Bioterrorism: Public Health Response to Anthrax Incidents of 2001.
GAO-04-152, October 15, 2003
Why GAO Did This Study
In the fall of 2001, letters
containing anthrax spores were
mailed to news media personnel
and congressional officials, leading
to the first cases of anthrax
infection related to an intentional
release of anthrax in the United
States. Outbreaks of anthrax
infection were concentrated in six
locations, or epicenters, in the
country. An examination of the
public health response to the
anthrax incidents provides an
important opportunity to apply
lessons learned from that
experience to enhance the nation’s
preparedness for bioterrorism.
Because of your interest in
bioterrorism preparedness, you
asked GAO to review the public
health response to the anthrax
incidents. Specifically, GAO
determined (1) what was learned
from the experience that could
help improve public health
preparedness at the local and state
levels and (2) what was learned
that could help improve public
health preparedness at the federal
level and what steps have been
taken to make those
improvements.
What GAO Found
Local and state public health officials in the epicenters
of the anthrax
incidents identified strengths in their responses as well as
areas for
improvement. These officials said that although their preexisting
planning
efforts, exercises, and previous experience in responding to
emergencies
had helped promote a rapid and coordinated response, problems
arose
because they had not fully anticipated the extent of coordination
needed
among responders and they did not have all the necessary agreements
in
place to put the plans into operation rapidly. Officials also
reported that
communication among response agencies was generally effective
but public
health officials had difficulty reaching clinicians to provide
them with
guidance. In addition, local and state officials reported that
the capacity of
the public health workforce and clinical laboratories was strained
and that
their responses would have been difficult to sustain if the incidents
had been
more extensive. Officials identified three general lessons for
public health
preparedness: the benefits of planning and experience; the importance
of
effective communication, both among responders and with the general
public; and the importance of a strong public health infrastructure
to serve
as the foundation for responses to bioterrorism or other public
health
emergencies.
The experience of responding to the anthrax incidents showed
aspects of
federal preparedness that could be improved. The Centers
for Disease
Control and Prevention (CDC) was challenged to both meet
heavy resource
demands from local and state officials and coordinate the
federal public
health response in the face of the rapidly unfolding incidents.
CDC has said
that it was effective in its more traditional capacity of
supporting local
response efforts but was not fully prepared to manage the
federal public
health response. CDC experienced difficulty in managing the
voluminous amount of information coming into the agency and
in communicating
with
public health officials, the media, and the public. In addition
to straining
CDC’s resources, the anthrax incidents highlighted both
shortcomings in the
clinical tools available for responding to anthrax, such as vaccines
and
drugs, and a lack of training for clinicians in how to recognize
and respond
to anthrax. CDC has taken steps to implement some improvements.
These
include creating the Office of Terrorism Preparedness and Emergency
Response within the Office of the Director, creating an emergency
operations center, enhancing the agency’s communication
infrastructure,
and developing databases of information and expertise on
the biological
agents considered likely to be used in a terrorist attack.
CDC has also been
working with other federal agencies and private organizations
to develop
better clinical tools and increase training for medical care
professionals.
In commenting on a draft of this report, DOD stressed the
critical role it
played in the public health response, and HHS provided additional
examples
of actions taken to enhance national preparedness for bioterrorism
and
other public health emergencies.
Read Full Report: Bioterrorism:
Public Health Response to Anthrax Incidents of 2001 [1.1 MB pdf]
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