Ten Years After September 11th and Anthrax

September 11, 2001 shook the country to our core.

On the heels of experiencing the unimaginable, the field of public health was thrust onto the front lines with the anthrax attacks – and was changed forever.

This month, to commemorate the public health response to these tragedies, the Trust for America’s Health and the Robert Wood Johnson Foundation issued Remembering 9/11 and Anthrax:  Public Health’s Vital Role in National Defense (http://healthyamericans.org/health-issues/anthrax-report), which features more than 30 firsthand, on-the-ground accounts of public health professionals.

The stories range from the steps health officials took on September 11th in the face of uncertainty to practitioners who diagnosed and treated anthrax victims, and the lab directors who tested thousands of potential anthrax samples in rapid response time.

As we talked with federal, state and local public health officials and medical professionals who were on the front lines in responding to 9/11 and anthrax, it became clear that being prepared means we must sustain enough resources and vigilance to prevent what we can and respond when we have to.

We learned how ten years ago, the public health system, which had been underfunded for decades, responded as it could, often without the technology, resources, workforce or training needed.  At the time, according to a 2001 report by the U.S. Centers for Disease Control and Prevention titled Public Health Infrastructure – A Status Report, the public health system was “structurally weak in almost every area.”

As Howard Koh, M.D., M.P.H., assistant secretary for health, U.S. Department of Health and Human Services, Massachusetts Commissioner of Public Health, Commonwealth of Massachusetts, wrote:

Here was a typical scenario: a jittery and unnerved town resident would discover ‘suspicious’ white powder in his community. Immediate notification of the local police or fire department would trigger both the closing of the local post office and the sudden arrival of HAZMAT teams, bedecked in imposing space- suit paraphernalia.

The teams would delicately handle the samples under the watchful eye of local media and news cameras. Then, those samples would be delivered to the Massachusetts Department of Public Health state laboratory for analysis. A hastily arranged press conference would feature harried state and local officials trying to explain the unfolding developments to an increasingly anxious public. And when testing in the laboratory subsequently yielded negative results for anthrax, that finding would prompt yet another round of news announcements as well.

Multiply this situation by several thousandand that was the fall of 2001 in our state, and indeed, around the country.

Since then, we learned a lot of hard lessons about what it means to be adequately prepared for diseases, disasters and bioterrorism. We’ve made smart investments, and there’s been a lot of progress to show for it. The public health community can be proud of all the accomplishments that have been made.

But, there’s still a lot left to be done, which will require further effort and investment. There are serious gaps in the public health workforce, in the ability to deal with mass trauma events, in “biosurveillance” needed to quickly identify attacks or outbreaks, in incentivizing new vaccines and antiviral medications and getting them to market quickly and in working with communities so they cope and recover quickly from disasters.

However, the most troubling gap is in sustained, adequate funding – which means existing gaps will persist and previously filled gaps will reemerge. Federal, state and local cuts to public health budgets threaten to erase the progress we’ve made in the past decade. Federal funding for preparedness has dropped 37 percent since FY 2005 (adjusted for inflation), 33 states cut public health funding last year and around 19 percent of local public health jobs have been cut since 2008.

Historically, funding for emergencies often comes after an emergency happens –when it’s often too late. Funds are often stopgap or diverted from one pressing priority to another–leaving ongoing needs unaddressed.

These cuts combined with a band-aid approach to dealing with emergency response means the gaps in preparedness will grow in number and depth–and leave Americans unnecessarily at-risk for the range of threats we face. We may not be able to predict the next threat we face–but we can predict with 100 percent certainty that there will be one.

Whether threats are man-made or from Mother Nature; whether they are catastrophic one-time events or around us in our daily lives–without the work done by public health, we don’t stand a fighting chance. And they don’t stand much more than a fighting chance without our support.

As Dr. Segaran Pillai, chief medical and science advisor, Ph.D. MSc, SM (AAM), SM (ASCP), Science and Technology Directorate, Department of Homeland Security, who was in Florida during anthrax, wrote:

My biggest concern is that the country is getting complacent and we might be losing focus on the importance of being prepared. We, as a nation, invested in building an infrastructure to ensure that the public health program is better prepared to respond to a biological attack. As time passes without an event and the budget continues to shrink, so does our ability to be fully prepared. The failure to maintain the infrastructure we have built can result in reverting us back to where we started.


“Opinions” blog postings are intended to allow non-Altarum Institute authors to pose their own opinions and policy positions in the realm of health care and health policy. As a leading nonprofit health care research and consulting institute dedicated to improving human health, Altarum encourages open discussion and debate about the many challenges in health care today. All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions. Read more.

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