Anthony S. Fauci Reflects on the 2001 Anthrax Attacks
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 first recognition of diagnosed anthrax attacks in the United States, NewPublicHealth continues to run excerpts from the report.
The following is an excerpt of the Q&A with Anthony S. Fauci, M.D., Director of the National Institute of Allergy and Infectious Disease in the National Institutes of Health.
Looking back after ten years, what stands out to you most about the 2001 anthrax attacks?
What stands out most to me about the 2001 anthrax attacks is the notion that from that point on, bioterror was a reality and no longer an abstract concept. Although discussions had been under way among public health officials in preparation for such an event, and our National Institute of Allergy and Infectious Diseases (NIAID) had a limited research portfolio in the area, the attacks really were a wake-up call.
Looking back, I am also struck by the uncertainty we all felt at the time.
Today, we know and can dispassionately describe exactly what happened. We know that of the people potentially exposed to anthrax in 2001, 22 people were infected, five of whom died. We know now that the attacks were unlikely a concerted effort by a group or organization intended to broadly affect our society and large numbers of people. We know that the attacks likely stemmed from the actions of a single individual who was probably mentally unstable. Today we know the anthrax attacks had a relatively limited and short-lived impact in terms of morbidity and mortality.
However, at the time the entire event was surrounded by uncertainty. No one had any idea who perpetrated the anthrax attacks or what the extent of their impact would be. With the timing of the anthrax attacks coming only weeks after 9/11, the uncertainty was accompanied by a gripping fear of what might happen next. People worried as they rode the Metro or shopped for their groceries that something unknown and unexpected would happen again, and that they and their families were at risk.
How would you characterize the overall response to the attacks?
I would describe the overall response as a “leaping into action” on the part of scientists and public health officials. We quickly brought together leading scientific experts and developed two important paths forward: the NIAID Strategic Plan for Biodefense Research and the NIAID Biodefense Research Agenda for CDC Category A Agents, a document that describes the Institute’s accelerated research plan for the most threatening bioterrorism agents. These were developed within five months after the anthrax attacks — and have since been used as a starting point for updates and progress reports for the future.
We asked the important questions in ways that I think were calm, measured, and scientific: Are there enough antibiotics? If not, why not, and how do we procure more? Where do we stand with regard to vaccines? Should we scale-up existing countermeasures? Do we need new countermeasures? Are there counter measures on the horizon that will help us achieve our goals or not? How do we develop new countermeasures? What are the readily available options, and what is missing?
Through the anthrax response, we built both a physical and an intellectual infrastructure that can be used to respond to a broad range of emerging health threats.
The result is that today we are in a much better position — from the perspective of both the research pipeline and public health preparedness— than we would have been had we addressed anthrax alone. Our improved ability to respond to emerging health threats was reflected in subsequent years as we addressed SARS, the threat of H5N1 influenza, and the2009 H1N1 influenza pandemic.
What were the biggest challenges you faced?
Without a doubt, the biggest challenge we faced was to separate the science from the hysteria. We had to ensure that our focus remained on rational planning and on determining the most appropriate, scientifically based actions at the time.
What are the biggest threats and challenges to bioterrorism preparedness today?
The biggest threat to bioterrorism preparedness today is complacency. If a health threat does not happen, be it naturally occurring or deliberate, we tend to make it a lower priority. The worst thing we can do is to make something a priority after it happens. After it happens is too late; you are playing catch-up. Preparedness for a threat must be a priority before it happens.
>>Read a Q&A with CDC on their role in the response to 9/11 and the anthrax attacks here.