Dr. Howard Koh: Risk Communication in the Anthrax Attacks of 2001
Trust for America’s Health and the Robert Wood Johnson Foundation have issued a new report, Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense. To mark the anniversary of the anthrax attacks ten years ago, NewPublicHealth continues to run excerpts from the report.
The following is an excerpt of the piece from Howard Koh, M.D., M.P.H., Assistant Secretary for Health of the U.S. Department of Health and Human Services, and Massachusetts Commissioner of Public Health in 2001.
Until the fall of 2001, I had devoted four years immersed in the demands of a state health commissioner: heading the Massachusetts Department of Public Health (MDPH) and overseeing a wide range of health services, four hospitals, and a staff of 3,000 professionals. The work was intense, broad and traditional. Then came 9/11.
The entire country was dazed and reeling. Then, to our utter disbelief, October 5 began the next chapter of national suffering marked by the first death from inhalational anthrax. The cases started in Florida but over a matter of weeks snaked up the East Coast to northern Connecticut, just a few miles from our state borders.
The MDPH laboratory was deluged with samples of white powder sent for anthrax testing. 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 MDPH 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. Multiply this situation by several thousand — and that was the Fall of 2001 in our state, and indeed, around the country.
As Commissioner, I was charged with leading MDPH through this time, interacting with other state officials, the press, health professionals, community groups, hospital leaders, advocates, among others. It soon became clear that my primary role was risk communicator-in-chief. The deluge of questions from the press and public alike seemed endless: What is anthrax? Why have we never heard of this before? How many people were infected? Am I safe?
In the midst of this chaos, I understood that each interview had to focus on facts, not speculation. With each press interaction, I shared the information known and promised to share more as soon as it came available. It was important to acknowledge the anxiety without succumbing to it. It was also critical to project some sense of calm, setting an empathetic and compassionate tone. It was difficult to lack ready answers in this constant swirl of uncertainty. But I was honored to emphasize to any audience that thousands of public health professionals had stepped forward in this unprecedented time, working 24/7 on their behalf. In fact, the crisis represented a tremendous opportunity to underscore and reaffirm publicly the fundamental mission of public health: to protect people against threats — known and unknown —in a time of crisis.
When it was all over, the nation witnessed 22 anthrax cases and five deaths, none in Massachusetts; but the trauma left millions in its wake. For the remainder of my tenure as Commissioner, we dealt with the aftermath, dramatically realigning budgets to balance fragile public health programs with new preparedness demands. I brought many of those lessons with me in 2009 to the U.S. Department of Health and Human Services where I now serve as Assistant Secretary for Health.
Looking back at the first decade of the 21st century, our public health history now covers many crises previously viewed as unthinkable. In addition to 9/11 and anthrax, this remarkable litany of “low probability, high consequence” events now includes SARS (2003), Hurricane Katrina (2005), the H1N1 pandemic (2009) and the Gulf Coast oil spill (2010), among others. Through each of these episodes, we have been subjected to the predictable elements of crisis: invalidation of previous fundamental assumptions, the irrelevance of conventional thinking and conventional responses, rapid escalation of events, moral trial by compelling images in the media and tremendous technical and even ethical uncertainty. Since 9/11, our nation’s ability to coordinate response has certainly grown dramatically. But the next challenge always seems to be just around the corner.
In the final analysis, each crisis can represent an opportunity to create a renewed sense of community, reminding us yet again that we are all interconnected, all interdependent and we all have promises to keep.