http://www.washingtonpost.com/wp-dyn/articles/A58747-2001Nov7.html

U.S. Officials Reorganize Strategy on Bioterrorism

By Ceci Connolly
Washington Post Staff Writer
Thursday, November 8, 2001; Page A01

Federal health officials have begun reorganizing their approach to fighting bioterrorism, an effort that critics in and outside of government say has been marred by mixed messages, bureaucratic infighting and lack of experience.

In recent days, Health and Human Services Secretary Tommy G. Thompson has hired three veteran bioterrorism experts to run a new Office of Preparedness, instituted a daily conference call to coordinate his agency chiefs, appointed a liaison to the White House Office of Homeland Security and elevated a well-known infectious disease expert to a more prominent public role.

The federal government's handling of the anthrax attacks has prompted criticism that officials failed to aggressively protect postal workers who may have been exposed to anthrax spores, have not adequately assisted the nation's network of overburdened laboratories and have yet to provide clear guidance on where and when to test buildings for contamination or who should be treated with antibiotics. Most importantly, officials say they hope to repair a public communications strategy criticized for being convoluted and inadequate.

"This is a new construct aimed at bringing together different people and activities so that we will be able to work more in harmony," said Donald A. Henderson, director of the new Office of Preparedness.

Henderson, the founding director of the Center for Civilian Biodefense Studies at Johns Hopkins University, is best known for his campaign to eradicate smallpox worldwide by 1980. He will be joined by Phillip Russell, a retired Army major general who specializes in vaccine development, and Michael Ascher, who heads the state of California's bioterrorism effort.

Already Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and well known to the public for his expertise on AIDS, has taken over most major public appearances in an attempt to have a medical expert, rather than a politician, explain the nuances of biological warfare.

"I have a feeling of momentum," said Scott Lillibridge, Thompson's special assistant for bioterrorism. He described Henderson's operation as the "bridge" to a new assistant secretary's office that would have broad authority.

"This is a harbinger of something a little more elevated and a little more robust," he said. "We would move to a very large assistant secretariat for emergency public health or health security."

While Thompson has publicly defended the department's handling of the anthrax attacks, several close advisers say the changes are a recognition that five weeks into the anthrax crisis, the nation's health system is still struggling to cope with the investigative and public relations demands of what is thus far a small-scale biological assault.

"I think you will see a turn for the better," said one administration official who earlier chastised HHS for its sloppy management.

As Fauci takes to the airwaves, Henderson and Russell are overseeing plans to expand vaccine programs, develop scientific protocols for lab workers and local health departments for handling biological agents and help rebuild a strained relationship between HHS and the Centers for Disease Control and Prevention in Atlanta.

"This gives the secretary some very senior scientific advisers who know this business," said one Thompson ally who meets regularly with the bioterrorism team. "CDC won't be able to sandbag him on issues because these guys have been there."

When Thompson first realized the death of Robert Stevens in Florida was the start of a broader bioterrorist attack, he created a "situation room," a military style, round-the-clock, command center led by Lillibridge.

But from the beginning, the operation had weaknesses. The CDC official assigned to track possible new anthrax cases has had to rely largely on cable television news programs to keep current. No one in the room coordinates public communication. And, according to some, Lillibridge has been pushed aside.

Lillibridge, in an interview last night, said he was happy to work under Henderson, his mentor. He also acknowledged that HHS was in dire need of a larger, centralized department to manage both the immediate crisis and a longer-term effort.

The most common complaint heard about the administration's handling of the anthrax attacks relates to its public relations strategy.

"You've got a large part of the population that doesn't know anything about anthrax," said Carole Zimmerman, spokeswoman for the American Public Health Association. "What's been missing all along is that they haven't had a public education campaign."

In the beginning of the crisis, all media requests were funneled through Thompson's press office, effectively silencing three central agencies -- CDC, the Food and Drug Administration and the National Institutes of Health.

HHS communications director Kevin Keane recently told reporters that the early clamp-down was less about censorship and more an effort "to make sure the left hand knows what the right hand is doing."

Henderson said one of his top priorities was to "work out what the communications system will be."

Local officials say they have been stymied by the lack of information coming out of HHS. When anthrax spores turned up in a machine shop in Indianapolis, for instance, state leaders received the news from television, said Andrew Stoner, spokesman for Indiana Gov. Frank O'Bannon. "We'd prefer a more direct line of communication," he said.

After treating a stricken postal worker at Inova Hospital in Fairfax, emergency physician Dan Hanfling said CDC too often demanded information, but rarely shared it.

"It became readily apparent that a lack of coordinated communication and inconsistent leadership from the top was hindering the ability of the medical community to respond in a coordinated fashion," he told a congressional committee last week. He said he had witnessed better emergency management during snowstorms.

Surgeon General David Satcher defended the CDC, noting that public health officials would have better information during a snowstorm. But Satcher has told friends he is so disheartened he will leave when his term expires in February.

Perhaps nowhere is the frustration greater than within the CDC.

"We've tried to adjust what we're doing based on changing circumstances and the best information available to us at the time," said Steve Ostroff, the CDC official in charge of the New York anthrax investigation. "There is a magnificent effort going on here but it's obscured by the public's frustration that there is not an answer yet."

Staff writer Rick Weiss contributed to this report.

© 2001 The Washington Post Company

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