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Sept. 11 Attacks Strain, Then Strengthen US Public Health System - 2002-09-05

Last year's terrorist attacks on New York and Washington combined with the anthrax scare one month later, pointed out what many observers called the inadequacy of U.S. emergency and public health capabilities. Now, one year later, the nation's public health and emergency infrastructure is considered much better prepared for a bioterrist attack. The response to the outbreak of West Nile virus is proof.

In the wake of the twin emergencies last year, U.S. public health, fire, police and disaster relief agencies were found to be poorly coordinated, understaffed, and unprepared to handle a mass bioterrorist attack. At the time, the head of a trade group for public health departments, Mohammad Akhter of the American Public Health Association, complained of the lack of readiness and linkages among national, state, and local agencies.

Today, he says the situation has turned around, especially in local jurisdictions where first response to an emergency occurs. "These people now go through training programs. These people are much better prepared today to recognize a case of smallpox or outbreak of anthrax than they were a year ago," says Mr. Akhter.

The improvement reflects a strong and swift policy reaction to the mailing of deadly anthrax spores to several members of the U.S. Congress and news organizations soon after terrorists attacked New York and Washington. Before that, U.S. public health authorities had been moving slowly to identify potential bioterrorist threats and preparing responses. The combination of events accelerated their program, bolstered by more than $3 billion appropriated by Congress.

As a result, the leading national public health agency, the Centers for Disease Control, or CDC, went into high alert. "We learned a lot of lessons and since that time, we've really scaled up our response capacity," says CDC Director Jule Gerberding. "We have sped up the processes by which we do our work and we have streamlined our overall emergency response operations."

Since September 11, 2001, the CDC has opened new laboratories to analyze disease outbreaks, trained rapid response teams with a variety of skills, and developed an emergency plan to communicate with public safety and health officials at various levels of government.

The CDC is also monitoring emergency room visits, telephone calls to public safety and poison control centers, and pharmacy records to detect increased use of antibiotics and diarrhea drugs.

The head of the CDC's infectious disease center, James Hughes, calls it a new way of doing business.

"We've taken steps to improve our public health surveillance capacity to monitor for occurrence and early detection of infectious disease outbreaks anywhere in the country and, indeed, we are working with partners in other parts of the world to strengthen surveillance capacity there as well," says Mr. Hughes.

In addition, the U.S. government has spent another $4.5 billion stockpiling smallpox vaccine, improving food inspections, and boosting security for water systems.

Nearly $1 billion is going to improve state and local responses to bioterrorism. The CDC's director for terrorism preparedness, Joseph Henderson, says this is nearly twenty times what the agency gave to lower level health departments last year. "People always ask me if we were to respond tomorrow, would we do a better job than we did a year ago," asks Mr. Henderson. "There's no question we clearly could, both as an agency, but also with the state and local health departments having these resources, they are clearly in a better situation today than a year ago."

Although the United States has been spared a massive bioterrorist attack, the outbreak of West Nile virus across much of the country has provided a valuable opportunity to hone the improved public health system. CDC director Julie Gerberding says this illustrates the dual purpose for increasing the nation's public health capabilities. "We are building terrorism capacity on the foundation of public health, but we are using the new investments in terrorism to strengthen the public health foundation," she says. "Both will benefit from the efforts and investments that we intend to make on an ongoing basis."

CDC officials point out that the renovation of the U.S. public health system is not complete. Mohammad Akhter of the American Public Health Association says many smaller communities remain unprepared to handle a terrorist attack with biological agents. He adds that many citizen volunteers must be recruited to help public agencies in the event of such an attack.

But he says the vast majority of the nation is better protected than it was one year ago. "For our major population centers, 90 percent of our population is well covered, plans are in place, departments are prepared, and we have made tremendous progress."