative, Morris told the 911 operator, but “I have a tendency not to believe these people.”

The letter Morris mentioned passed through the Brentwood Road facility on Oct. 13, which may have been the same time that an anthrax-tainted letter sent to U.S. Senate Majority Leader Tom Daschle (D-S.D.) also went through the facility, according to the Post.  The coincidence is startling, postal officials said.  The letter Morris talked about, however, was not the same as the Daschle letter and did not contain anthrax, Postal Service Vice President Deborah Willhite said.

The letter Morris mentioned was set aside when someone noticed powder leaking out of it and taken to the FBI for testing, Willhite said.  “It was torn enough that powder was coming out of it,” she said.  “The FBI had it tested, and it came back negative and the workers were informed that it was negative” (Justin Blum, Washington Post, Nov. 8).

Source Remains Unknown

The source of the anthrax used in the recent incidents was still unknown, Office of Homeland Security Director Tom Ridge said yesterday in a press briefing.  “The investigation continues to preserve—we haven’t included or excluded either a domestic or an international source for the anthrax,” he said.  “There have been some suggestions that it could be domestic, but that has not been confirmed in any manner, shape or form” (U.S. State Department transcript, Nov. 7).

Baby’s Case Enters Medical Journal

The case of a 7-month-old baby boy of an ABC employee who contracted skin anthrax (see GSN, Oct. 16), in a location where no traces of anthrax had been found, was so rare it caused the New England Journal of Medicine to report the case, according to USA Today.

The lesion on the boy’s arm was initially believed to be a spider bite, said New York City physician Mary Wu Chang.  “This was before the first New York anthrax case was known,” Chang said.  Later tests would determine the cause was skin anthrax, a diagnosis doctors had not considered because they had no reason to, according to Chang.  “In the whole country, there would be very few doctors who’ve seen anthrax,” she said.  “It’s just so rare, unless you’re in a place with infected cattle.  This was Manhattan.”

The symptoms of the lesion, however, matched those of skin anthrax, according to USA Today.  The arm was swollen from shoulder to hand and a sore on the elbow oozed out a sticky yellow fluid.  The wound did not hurt, which is typical of anthrax, doctors said.  “It looks terrible but it’s painless,” Chang said.  “He didn’t feel 100 percent, but he would play and interact as if he wasn’t really ill.” 

The boy’s doctors chose to submit pictures of the lesion to the medical journal so other doctors could recognize the symptoms of skin anthrax and learn how to diagnose it early.  The journal decided to release the article on the boy’s case before the issue’s Nov. 29 publication date because of “public health concerns” (Steve Sternberg, USA Today, Nov. 7).

Postal Workers Try to Close Facilities

The anthrax-tainted Bellmawr postal facility in New Jersey (see GSN, Nov. 1) was closed again yesterday after workers complained that clean up efforts had failed.  The South Jersey Area American Postal Workers union asked a federal judge to close the facility after a government-hired contractor cleaned the wrong machine.  A hearing has been set for next week to determine if Bellmawr should remain closed, according to the Associated Press (Associated Press/New York Daily News, Nov. 8).

Compressed air used to clean mail-sorting machines at the Morgan mail facility in New York City are likely responsible for the spread of anthrax there, a public health expert testified yesterday.  The New York Metro Area Postal Union has filed suit to close the Morgan facility after spores were found on five machines there. 

Whoever sent the anthrax “lucked into a perfect vector” as the bacteria and fears spread, Columbia University Professor Jeanne Stellman said (Jim Fitzgerald, Associated Press/RealCities.com, Nov. 8).

Perpetrators May Have Killed Themselves in Attack, Experts Say

Investigators are working with coroners’ offices to examine if those responsible behind the recent anthrax incidents may have killed themselves in the process, a health official said yesterday.  “There may be perpetrators that may be ill and may have died” from handling the anthrax, said Scott Lillibridge, a bioterrorism advisor to Health and Human Services Secretary Tommy Thompson.

Officials in New Jersey, where two of the anthrax-tainted letters may have originated, are looking through coroners’ records for deaths that may have resulted from anthrax, said State Attorney General’s Office spokeswoman Emily Hornaday.  “They just haven’t found anything at this point,” Hornaday said.

Some experts, however, are unsure that those responsible would have infected themselves. “If they knew anything about anthrax, they would have been on antibiotics beforehand,” said Greg Ackerman, a researcher at the Center for Nonproliferation Studies.  “They would have limited exposure as much as possible” (Seth Borenstein, Knight-Ridder/RealCities.com, Nov. 8).

World Anthrax Cases

Preliminary testing on a suspicious powder found at an oil company in Vietnam came back positive, a Vietnamese Ministry of Health official said today.  Another sample of the powder is being retested at the Central Institute of Hygiene and Epidemiology in Hanoi, the official said. 

The powder was found between pieces of folded paper in a BP Petco meeting room in Ho Chi Minh City, General Manager John Kilgour said.  Until conclusive test results were available, all findings were “purely speculative,” Kilgour said (Associated Press/RealCities.com, Nov. 8). 

A letter mailed to the U.S. Consulate in Lahore, Pakistan tested negative for anthrax (see GSN, Nov. 6), U.S. State Department spokesman Richard Boucher said yesterday.  Preliminary tests by Pakistan on the letter had tested positive.  Further testing done at the U.S. Army Medical Research Institute of Infectious Diseases, however, came back negative, Boucher said.  “Speculation about foreign origins of anthrax spores is rather uncalled for, one might say, given the result,” Boucher said (Alan Sipress, Washington Post, Nov. 8).  

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Smallpox: Small Drug Makers Offer Cheaper Vaccines; More

Three small vaccine manufacturers that lost the first bidding round for a smallpox vaccine contract with the United States said yesterday they could supply the requested 250 million doses at a lower price than the larger companies still being considered.  Their claim came the day after U.S. Health and Human Services Secretary Tommy Thompson said his original request of $509 million was substantially inadequate in light of proposals from remaining competitors (see GSN, Nov. 7).

Louis Potash of Novavax, a company eliminated from the bidding a week ago, said his company could have met the government’s requested price of $2 per dose, lower than any of the remaining bids.  Some small companies have already done research work on smallpox vaccine in the last two years and said they have the viral seed stock to produce the vaccines quickly and cheaply if they rented space at larger laboratories. 

The larger companies, however, would have to “spend a couple months figuring out what to do,” said an official at Dynport, which currently is developing a smallpox vaccine under a U.S. Army contract.  The Army told Dynport to give its viral seed stock to Merck, a company still in negotiations for a contract, the official said.

The three remaining competitors for a government contract are Merck, GlaxoSmithKline and a partnership between Acambis and Baxter International.  Thompson said his department was basing its decision not only on price but also on speed, safety and effectiveness.

Liability

Meanwhile, Congress has been debating whether the federal government or drug companies should accept the burden of liability for a smallpox vaccine.  Doctors have predicted that vaccinating the entire U.S. population against smallpox would result in hundreds of deaths and another 1,000 or more cases of brain damage from the vaccine, so drug companies have asked the federal government to provide them with immunity. 

Representative Billy Tauzin (R-La.) said yesterday the government should accept liability (Keith Bradsher, New York Times, Nov. 8). 

Scientists Speed Efforts

U.S. scientists have dramatically increased efforts to develop drugs to prevent or treat diseases such as smallpox or anthrax that could be used in bioterrorism attacks, the Washington Post reported today.  Private-sector scientists have been working overtime and breaking through usual bureaucratic barriers in an attempt to protect the United States from terrorists.

“A lot of people would say we won World War II with the help of a mighty industrial base.  In this new war against bioterrorism, the mighty industrial power is the pharmaceutical company,” said Michael Friedman, a former U.S. Food and Drug Administration official now charged with coordinating the pharmaceutical industry’s efforts.

Pharmacia Corp. in New Jersey made an unprecedented offer to allow government scientists access to its confidential libraries of millions of compounds—one of the company’s greatest assets—to look for drugs that could fight bioweapon agents.  Other companies have indicated they would also grant government scientists access if asked (Justin Gillis, Washington Post, Nov. 8).

Canadian Germ Squads Vaccinated

Canadians responsible for responding to potential smallpox terrorist attacks have been vaccinated against the disease (see GSN, Nov. 7), Canadian Health Minister Allan Rock said, according to a report today in the Ottawa Sun. The action came shortly after the United States began vaccinating its first-responders (see GSN, Nov. 6).  “We’ve already vaccinated here in Canada people who are working on the preparation for the remote possibility of smallpox.  And we’ll continue to do that as appropriate,” Rock said.

Canada Considers Stockpiling Vaccines and Looks At Cost

Rock also said he was considering stockpiling enough smallpox vaccine doses for every Canadian, contrary to an announcement last week that he had decided against such a move (see GSN, Oct. 31).  “We’re not talking about vaccinating our populations now, but having the capacity to do so in the future if necessary,” he said (Stephanie Rubec, Ottawa Sun, Nov. 8).

Canadian officials have revised the estimated cost of ordering 30 to 32 million doses of the vaccine after the United States announced the cost would exceed its original estimates.  Stockpiling the vaccine could cost Canada around $400 million, four times more than originally planned, according to the Ottawa Citizen (Ian MacLeod, Ottawa Citizen, Nov. 8).

Germany Buys Vaccines

Germany has ordered six million smallpox vaccine doses to respond to concerns about biological terrorist attacks, German Health Minister Ulla Schmidt said yesterday.  Germany would spend about $46 million for the vaccines and take additional steps toward increasing smallpox vaccine production, Schmidt said (Agence France-Presse, Nov. 8).

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Vaccine Supply: Government Should Oversee Vaccines, Academy Says

Private companies are unable to develop and produce the vaccines that the United States needs, so the federal government must shoulder the task, members of the National Academy of Sciences said on Monday.

In an open letter to the Bush administration, the 22 members of the academy’s Council of the Institute of Medicine cited evidence that the private sector cannot meet the country’s basic vaccine needs. For example, tetanus and flu vaccines are in short supply, a vaccine against pneumonia-causing bacteria is unavailable in several states, and vaccines for meningitis and measles-mumps-rubella are each made by only one manufacturer.

The threat of bioterrorism poses additional problems, such as delays in developing and procuring vaccines against anthrax and smallpox (see GSN, Nov. 7). The council members said that, beyond the media hype, recent concerns about vaccine shortages are only one example of a greater national need that has been building since the early 1990s. An entity such as a national vaccine authority is “long overdue,” they said.

Only four major vaccine manufacturers are operating in the world today—including two in the United States—compared with four times that many 20 years ago, according to the council. Small venture firms produce good vaccines but often cannot finance the costs of clinical trials and manufacturing necessary to bring their products to market (National Academy of Sciences release, Nov. 5).

A national vaccine authority could spur private vaccine development by guaranteeing prices or financing vaccine research, the council said. The authority could oversee a government vaccine factory and facilitate communication among researchers. It also could ensure that large federally approved factories are available to produce emergency supplies while ensuring that routine vaccines are not ignored, and it could potentially protect against lawsuits (Lauran Neergaard, Associated Press, Nov. 6).

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Iraq: Defectors Describe Camp Where Weapons Were Made

Two Iraqi defectors said yesterday that they had worked at a covert Iraqi government camp that produced biological weapons and trained Islamic terrorists.  At the site at Salman Pak, terrorists trained to carry out attacks against neighboring countries, and even Europe and the United States, the defectors said. An Iraqi group that wants to overthrow Iraqi President Saddam Hussein introduced the two men to the New York Times, the newspaper reported.

“We were training these people to attack installations important to the United States,” said one defector, a lieutenant general and a former senior official in the Iraqi intelligence service, the Mukhabarat.  “The Gulf War never ended for Saddam Hussein.  He is at war with the United States.  We were repeatedly told this.”

Inside Salman Pak was a highly guarded compound headed by a German, where Iraqi scientists worked to create biological agents, according to the defectors.  The German had been described as “the man who caused all our problems in 1991,” the general said.  The compound where the biological agents were said to be produced was bombed during the Gulf War, he said. 

The general said there was a lot he did not know about the workings of Salman Pak.  “We were forbidden to speak about our activities among each other, even off duty.  But over the years you see and hear things.  These Islamic radicals were a scruffy lot,” he said.

Iraq had told U.N. inspectors that the camp was an anti-terrorism training camp for Iraqi special forces, said Richard Sperzel, former head of the U.N. biological weapons inspection teams in Iraq.  “But many of us had our own private suspicions,” Sperzel said.  “We had nothing specific as evidence.  Yet among ourselves we always referred to it as the terrorist training camp” (Chris Hedges, New York Times, Nov. 8).

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Anthrax: Investigation Going Slowly, FBI Says

Investigators have been unable to gather much information about the recent U.S. anthrax incidents, FBI officials told Congress yesterday.  Meanwhile, anthrax’s reach extended to Siberia, with spores discovered in a U.S. consulate in Russia, according to reports.

The FBI was “pressing hard” to answer many questions relating to the anthrax incidents, including how many people have access to anthrax strains, said James Caruso, deputy assistant director of the FBI’s counterterrorism division.  “The research capabilities of thousands of researchers is something that we’re still trying to run down,” Caruso said.

Caruso’s testimony surprised the senators at the hearing, according to the New York Times.  “The bottom line is this: As of now, you don’t know where the anthrax came from and you have not been able to identify all the people who may have access to it.  Is that correct?” Senator John Edwards (D-N.C.) asked.  Caruso said, “That’s correct.” 

“I’m very surprised by how little people know,” said Senator Diane Feinstein (D-Calif.), who has sponsored legislation to improve laboratory security.  Feinstein said the gaps in the U.S. government system to track laboratories that work with deadly pathogens are “just a symbol of a kind of laissez-faire system that is very detrimental to the security of the American people.”  One reason that officials do not know how many laboratories handle pathogens is that not all of them are required to register with the government (see GSN, Oct. 31), according to FBI officials.  “There is no doubt we can make some improvements in the law,” Senator John Kyl (R-Ariz.).

Under federal law, anthrax is classified as a “select agent” and is regulated by the U.S. Centers for Disease Control and Prevention, according to the Times.  Laboratories that ship select agents must register with the CDC when doing so.  Investigators were examining those shipping records for clues, said Justice Department official Jim Reynolds.  “I don’t want to leave the impression that we have no idea where anthrax is,” Reynolds said.

There are loopholes in the law, said American Society for Microbiology President-elect Ronald Atlas.  If a laboratory acquired anthrax before 1997, it could continue to possess the microbe without notifying the government, as long as it did not ship the anthrax, he said.  Atlas said a plan to remove the grandfather clause “makes sense.”

Too much regulation, however, would prevent researchers from studying deadly pathogens, according to Atlas.  “We can’t cripple the biomedical community,” Atlas said.  “You can impose all the biosafety rules you want and the bioterrorists aren’t going to necessarily follow them” (Stolberg/Johnston, New York Times, Nov. 7).   

Anthrax in Siberia

The U.S. Consulate in Yekaterinburg, Russia today confirmed the presence of anthrax spores.  The State Center for Medical-Epidemiological Control in Yekaterinburg found spores inside one of six unclassified diplomatic mailbags received from Washington, the consulate said in a statement.  The source of the anthrax was unknown.

Since it took a second test to detect the anthrax spores, the amount in the bag is likely to be negligible, consulate officials said.  Officials did not know what to do with the potentially tainted mail inside the bag, said a health official.  “By Russian rules, it should be destroyed,” said Igor Romanenko, deputy head of the regional health service.  “On the other hand, it is American property.”

Yekaterinburg was the scene of an anthrax release in 1979, when it was known as Sverdlovsk.  About 100 people died after an accident at a secret germ warfare plant there (Reuters/South China Morning Post, Nov. 7).

Putin Says Russian Pathogens Are Secure

It is impossible for terrorists to steal or buy supplies of anthrax or smallpox from Russia, Russian President Vladimir Putin said Monday.  “Those materials have been guarded, we guarded in the Soviet Union and Russia, very securely,” Putin said.  “So I exclude that possibility.  I believe this is true of anthrax and smallpox” (Barry Schweid, Associated Press/Washington Post, Nov. 7).  

Some Tests Turn Out to be Negative

New anthrax tests conducted on U.S. Food and Drug Administration mailrooms (see GSN, Nov. 2), a Health and Human Services Department office (see GSN, Oct. 30) and the clothing of Kathy Nguyen, who died last week from anthrax (see GSN, Oct. 31), have all come back negative, officials said Monday.  Preliminary tests had been positive.  “Everything is negative,” said FDA spokesman Lawrence Bachorik.

Initial tests, which can be done in a matter of hours, are not precise, said CDC lead investigator Bradley Perkins.  To confirm whether a site is contaminated, investigators must conduct tests that take 24 to 48 hours (see GSN, Nov. 7), because they involve growing cultures of bacteria found in samples.  The results of the faster, earlier tests are often reported prematurely and that can lead to some people being placed on antibiotics unnecessarily, according to some experts.

The CDC is “trying to find the right balance point,” Perkins said, and added that most findings of anthrax spores in buildings pose little risk to workers (Garrett/Povich, Newsday, Nov. 6).

All recent tests for anthrax at the Pentagon Concourse post office are negative, Defense Department officials said yesterday.  Trace amounts of anthrax had been found earlier in two mailboxes at the post office.  There was no evidence of contamination and no evidence that the anthrax had spread to the customer service area or any other area of the post office, said Pentagon spokesman Dick McGraw.  “Every swab returned negative results,” McGraw said (Jim Garamone, American Forces Press Service, Nov. 6).

Senate Clean-Up Plan Dropped

A plan to clean the anthrax-contaminated Hart Senate Office Building with chlorine dioxide gas (see GSN, Nov. 6) has been abandoned, Senate Majority Leader Tom Daschle (D-S.D.) said yesterday.  “There are too many dangers inherent with using gas throughout the entire complex,” Daschle said.  A new plan will pump gas into Daschle’s office and Senator Russell Feingold’s (D-Wis.) office, as well as the heating and air conditioning system, while other areas where anthrax spores were found will be treated with disinfectant foam, according to Daschle. He added that he hoped the process would be finished by Thanksgiving week (David Rosenbaum, New York Times, Nov. 6).

Hamas Writer Praises Anthrax

Atallah Abu al-Subh, a Hamas writer, published an article titled “To Anthrax” that encouraged terrorists to continue to use anthrax to create horror in the United States, according to the Jerusalem Post. 

“If I may give you a word of advice, enter the air … the water faucets from which they drink, and the pens with which they draft their traps and conspiracies against the wretched peoples,” he wrote (Al-Risala, Middle East Media Research Institute translation/Jerusalem Post, Nov. 7).

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Smallpox:  Vaccine Cost Will Exceed $509 Million

Buying enough smallpox vaccine doses for the U.S. population will cost more than the previously requested amount of $509 million (see GSN, Nov. 6), U.S. Health and Human Services Secretary Tommy Thompson said yesterday, and added that the cost could be four times that amount, about the equivalent of the department’s entire $1.9 billion bioterrorism budget (Ceci Connolly, Washington Post, Nov. 7).

The prices drug companies have proposed in negotiations have exceeded the $1.70 per dose the government estimated earlier, Thompson said. 

The government might award a contract to a potential vaccine manufacturer by the end of this week, Thompson said.  Ten companies originally applied to produce the smallpox vaccine (see GSN, Oct. 25), and HHS is considering three finalists.  Last week, GlaxoSmithKline, Merck & Co., American Home Products Corp. and a collaboration including Baxter Healthcare Corp. and Acambis remained in the running.  Thompson would not say which company had dropped out of the negotiations.

The United States already has a contract with Acambis to produce 54 million smallpox vaccine doses by next year (see GSN, Oct. 18).

A U.S. federal commission last week recommended the U.S. government create its own facility to produce anti-bioterrorism vaccines, saying, “The private sector is unlikely to be the answer to some of the more difficult vaccine issues” (Charles Ornstein, Los Angeles Times, Nov. 7).

Diluting the Current Vaccine Stockpile

Meanwhile, researchers are beginning a 2 1/2 month study to test the efficacy of diluted smallpox vaccines to learn if the current U.S. stockpile of 15.4 million doses could be stretched to inoculate many more people.  Researchers at four institutions will test diluting the vaccine by one-fifth and one-tenth of the original concentration.

In a pilot study last year on 20 people, researchers discovered that vaccines diluted by one-tenth had a significant number of positive results, but doses diluted 100 times offered little protection against infection.

If the experiment works, the diluted vaccine could be ready by the end of this year, said Anthony Fauci, head of the National Institute of Allergy and Infectious Disease, which is funding the research, adding, “It’s a very quick way to markedly expand the amount of vaccine that we already have, which on face value in the undiluted form would not be a lot.  It’s prudent to be prepared.”

Diluting the U.S. stockpile would be only a temporary measure to provide a response to a potential smallpox terrorist attack until millions more doses could be produced, experts said.  “This is a stopgap measure to make more doses available until that new vaccine is developed,” said Sharon Frey, lead researcher on the smallpox study at St. Louis University.

Anything to increase the number of doses is an improvement, said Neal Halsey of Johns Hopkins University, adding, “I am sure there is nowhere near enough smallpox vaccine to provide it to everyone in the country and even those who would be exposed in a large incident” (TB & Outbreaks Week, Nov. 6).

Canadian Response

Health Canada is considering following a U.S. decision last week to vaccinate some medical personnel who would investigate suspicious smallpox cases, Paul Gully, director general for Health Canada’s Center for Infectious Disease Prevention and Control, said Monday (Ian MacLeod, Ottawa Citizen, Nov. 6).

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Anthrax: New Tests and Vaccines Developed

Researchers at the Mayo Clinic, based in Rochester, Minnesota, said yesterday they had developed a new test that dramatically reduces the time needed to detect anthrax.  It can identify the presence of anthrax in about 35 minutes instead of in days, according to the clinic. The test could be available in some regions as soon as Nov. 9.

“The first thing people want to know in a case of suspected exposure is whether the agent was anthrax,” said Mayo Clinic microbiologist Franklin Cockerill, who led the development team.  “Until now, local labs have been able to quickly determine the presence of a bacterium, but they can’t tell whether it was anthrax or not.  The current process to identify the presence of anthrax may take several days.  The events of the last several weeks require as rapid a response as possible” (Mayo Clinic release, Nov. 5).

Mayo Clinic researchers developed diagnostic biochemicals that could be used to identify signature patterns in anthrax DNA, but they needed a large quantity of DNA material on which to run the test. They turned to Switzerland-based Roche Diagnostics, which makes an instrument called LightCycler. The instrument can take a small sample of DNA and replicate many copies using a common laboratory technique known as polymerase chain reaction, or PCR. The LightCycler simultaneously probes for signature anthrax patterns while it replicates the DNA (Mayo Clinic release, May 20).

Roche is working to expedite regulatory approval from the U.S. Food and Drug Administration.  Once the test receives FDA approval, which is expected later this year, it will cost about $50 to $60, said Juergen Flach, vice president for Roche Molecular Biochemicals (Knight-Ridder/Baltimore Sun, Nov. 6).

Indian Scientists Develop Safer Anthrax Vaccine

Biochemists in India have developed a new anthrax vaccine that could be available in six to nine moths, the Indian government said on Monday.  The new vaccine, which researchers have worked on for more than six years, has already been tested on mice and guinea pigs and would be tested on humans in the next six months under a fast-track plan used in emergencies, scientists said. 

The new vaccine “is much easier to produce and the cost of production would be very low,” said Murli Manohar Joshi, India’s science and technology minister.  “Vaccines are available even now but they have strong side effects, they need boosters and are expensive, but the recombinant process through which Indian scientists have now developed a vaccine avoids toxic effects.”

To make the new vaccine, biochemists at Jawaharlal Nehru University and the Center for Biochemical Technology extracted a small amount of a protective biochemical called an antigen from E. coli bacteria. Previous versions of the vaccine have used potentially harmful B. anthracis, the bacteria that cause anthrax.  After extracting the antigen the biochemists produced five grams—a relatively large amount—by cloning it in the laboratory.  “One gram of the protective antigen can make millions of shots of the vaccine,” Joshi said (Y.P. Rajesh, News24.com, Nov. 6).

U.S. Vaccine Supply

The United States is seeking to obtain British- or Russian-made anthrax vaccine, Health and Human Services Secretary Tommy Thompson said Friday.  Manufacturers, however, have not done tests to determine whether such vaccines are as safe as those made in the United States, he said, adding, “That’s one of the problems.”

Foreign manufacturers have been urged to present safety data on their vaccines to the FDA as soon as possible, said Scott Lillibridge, a bioterrorism adviser to Thompson.  “Arrangements have been made for several people to provide such information, and that’s in progress,” Lillibridge said.

The British vaccine has some side effects, while the Russian vaccine is made with live anthrax bacteria and has been found by the U.S. government to be unsafe for humans, scientists have said (Reuters/Environmental News Network, Nov. 5).

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U.S. Response: Several Diseases Pose Threats, Surgeon General Says

U.S. Surgeon General David Satcher cited several biological warfare agents as potential threats Friday at the Conference on Global Infectious Diseases and U.S. Foreign Policy, sponsored by the U.S. State Department and other agencies in Washington.

Satcher said he was “very concerned” about the recent anthrax incidents, but there are other diseases that the U.S. government also considers high risks.  Smallpox is a major concern, he said.  Only two official supplies of smallpox exists—one at the U.S. Centers for Disease Control and Prevention and one in Russia—but there are concerns that some have moved into the hands of terrorists, Satcher said.

Fears of terrorists using smallpox as weapon, however, should not lead to mass immunizations against the disease, Satcher said.  “Is the probability of an attack worth the risk?” Satcher asked, and added that for every 4,000 people immunized, one will suffer serious side effects.  “There are strategies beyond immunizing everyone,” Satcher said.  “Absent the high probability of an attack, vaccines should not be used.”

Other diseases that are considered threats include bubonic plague and tularemia, Satcher said.  There are effective antibiotic therapies for both, according to Satcher, and tularemia is considered a low risk.  He said hemorrhagic fevers, such as the Ebola virus, are more of a worry. “There is a lot of work to do,” Satcher said.  “There are no bioterrorism experts.”

What Can the Public Do?

There are several things people can do to minimize their risk from a potential biological attack, Satcher said.  They should primarily be aware and alert to any unusual occurrences, and they should also avoid high-risk mail and immediately wash their hands after opening anything that has something suspicious in it, he said. 

If a powder or other substance is in a piece of mail, immediately cover it, and then evacuate and close off the area, Satcher said.  People also should report any suspicious symptoms to physicians.  “Frontline providers must ask the right questions,” Satcher said.  “Armed with information, people don’t panic because there’s something they can do.”

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Anthrax: New Jersey Inhalation Case Recovers

A New Jersey postal worker who contracted inhalation anthrax (see GSN, Oct. 29) is the second reported person to have recovered from the often-fatal disease (see GSN, Oct. 25), according to Reuters.  In Pakistan, preliminary tests have detected the presence of anthrax spores in a U.S. consulate, according to U.S. State Department officials.

Norma Wallace left a New Jersey hospital yesterday after spending 18 days in treatment from inhalation anthrax, which almost killed her by flooding her lungs with fluid, according to Reuters.  “There is hope,” Wallace said.  “We have the greatest scientists, we have the greatest physicians.  We don’t have to step back in fear.  We just have to step forward and apply the knowledge we know to overcome whatever stands before us.”

All five anthrax cases in New Jersey are likely to have originated from the contaminated Hamilton postal facility, said State Epidemiologist Eddy Bresnitz.  “It’s our working hypothesis,” Bresnitz said, and added that anthrax cases may be coming to an end since no new cases have been found recently.  “There may still be people at risk.  But all the cases so far involve people whose symptoms began within the (two-week incubation) time frame of the postmarks,” Bresnitz said.

Wallace said she was unsure if she would return to work at the Hamilton facility, and added that she could understand people who might be wary of their mail.  “I still have a little trepidation going for my own mail,” Wallace said (Carl Winter, Reuters/Yahoo.com, Nov. 5).

A State Department offsite mailroom worker who contracted inhalation anthrax (see GSN, Oct. 26) is improving, State Department spokesman Richard Boucher said in a briefing yesterday.  “He is out of intensive care; I think he is still in the hospital,” Boucher said (U.S. State Department transcript, Nov. 5).  

U.S. Consulate in Pakistan May be Contaminated

Preliminary testing at a U.S. Consulate in Lahore, Pakistan, came back positive for the presence of anthrax, Boucher said yesterday.  Other tests by Pakistani laboratories, which conducted the consulate tests, had produced false positives, Boucher said.  “The final results of those are still pending from U.S. testing.  So I wouldn’t go too far with that.  That’s just a possible.”

Anthrax traces were detected in two other locations in State Department mailrooms, one each in a mailbag at the U.S. Embassy in Lima and Vilnius, Lithuania (see GSN, Nov. 1).  “We have a preliminary positive, but we’ll check it out further at a U.S. lab to be sure,” Boucher said.  “I think I remember the other day some of the reports in Pakistan, some of the tests that proved positive initially turned out to be negative when they did the final testing” (Reuters/Yahoo.com, Nov. 5).

Clean-Up Delayed at U.S. Senate

The U.S. Senate has postponed plans to clean the anthrax-contaminated Hart Senate Office Building with chlorine dioxide gas (see GSN, Nov. 2). The U.S. Environmental Protection Agency will conduct further tests on the method, the agency said yesterday.  The technique needs to be “scaled up” to ensure that it works properly in such an immense building as the Hart office building, said Marianne Horenko, an EPA assistant administrator. 

Decontamination efforts in the Hart building began yesterday with foam and liquid cleaners in a stairwell and freight elevator, said Capitol Police spokesman Lt. Dan Nichols (Guy Gugliotta, Washington Post, Nov. 6).

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Smallpox: Vaccinate World, Say Russian Scientists

Two top Russian scientists called for worldwide smallpox vaccination yesterday, saying the dangers of bioterrorism involving the disease are too great (see GSN, Oct. 26). 

Smallpox “is a very dangerous weapon in the hands of terrorists, and all you need is a sick fanatic to get to a populated place.  The world health system is completely unprepared for this,” said Lev Sandakhchiyev, director of Russia’s Vektor Institute, which holds one of the world’s two official samples of smallpox.  The other sample is held at the U.S. Centers for Disease Control and Prevention in Atlanta (Roland Watson, London Times, Nov. 6).

Sandakhchiyev expressed concern that poorly paid Russian scientists with knowledge of former Soviet biological weapons programs could be tempted to sell material or expertise to terrorist groups or rogue states.  “If the question is, ‘Do Russian scientists work in Iran or Iraq?’ my answer is no.  Do Iraqis work at Vektor?  The answer is no … But only the devil knows with whom they meet.  Our scientists sit at international conferences as part of large government delegations with a large team from Vektor,” he said.

Anatoly Vorobyov, a former general involved with the Soviet Union’s secret biological weapons program in the 1980s, echoed Sandakhchiyev’s warning.  “In principle, the whole population needs to be vaccinated, not only in the United States, but in Russia and everywhere in the world,” he said.

Harry Smith, chairman of the British Royal Society working group on biological weapons said worldwide vaccination was unnecessary.  He suggested, however, that governments have smallpox vaccine and be prepared to immunize “key people” to deal with any outbreak (Aris/Broughton, London Telegraph, Nov. 6).

The Vektor Institute’s collection of biological agents was protected, said Sandakhchiyev, adding, “We do have security system against terrorism and attacks … and we have a controlled entry.  People don’t just show up there by chance.”

Former top Soviet biological weapons scientists Ken Alibek (see GSN, Oct. 12) wrote that the Vektor Institute tested a smallpox weapon in 1990 (Adam Tanner, Reuters/YourHealth.com, Nov. 5).

U.S. Vaccinates Select Health Workers; Trains Doctors

The CDC last week vaccinated about 140 members of epidemiological teams responsible for investigating any suspected smallpox cases in the United States against smallpox.  The CDC also planned to begin smallpox training courses this week for certain CDC employees and state and local health workers.  The CDC planned to provide courses, which would train medical personnel to recognize and respond to smallpox cases, for several weeks in Atlanta, Georgia. 

Most U.S. doctors have never seen a case of smallpox, and experts have expressed concern doctors could confuse the disease with chickenpox and other diseases that have similar early symptoms (Lawrence Altman, New York Times/National Post, Nov. 5).

Smallpox experts investigated three suspicious cases last month, but none were smallpox, said James Hughes of the CDC.  The CDC had no current plans to vaccinate the public at-large, CDC spokesman Tom Skinner said Sunday (Associated Press, Nov. 5).

Funding for Smallpox Vaccines

The CDC has been criticized for requesting only $509 million for 250 million new smallpox vaccine doses (see GSN, Oct. 18).  GlaxoSmithKline, one of four pharmaceutical companies who could receive a smallpox vaccine contract from the CDC this week, said meeting the CDC goals of 250 million doses in a short period of time for $509 million would be very difficult.  The price amounts to about $2 per dose, compared to $8.50 per dose, which the United States paid the British company Acambis for 40 million doses last year.

U.S. Senator Arlen Specter (R-Pa.) criticized the CDC for not requesting more vaccine funding and said he thought Congress would provide whatever funding would be necessary to provide vaccine for the entire U.S. population (Wall Street Journal, Nov. 5).

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U.S. Response: Public Health System Underprepared, Experts Say

The recent anthrax incidents have shown that the U.S. public health system is underprepared and underfunded, a panel of experts said Thursday at a policy briefing on biodefense sponsored jointly by the Alliance for Health Reform and the Forum on Technology & Innovation.

“The assumptions that we would have made at this very conference a month ago, throw them out the window,” said U.S. Senator Bill Frist (R-Tenn.).  “We’re on a steep learning curve.  The public health infrastructure, in terms of surveillance, in terms of coordination, communication, our laboratories … we have underinvested as a nation.”

The recent anthrax incidents have shown that the U.S. public health system is underprepared to handle multiple disease epidemics, said Laurie Garrett, a medical and science writer.  Garrett used as an example a recent outbreak of Dengue hemorrhagic fever in Hawaii that the state government did not have the resources to respond to because it was overwhelmed responding to anthrax.  “There they were, more than 6,000 miles away from any epicenter or any envelope known to contain anthrax,” she said.  “And yet, in the midst of what was a true threat to the state of Hawaii —a true public health catastrophe for the state of Hawaii potentially unfolding before their eyes—the entire Hawaiian State health Department … [was] overwhelmed dealing with anthrax fears.”

Hawaiian hazardous materials teams have responded to an average of 10 calls a day since the first anthrax cases were reported, up from 10 calls a month before September, Garrett said.  Tests needed to diagnose Dengue were unavailable from the CDC because of slow responses, and the one person in the Hawaii Health Department who does bacterial disease suspect case testing has been working 17-hour shifts solely on anthrax tests, according to Garrett.

“What will happen if we have another epidemic—naturally occurring epidemic right now, when every single resource in the public health system, from the federal level on down to the city of Honolulu, is taxed and stressed beyond belief?” Garrett said.  “If you look around the nation right now at where we stand with laboratory capacity, surveillance capacity and personnel, we’re in bad shape.  We’re in very bad shape.”

How to Address the Problem

A biowarfare attack, as has been seen on a small scale with the recent anthrax incidents, will likely develop in the same way as epidemic disease, said Margaret Hamburg, vice president for biological programs at the Nuclear Threat Initiative.  “So we know from the get-go that we have to address this in a different way,” Hamburg said.  “We need to have a strategy that reflects the real dimensions of the challenge before us.”

Hamburg gave several areas where the public health system needed to be strengthened, including a better ability to investigate and respond to unusual outbreaks of disease, more research on detection methods and treatments, building up a national stockpile of drugs and vaccines and reducing access to dangerous pathogens.

The pharmaceutical stockpile is a “critical need,” Hamburg said, because of the low-probability of an all-out biological warfare attack.  It is difficult to predict where an attack would occur, who would be affected or what biological warfare agents would be used, so it is counterproductive for local and state governments to build up their own supplies.  “We have an obligation to have [drugs and vaccines] available to the American people, and there is a national pharmaceutical stockpile that needs to be strengthened and expanded,” Hamburg said. 

Other experts on the panel were unsure of the value of stockpiling large amounts of vaccine doses, and whether or not the public would go along with a widespread vaccination program.  “Right now at this moment, there’s widespread support for coming up with 300 million doses of smallpox vaccine,” Garrett said. “Will everyone feel that way when the one out of a million deaths occur, or the one out of 1,000 sever side effects?  What our experience with swine flu tells us is that the public can switch its view of vaccines.”

Important steps have been taken in reducing access to pathogens such as anthrax and in monitoring their movement, Hamburg said, but more can still be done.  Garrett suggested that the scientific community might need to do a better job of self-regulation before the government stepped in.  “What are the criteria by which you decide that, yes, this gene that you’ve isolated for virulence should be sent to this guy, who sent a letter to you with some kind of letterhead you’ve never seen before saying he would like you to collegially share?” Garrett said.

A proper communication strategy, by working with both the press and public to inform them about what is going on and what can be done in the event of a biological warfare attack, is highly important, Hamburg said.  “Clear communication with the public and galvanizing them into action may be absolutely essential to our ability to contain and control an outbreak,” she said.  “The behavior of individuals, as well as institutions, is key to the response.”

Healthcare workers need to be properly prepared to deal with the effects of a biological warfare attack, said Center for Infectious Disease Research and Policy Director Michael Osterholm.  “One of the things we have to understand with infectious diseases that are very different than any other weapon that’s out there, is they do push all our ancestral buttons of fear,” Osterholm said. 

It is important to help health care workers understand the risks involved and how they can protect themselves when dealing with victims of a biological attack, Osterholm said.  “Frankly, they’re humans first,” he said.  “They’re parents first.  They’re siblings first.”  Giving healthcare workers the tools and information needed in the event of a biological warfare attack will “provide us not only a well professionally trained group of individuals, but also personally, the commitment in what they can do will be there,” Osterholm said.

Potential Biological Threats

The United States has listed several biological warfare agents as high risks, said Phillip Russell, former commanding general of the U.S. Medical Research Institute for Infectious Diseases.  One of agents that was high on the list was smallpox, Russell said, for which the United States needs a stockpile of vaccine.  “It’s not new technology,” Russell said.  “It’s existing technology.  All they have to do is apply the manufacturing.”  Vaccine immunoglobin, as well as anti-viral drugs against the vaccinia virus and smallpox virus and rapid diagnostic technology was also need against smallpox, according to Russell.

Second generation vaccines were needed for anthrax and plague, two other high-risk agents.  Speaking on a new and improved anthrax vaccine, Russell said, “We need a vaccine that’s highly purified, it has low reactogenicity and immunizes in one or two doses.” 

Since the 1940s, there have been concerns about the lack of vaccine capacity and development, Garrett said, and cited General Accounting Office and Office of Technology Assessment reports on the subject that dated back to the 1980s.  “They just simply were ignored,” Garrett said.

Other biological warfare agents that presented a risk included botulism, tularemia, hemorrhagic fevers and encephalitis viruses, Russell said.  “There really is very little disagreement in the medical community about what’s needed,” Russell said.  “The problem has been the political will, the appropriations and, in the case of vaccines, the organizational structure to carry out an effective national program.”

“Many, Many More Civilian Casualties”

The recent anthrax incidents may only be the beginning, which heightens the need to rapidly improve the U.S. public health system, according to the panel.  “Ladies and gentlemen, we have had some casualties so far, and that’s very unfortunate,” Osterholm said.  “But, you have to understand, it’s the beginning.  I will be very happy to be proved wrong.  I believe we will see many, many more civilian casualties” (Mike Nartker, GSN, Nov. 5)

To read a full transcript of the briefing, click here.

[EDITOR'S NOTE: The Nuclear Threat Initiative is the sole sponsor of Global Security Newswire, which is published independently by National Journal Group, Inc.]

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Anthrax:  Summary of Recent Anthrax Infections

Following the confirmation Friday of the infection of a New York Post editor with skin anthrax, 17 people have been diagnosed with anthrax infections since the first case was announced in Florida (see GSN, Oct. 5), according to the U.S. Centers for Disease Control and Prevention.

The CDC counts a confirmed case as one in which symptoms match those of anthrax and laboratory testing isolates anthrax bacteria from infected tissue, or one in which evidence of anthrax bacteria is supported by at least two other laboratory tests.

(CDC release, Nov. 4; Washington Post, Nov. 3)

	Deaths (From inhalation anthrax)	Inhalation Anthrax Infections	Skin Anthrax Infections
Florida ú   Bob Stevens, Inhaled, American Media Inc. building, Died Oct. 5 ú   Ernesto Blanco, Inhaled, American Media Inc. building	1	1	0
New Jersey ú   Unnamed woman, Inhaled, Hamilton mail center ú   Unnamed woman, Inhaled, Hamilton mail center ú   Patrick O’Donnell, Skin, Hamilton mail center ú   Teresa Heller, Skin, West Trenton post office ú   Non-postal worker, Skin, Trenton	0	2	3
New York ú   Kathy Nguyen, Inhaled, Manhattan Eye, Ear and Throat Hospital, Died Oct. 31 ú   Erin O’Connor, Skin, NBC ú   7-month-old boy, Skin, ABC ú   Claire Fletcher, Skin, CBS ú   Editor, Skin, New York Post	1	0	4
Washington ú   Thomas L. Morris Jr., Inhaled, Brentwood mail center, Died Oct. 21 ú   Joseph Curseen Jr., Inhaled, Brentwood mail center, Died Oct. 22 ú   Leroy Richmond, Inhaled, Brentwood mail center ú   Unnamed man, Inhaled, Brentwood mail center ú   Unnamed worker, Inhaled, U.S. State Department mail center	2	3	0
Total	4	6	7

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Anthrax: Small Finds in Investigation, But Larger Issues Go Unsolved

As federal officials broadened their efforts to find those responsible for the recent anthrax incidents, the results of the investigations have provided disappointing information, according to news reports.

New York City

The biggest mystery remained the source of the anthrax infection that killed Kathy Nguyen in New York last week (see GSN, Oct. 31).  “She’s an epidemiologist’s worst nightmare in that she lived alone and had no relatives in this country,” said Centers for Disease Control and Prevention epidemiologist Stephen Ostroff.  “It’s very, very labor intensive and difficult to piece together what this woman may have been doing in the one to two weeks since she fell ill” (Weiss/Brown, Washington Post, Nov. 5).

Experts took some comfort from the fact that no new cases appeared over the weekend.  “I really doubt it’s some new onslaught because you’d expect to see new patients and we’re not seeing anything,” said Jerome Hauer, former director of New York’s Office of Emergency Management.  New York emergency rooms and medical offices were place on heightened alert since Nguyen’s death to look for additional anthrax cases, according to the New York Times (Revkin/Finkelstein, New York Times, Nov. 3).

New Jersey

Some progress was made in the case of the New Jersey bookkeeper suffering from skin anthrax (see GSN, Oct. 29).  Anthrax spores were found in the mail bins at her accounting company.  The bin came from the Hamilton Township postal facility that processed the three known anthrax-tainted letters: one to U.S. Senate Majority Leader Tom Daschle (D-S.D.), the second to NBC News and the third to the New York Post.

Today, federal investigators were holding at least one Trenton, New Jersey, man in custody related to the anthrax incidents.  He was being held, on immigration charges, because of “information that we’ve been getting in the investigation of anthrax that led us to his address,” said FBI spokeswoman Sandra Harris.  The FBI was conducting anthrax swab tests at the man’s apartment, she said.

Last week two men were arrested in Hamilton Township as part of the anthrax investigation, according to the Wall Street Journal (Sandberg/Tkacik, Wall Street Journal, Nov. 5).

The London Guardian reported today that two associates of the Trenton suspect were also in custody (Gillan/Campbell, London Guardian, Nov. 5).

The Larger Investigation

FBI Director Robert Mueller asked for the nation’s help on Friday: “Join us in trying to bring leads to the front that will help us solve both the anthrax investigation, [and] the Sept. 11 hijacking investigation.”

Forensic examination of the anthrax-tainted letters had produced no latent fingerprints, hairs, clothing fibers or other evidence, officials said.  The $1 million reward for information has not resulted “in as many tips or leads … as we would like,” Mueller said (Eggen/Schmidt, Washington Post, Nov. 3).

Senior FBI and CIA officials were becoming more persuaded that the anthrax incidents were rooted in the United States, according to the Washington Post.  Some terrorism experts are theorizing that any angry loner with scientific expertise may have piggybacked on the Sept. 11 bombings.

“Any terrorist worth the name would realize it was a good time to strike,” said Harvard lecturer Jessica Stern.  “Right-wing domestic extremists want to undermine American citizens’ faith in the government.  They want to prove to the American people that the government isn’t serving their interests” (Peter Slevin, Washington Post, Nov. 5).

Meanwhile, the FBI today plans to begin testing hundreds of barrels of quarantined mail.  “We have an enormous amount of mail from Capitol Hill that has to be sorted and examined.   We won’t know how significant any of it is until we go in there and see what we find,” said an FBI official (Dallas Morning News, Nov. 5).

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