A Dose of Reality for The Health Watchdogs

By Jeffrey Kluger

If you're Secretary of State or Secretary of Defense, a war room comes with the job. But when you're Secretary of Health and Human Services, you don't have to worry about such things.

Tommy Thompson has his own war room now--though the low-key Health Secretary prefers to think of it as a mere operations center. Whatever it's called, it's a conference room across from his office humming with computers, printers, fax machines and televisions and tended by a team of round-the-clock staff members. It has the look of a place where a war is being waged--just not necessarily one that's being won.

By most measures, the early performance of the federal department in charge of protecting the nation's health in the face of its first bioterrorism attack was not reassuring, mostly because Thompson, the former Governor of Wisconsin, has sometimes seemed utterly overtaken by events. His early statements that the government was prepared to deal with any biological emergency never squared with the facts. In a conversation with TIME, he admitted that his new position was nothing like what he had imagined it would be. "When I was asked to take this job," he says, "I never expected I was going to spend all my time on embryonic stem cells and bioterrorism."

But that's what Thompson's job has become, and the confusing and sometimes conflicting information coming out of Washington has caused some who remember the avuncular and authoritative former Surgeon General Dr. C. Everett Koop to wince. "There has been a breakdown in the public-diplomacy aspect of [the bioterrorism] issue," says Elisa Harris, a veteran of the Clinton Administration's National Security Council. "What's needed is a constant, calming presence."

If Thompson hasn't always been good, however, this time around he's been lucky. The anthrax scare has been a decidedly small one, with only eight infections so far and all but one caught in time. And while HHS, an amalgam of a dozen divisions that deals with everything from aging to drugs, has never been the smoothest-running machine in Washington, so far it has effectively mobilized its resources and overseen the testing of thousands and the treatment of all who have needed it. The small scale has also let Thompson maintain that we have enough antibiotics to handle the crisis, thereby avoiding the politically painful move of breaking Bayer's patent on the anthrax treatment Cipro.

But the crisis has exposed problems in the system that could be disastrous in a bigger emergency. In that sense, the current, manageable alarm may actually serve as a sort of bureaucratic vaccine, exposing the government to a low dose of what a real bioterror attack is like so that it can fortify itself against a bigger hit later. If so, Thompson's department, which seems so unsure of itself now, will have to gain its footing in a hurry. Says Democratic Congressman Sherrod Brown of Ohio: "This should serve as a call to action."

The first problem with asking the Federal Government to intervene in a crisis of this kind is that too often no one knows just who should answer the alarm. The General Accounting Office concluded that there is a "significant coordination and fragmentation problem" in the government's ability to handle terrorism. "If I was going to rebuild the system," Thompson himself told TIME, "I'd probably make some changes."

One change might involve making it clear to the public just what the Federal Government's limits are, and making sure the government remembers that as well. When an infection occurs in Boca Raton, Fla., New York City or anywhere else, the local police, fire fighters and medical teams are our first line of defense. Washington's job is to be ready when summoned and also--more important--to provide local governments with the money and resources they need so that they'll be more able to manage things on their own.

Last year Congress and the Clinton Administration took steps to accomplish just that, enacting the Frist-Kennedy Public Health Threats and Emergencies Act. The law was designed to provide massive training of local public health personnel, upgrade and expand the National Pharmaceutical Stockpile and fund vaccine research and expansion of hospitals' emergency capabilities--in short, to respond to exactly the kind of crisis the nation may now be facing. Though $1.4 billion was originally earmarked, that money was never appropriated. The Bush Administration originally seemed indifferent too, requesting a mere $345 million to combat bioterrorism. Now that's changed. Thompson has requested nearly $2 billion to achieve the Frist-Kennedy objectives, and Congress may up the bid considerably and ask Bush for $10 billion.

However much money is ultimately allocated, the bulk of it should go to training and recruiting first responders, bringing local emergency teams up to speed on dealing with biological and chemical terrorism. Thompson likes to boast about HHS's metropolitan medical response system, federal teams in 97 cities that would provide mass immunizations or treatments within 24 hours of a bioterrorist attack. The GAO, however, estimates that only 22% of the population is within reach of trained first responders, making the need for greater local investment all the more pressing.

Money to increase the number of local hospital beds will be well spent, since many hospitals, facing budget crunches, have slashed bed capacity as much as 40% in recent years. Experts agree that even a small overflow of patients would overwhelm hospitals in nearly every city. Also due for a cash infusion are the woeful local labs, whose technicians are expected to test for diseases and report any outbreaks they discover to the CDC in Atlanta. Many of these labs don't even have fax machines or computer links to the CDC. "Our idea of disease monitoring is to send a postcard to Atlanta," notes a senior Senate aide. Says Senator Ted Kennedy: "Some labs are in an extraordinary state of disrepair; some have been ignored for years."

More money will also have to go to producing and stockpiling drugs to treat anthrax, such as Cipro and other antibiotics, as well as vaccines to protect against other potential threats like smallpox. But getting the drugs manufactured will do no good if they can't be shipped out into the field. The National Pharmaceutical Stockpile has in place around the country eight "push packets"--50-ton pallets of medical supplies and drugs that are kept in secure locations and can be airlifted to the site of a disaster within 12 hours. Thompson ordered one such packet driven to New York immediately after the World Trade Center attacks. The White House is now seeking $643 million in new spending, in part to expand the stockpile by at least four new packets.

Also due for an overhaul is the CDC. The heart of the nation's public health system, the CDC operates out of facilities that are falling apart. Many of the centers' 20 buildings were built during World War II and were intended to last only five to 10 years. Today the structures are crumbling, with duct tape and patches preventing leaky walls from destroying state-of-the-art equipment. Just last week the aging electrical system sputtered out, causing anthrax testing to come to a temporary halt. Most troubling of all, the CDC is where the only stockpile of smallpox virus is kept. Says Patricia Murphy, spokeswoman for Georgia Senator Max Cleland, who has been lobbying for money to restore the facility: "If that fell into the wrong hands, it could be quite a disaster." Now it looks as if Cleland will get the cash he wants, as the Senate is set to recommend $250 million for CDC rehabilitation.

All this appropriating puts Washington in a ticklish position, bankrolling Big Government projects, and then stepping back and cheerleading from the sidelines while other people carry them out. In the unfamiliar world of terror wars, however, everyone has had to learn new ways of doing things, and the Feds are no exception. "We let the public health system slip and slide," says C.J. Peters, former head of the CDC's special pathogens branch. Now it's time for the Federal Government to build it back up--then stand aside and let the CDC do its job.

--Reported by Anne Berryman/Atlanta, Sally B. Donnelly, Andrew Goldstein and Douglas Waller/Washington and Alice Park/New York

With reporting by Anne Berryman/Atlanta, Sally B. Donnelly, Andrew Goldstein and Douglas Waller/Washington and Alice Park/New York