Public health response as informed by recent events anthrax attacks 2001

During October and November of 2001, beginning just weeks after the events of 11 September, the US experienced a series of biological attacks using weap-onized anthrax spores deployed in mailed letters. In total there were 22 confirmed or suspected cases, 11 of inhalational anthrax and 11 of the cutaneous form (Jernigan et al., 2001); five of the inhalational cases were fatal. Although these attacks were small scale and employed a low-technology approach to anthrax delivery, their impact was substantial: two branches of the Federal Government were temporarily closed, postal operations were severely disrupted, thousands of potentially exposed persons received post-exposure prophylaxis, total mitigation costs approached US$3 billion, and scarce public health resources were diverted away from other concerns to manage the inordinate volume of false alarms that accompanied the actual exposures (Heyman, 2002). Not unexpectedly, a host of after-action reports and analyses have subsequently reviewed the salient features of the response to these significant acts of bioter-rorism (Gursky et al., 2003; Lucey, 2005).

A number of important lessons, at all levels, were learned from the response to the anthrax attacks of 2001. First and foremost, they exposed the numerous deficiencies in the national and local public health infrastructures, including laboratory and diagnostic capabilities. Second, the events revealed significant knowledge gaps in the scientific community regarding biological threat agents -for instance, the finding of secondary spore aerosolization with experimental routine office activities in the US Hart Senate Office Building during the decontamination phase suggests an additional risk from anthrax weapons (Weis et al., 2002). Third, the attacks caused the public health community to question previously held assumptions regarding bioterrorism; the idea that such substantial social and economic disruption could result from such a small event represents a new potential paradigm for terrorists and planners alike (Artenstein, 2003).

Perhaps the most durable lesson resulting from the anthrax attacks revolves around the difficult yet important issue of communication. Local and federal authorities struggled with imparting appropriate crisis and risk communication, and at times were viewed as giving contradictory messages to the media and the public (Gursky et al., 2003). This uncertainty, along with a rapidly evolving situation on the ground and heightened public anxieties (no doubt magnified in the immediate post-9/11 period), led to inconsistent statements and actions by public health authorities, which exacerbated the public's lack of confidence in its leaders. One such example was the recommended use of ciprofloxacin as post-exposure prophylaxis for the Senate Office workers, while the mostly African-American postal workers were given doxycycline. As both drugs are effective, a consistent message and recommendation would have gone a long way towards assuaging public concern. The overarching theme highlighted by the anthrax attacks of 2001 is that our public health response planning must be proactive, not reactive to future events.

0 0

Post a comment