The Anthrax Letters: The Attacks That Shocked America (24 page)

So what are you worried about now?

Morse mentioned how surprised everyone was about the method of attack. “We had been thinking about the military mode of transmission of these agents, by an aerosol release.” Kellogg and Lillibridge nod in agreement. Like many others, they were shocked to learn how effective the mail could be to deliver the anthrax. Morse shakes his head to lend emphasis as he adds: “We were just fortunate that it was small and that we could learn a lot about inhalation anthrax and how the organisms could be spread.”

They all agreed that after the first anthrax case communication between agencies was poor. Some of the leadership at the CDC and the FBI were reluctant to share information with each other. Did the leaders want the limelight for themselves? “Well, for a while, it seemed they all wanted to be president,” Kellogg quipped.

Newspapers had reported complaints that the CDC’s hotline was providing confusing information. Dr. Daniel Ein, a physician in Washington, D.C., despaired that his inquiries were met with “fumbling” answers. Even communication among CDC investigators was erratic. Epidemiologists in the field said that they were getting more information from news reports than from colleagues in Atlanta. The agency also faced a barrage of criticism after the deaths of the two postal workers for not having foreseen that spores could leak from envelopes.

Through it all, CDC Director Jeffrey Koplan insisted that the centers were acting responsibly, though later he acknowledged that early communication with the public could have been better. But he believed that the agency’s reaction to the outbreak was largely successful, while granting that it was also a learning exercise. Indeed, there was much to be learned because cases of inhalation anthrax had been so infrequent in the past. Amid the continuing rumble of criticism, Koplan resigned in March 2002.

Despite missteps, which doubtless will be pointed to and debated for years to come, the CDC did provide essential public health support during the crisis. As anthrax was suspected in Florida, then New York City, New Jersey, the Washington, D.C., area, and, finally, Connecticut, CDC professionals arrived quickly at each location. With a few hours’ notice, Brad Perkins, Steve Ostroff, Beth Bell, and hundreds of others were on planes out of Atlanta to every hot spot. In cooperation with local officials, they joined in assessing the extent of the disease, providing laboratory analyses, conferring with physicians, and informing the public.

As my conversation with Morse, Kellogg, and Lillibridge wound down, Morse observed, “You know, Julie Gerberding really coordinated the CDC’s operations as the events unfolded.”

Dr. Julie Gerberding took the escalator down one level from the lobby of the Regency Hyatt and headed right, to Ballroom II. A silver streak threads through her trim dark hair. In a white turtleneck sweater and dark blue jacket, she was a striking figure as she moved to the front of the room. After a few moments, with two fellow panelists, she began to speak on health care issues. Her audience was sparse; there were plenty of empty seats. At the same time, 500 people were packed into Ballroom III next door for the panel on “Anthrax 2001.” No surprise—the letter incidents had happened only a few months earlier and were still on people’s minds.

Later, Gerberding told me that 2,000 CDC employees had been working full-time on anthrax, “although virtually all of CDC’s 8,500 employees participated to some degree.” In the fall of 2001 she had been acting deputy director of the National Center for Infectious Diseases, “so I was working here in Atlanta with Dr. Jim Hughes, the director, to try to coordinate the investigation and response.” (The NCID is one of 11 component centers and programs of the CDC.)

Articulate and accessible, Gerberding emerged as a principal spokesperson at the CDC’s daily press briefings. On November 15, 2001, for example, she fielded dozens of questions during a telephone press conference. Please define “cross-contamination,” a reporter from Japan requested. What are the side effects of Cipro? asked the
Atlanta Constitution
. Are the recommended antibiotics safe for women who are breast-feeding? inquired Reuters. Her responses were quick and clear, for which the questioners expressed appreciation.

Gerberding had been at the CDC only since 1998. Before that, she was an infectious disease physician for 17 years at the University of California Medical School in San Francisco. But her managerial skills during the anthrax crisis were so highly regarded that in July 2002, at age 46, she was named the first woman director of the CDC.

Gerberding is at once friendly and authoritative. She praised the leadership of Koplan and Hughes during the anthrax crisis but is unabashedly proud of her own role. “One of the things I was uniquely able to contribute was an immediate appreciation of how important it was to have infectious disease clinical expertise on the ground,” she said. She anticipated that wherever anthrax was found, people would show up at medical facilities worried that they had become infected. At the same time, some of them might indeed have the disease. So she was determined to send CDC experts to the field only if they had recent infectious disease experience, “not people who were trained in the remote past.”

“Let me tell you another interesting thing from my unique perspective,” Gerberding said. She paused, seeming to consider whether she was touting herself unduly, then chuckled and continued:

Dr. Gerberding understood that despite evidence that anthrax was not contagious, people might still fear contacting someone who had the disease. “You don’t take away subjective emotion on the basis of data alone,” she said. So she sent Dr. Michael Bell, a CDC doctor she had helped train in San Francisco, to work with the autopsy crew in Florida. He was already familiar with fear and infection containment in autopsy suites where AIDS was involved. Dr. Sherif Zaki, the CDC’s soft-spoken chief pathologist, was pleased to have Bell come down to Miami with him, recalling that “the pathology people down there were really reluctant to do the autopsy.” When Zaki, Bell, and others from CDC arrived, they helped to alleviate the local crew’s concerns about risk. Gerberding said, “You know, they realize that if the CDC is willing to do it, it must not be so dangerous.”

Basically, Gerberding’s role was to coordinate a large number of support systems and field investigations.

It was Gerberding who helped determine whether a suspected case was actually anthrax, not a simple task when laboratory test results were ambiguous. “So I played the role of calling a case ‘a case.’” She emphasized that “a lot rode on whether there was a case or not—you know, closing a postal facility, for example. I didn’t take that lightly, believe me.”

In dozens of interviews with CDC officials and public health doctors, I asked about their emotional reactions during the anthrax events. Most were stoic. In effect they said, “I’m trained for this kind of thing and my emotions are set aside.” Not Dr. Gerberding. “This was a horrible thing,” she answered without hesitation. “Of course, I was not dispassionate.”

Gerberding’s and D.A. Henderson’s paths began to intersect more frequently after the anthrax letters. They appeared on panels together and were among the coauthors of a major article in the May 2002 issue of the
Journal of the American Medical Association
titled “Anthrax as a Biological Weapon, 2002.” The article was an update of the 1999
JAMA
article by the 21 experts who wrote about managing an attack with anthrax.

Henderson’s earlier career focus had been on eradicating smallpox, Gerberding’s on preventing and treating AIDS. In those bygone days, neither had thought a whit about bioterrorism. Now, they were exemplars of a new and pervasive mind-set. Like many other Americans, they had come to view bioterrorism as a threat to the health and security of the nation.

In 1990, Secretary of Health and Human Services Louis Sullivan made a stunning announcement. The United States would seek to map the DNA sequence of the
variola
virus and then “will destroy all remaining virus stocks.” Soon after, the Soviets agreed to do the same. The target date for destruction of the two remaining repositories was December 31, 1993. By the end of 1992, scientists at the CDC had sequenced a strain of the virus, but a debate about the wisdom of destruction had already begun.

In his book,
Scourge: The Once and Future Threat of Smallpox
(2001), Jonathan Tucker summarizes the opposing positions. Some supporters of destruction viewed the virus as an absolute evil that should not be preserved. Total extirpation would also, of course, eliminate the chances that the virus might be accidentally released. But even if smallpox were to appear again, people could be immunized by vaccination. (The vaccine is derived from the relatively harmless
vaccinia
virus.) Finally, destroying the
variola
stocks would strengthen the norm against biological weapons. Their elimination would deepen the sense that “it’s a crime against humanity to develop such weaponry,” according to Jeffrey Almond of the University of Reading.

Opponents of destruction contended that if smallpox reemerged, stored samples of the virus could be useful for comparative investigations. Moreover, the manner in which the
variola
virus caused infection was scientifically interesting and worthy of study. Opponents also felt that the absence of the virus might diminish the sense of need to retain stockpiles of the vaccine. People would therefore be even more vulnerable in the event of an outbreak. As to the moral argument, Wolfgang Joklik of Duke University Medical School retorted that the “symbolism of destroying the remaining stocks of smallpox virus is highly unlikely to influence anyone contemplating biological warfare or terrorism.”

During the 1990s, the WHO, through committee decisions and assembly resolutions, repeatedly affirmed the goal of destruction. But debate among scientists continued, and proposed dates for the final act came and went: December 1993, June 1995, June 1996, June 1999. Then in 1999 the World Health Assembly authorized “temporary retention up to no later than 2002 of the existing stocks of
Variola virus
at the two current locations.” (The assembly is the decision-making body of the WHO and is made up of health ministers of member countries.) But in 2002, in part prodded by the U.S. administration, the assembly postponed destruction pending further international research. It resolved that the matter be considered again no later than 2005.