Cleland, Barnes talk bioterrorism at Emory

By Michael Terrazas mterraz@emory.edu

U.S. Senator Max Cleland (D-Ga.) wants to pass legislation to help America deal with the threat of biological and chemical warfare. In order to assess the current state of readiness in the public health system, he wanted to talk to people on the front lines—and even ahead of the game.

Cleland held a Nov. 19 roundtable to discuss bioterrorism in the auditorium of the Nell Hodgson Woodruff School of Nursing, and some of public health’s heaviest hitters were on hand to contribute. Participating in the discussion were Emory’s own James Curran, dean of the Rollins School of Public Health; Jeffrey Koplan, director of the Centers for Disease Control and Prevention; Kathleen Toomey, director of the Georgia Division of Public Health; and Phil Jacobs, chairman of Friends of CDC, an organization dedicated to lobbying for adequate funding for the federal agency. Joining the roundtable toward the end was another guest of some repute, Georgia Gov. Roy Barnes.

“National homeland defense begins and ends at the state and local levels,” Cleland said. “As we work to shore up our preparedness on the national level, it will be our first responders, our emergency room doctors and our fire and police forces who will be the ones on the front lines. They must have the best training, resources and information to successfully prevent a bioterrorist threat from becoming a tragedy.”

Cleland has authored a piece of legislation, the Public Health Emergencies Account-ability Act, that would clarify the chain of command in a crisis such as that caused by a bioterrorism attack.

Currently, Cleland said, federal law is unclear as to which agency would assume authority in the event of such an attack, but Cleland’s bill would provide some marching orders.

The bill would put the Federal Bureau of Investigation in charge in case of an attack, but the secretary of Health and Human Services would retain the authority to declare a “public health emergency,” at which point the CDC would begin calling the shots. But whoever is in charge, Cleland said, most important is that both law enforcement and public health agencies work together to deal with a crisis.

As for the new Department of Homeland Defense, headed by former Pennsylvania governor Tom Ridge, Cleland said the fledgling agency would be hard-pressed to comprehensively manage a government response in such an event.

“I wish Tom Ridge the best of luck—he’s a fellow Vietnam veteran—but he’s got 18 people,” Cleland said. “How can 18 people oversee 70 federal agencies? I don’t know. Pray for him.”

Koplan spoke of the importance of communication between the CDC and local health departments, which would be the first line of defense against a biological or chemical attack. The recent discovery of anthrax in Florida, Koplan said, was due to the diligence of a local health official in Palm Beach County, who made a preliminary diagnosis and then quickly sent specimens to CDC for confirmation.

“The state of public health in America as a whole is only as strong as its weakest link in the local health departments,” Koplan said.

Koplan estimated that CDC had studied barely 200 cases of anthrax in the 55 years before Sept. 11, and just 18 of those were inhalation anthrax. “We have learned things every day during this crisis,” he said.

Curran commented on Cleland’s belief that Atlanta, as one of the country’s—and, thus, the world’s—premier centers of public health, should be viewed as a model for other cities in preparing for bioterrorism.

“Nobody knew what it meant to be the ‘public health capital of the world’ until Sept. 11,” Curran said. “Public health is the pulling together of everything we do as a society to ensure health, both in times of emergency and more ‘normal’ times.”

Toomey said Atlanta, and DeKalb County particularly, have a leg up on much of the country in planning for terrorist attacks for a couple reasons. First, DeKalb has been working with CDC and Toomey’s office for more than a year to develop a bioterrorism response plan; and second, the city is building off preparations made for the 1996 Olympic Games.

Toomey added that communication is critical in a crisis, and adequate resources must be directed toward improving communication for the public health system. She said roughly 60 local health departments across the state are not yet connected to CDC’s online system, but they should be by early 2002.

“What has really emerged from the events of Sept. 11 is the fact that the public wants a single, credible source for health information,” Toomey said. “Discordant messages can lead to confusion.”

Jacobs spoke of the “deplorable” condition of much of CDC’s laboratory facilities and the drive to increase the agency’s federal funding. Before Friends of CDC was created, Jacobs said, the agency’s annual facilities budget was $30 million. The first year the group began lobbying on CDC’s behalf, that number jumped to $60 million. Last year it stood at $175 million, and Jacobs said he hopes to secure as much as $300 million in FY03 to upgrade CDC labs.

Barnes, who arrived at the event just as the floor opened up for questions, echoed Jacobs’ sentiments. “Without a significant investment from the federal level,” Barnes said, “we run the risk that this agency will not be able to provide the critical support we all need. This needs to be done, and it needs to be done now. I can think of no higher priority.”