The Anthrax Letters: The Attacks That Shocked America (23 page)

By then he had already had several conversations about the threat of bioterrorism with Michael Osterholm, a public health colleague. Osterholm, the state epidemiologist for Minnesota, had been speaking publicly on the subject for a few years. “Mike was ahead of me in perceiving that there was a real problem,” Henderson said. Osterholm recalled a 1993 meeting at which Soviet defectors said their former regime had produced tons of anthrax and smallpox to be used as bioweapons. “That briefing created a visceral memory for me,” said Osterholm. He became increasingly convinced that the United States was unprepared for a biological attack, but he felt frustrated because he could arouse little interest in others.

Henderson came to share Osterholm’s worries, especially about the possible reemergence of smallpox. Still, he felt that public discussion would not be helpful. That all changed toward the end of 1997, when he finally agreed to appear on a panel to discuss bioterrorism. “It was September 1997,” Henderson recalled, “at the opening session of the annual meeting of the Infectious Diseases Society of America—IDSA.” In addition to Osterholm and Henderson, another panelist was Richard Preston, whose fictional thriller on bioterrorism,
The Cobra Event
, was about to be published. As they sat on the stage, the panelists were amazed. Henderson turned to a wide-eyed Osterholm on his left and said, “Can you believe this? The hall is packed, standing room only.” “There’s gotta be more than 2,000 people here,” Osterholm replied. John Bartlett, who was president of IDSA, later told Henderson that throughout the remaining days of the conference the “discussion came back again and again to the risk of bioter-rorism.” Henderson had begun his remarks with an acknowledgment of his conversion:

After his appearance on that panel, Henderson was flooded with speaking invitations from groups of all types, he says, including hospital staffs, policy associations, and the governing board of the National Academy of Sciences. His message was that too little was being done to prepare for a bioterrorism attack. The following year he invited 24 people to his fledgling biodefense center at Johns Hopkins to develop policy initiatives. “Some of the people were in government, some were academics, some public health doctors. We sat down in the fall of 1998 and asked ‘What are the organisms we’re most concerned about?’”

Until then, more than 30 potential microorganisms and toxins had been listed by the U.S. Army and NATO as potential biowarfare agents. The Hopkins working group determined that six of them were the most likely to be used and deserved particular attention. Designated “Category A” agents, at the top of the list were the bugs that cause smallpox and anthrax and then plague, botulinum toxin, tularemia, and viral hemorrhagic fevers (such as Ebola or Marburg).

The heightened concern about smallpox was only recent. The last case of smallpox in the United States had been in 1949, and in 1972 routine vaccinations in this country were ended. (By then the disease was absent in the Western Hemisphere. The occasional serious side effects from a vaccination no longer seemed worth risking.) In 1984, four years after its declaration of global eradication, the WHO authorized only two laboratories in the world to retain stocks of
variola
virus. One was at the CDC in Atlanta and the other at the Research Institute for Viral Preparations in Moscow.

Thus, on the assumption that the virus was safely locked away, U.S. authorities considered smallpox an unlikely bioweapon. As recently as 1994, a publication by the U.S. Army Medical Research Institute of Infectious Diseases had failed to mention smallpox among 12 biological threat agents. But the discovery that the Soviets had been illegally producing the virus, and suspicions that other countries (notably Iraq and North Korea) might be doing so, prompted a reassessment. The push from Henderson, Osterholm, and others resulted in a reordered sense of risk. Almost all Americans were now deemed vulnerable to smallpox since none had received vaccinations in the past 30 years.

Meanwhile, Henderson had been unsuccessfully seeking funds for his new biodefense center at Johns Hopkins. The center’s startup money, a $1 million congressional appropriation sponsored by Senator Barbara Mikulski, was running out. He spoke ruefully about his drawerful of rejections:

Before giving up, Henderson tried one more possibility—Ralph Gomory, whom he knew from meetings of the National Academy of Sciences. (Gomory is a member of the Academy and Henderson a member of the allied Institute of Medicine.) Gomory, a mathematician, is president of the Alfred P. Sloan Foundation. As Henderson later learned, he had an abiding concern about bioterrorism.

Gomory is a slightly built man with a businesslike demeanor. Early in 2000 he had ordered disaster kits for everyone who worked at Sloan. Every employee now had a kit at his desk that included a whistle, flashlight, gas mask with filter tips, and more. In 2002, during a conference on bioterrorism sponsored by the foundation, Gomory stood to the side of the room and said he wanted to show me something. He reached into his left pants pocket and pulled out a blue cloth protective mask. “I carry this all the time,” he said, his brows furrowed with a sense of gravity. “It will be helpful against either a biological or chemical agent.” Gomory’s preoccupation had been Henderson’s good fortune.

“D.A., How many foundations have supported you until now?” Gomory asked when Henderson first approached him.

“Precisely none, Ralph.”

Henderson was bowled over by Gomery’s reaction. “Great,” he said, “We’re definitely interested. Send us a proposal.”

“For how much money?” Henderson asked.

“Why don’t you ask for what you need, and we’ll cut it back if we think it’s too much.”

Henderson huddled with his staff at the center and came up with a request for $3.5 million. They sent the proposal in and held their breath. Three weeks later they received an answer. Henderson grinned, “We got a check back for $3.5 million.”

Subsequently, Henderson heard from Gomory that the foundation was “absolutely delighted” with the decision to grant the money. It had become clear in Congress and elsewhere, Henderson said, that “if not for the center and for Sloan, we would have been much less well prepared for bioterrorism than we are.” During the anthrax incidents, the Hopkins center was a magnet for callers, especially from the media, who were hungry for information. Five of the center’s experts were on the phone 10 hours a day, fielding inquiries from the press. Actually, though, the public health backbone of the nation’s preparedness for a bioattack is the CDC. The anthrax incidents tested that responsibility as never before.

Stephen A. Morse became associate director of the CDC’s bioterrorism preparedness and response program when it was established in 1999. A microbiologist, he had previously been working on the AIDS virus at the CDC. In March 2002 we met over beers at the Regency Hyatt Hotel in Atlanta. It was between sessions of a conference on emerging infectious diseases, sponsored by the CDC and the American Society for Microbiology. Richard Kellogg, who coordinates the CDC’s bioterrorism laboratory response network, joined us.

I asked what life was like at CDC the previous fall. Morse spoke evenly through a close-cropped salt-and-pepper beard. He mentioned a meeting of CDC officials that convened just after Bob Stevens’s blood samples were confirmed for anthrax.

Kellogg reflected on their exhausting schedule: “After 9/11, if I’d go home, Stephen would borrow my sleeping bag because he’d be on the late watch. We were all waiting for the next thing to happen.” And then the anthrax letters. I asked Kellogg whether he felt traumatized by all this. He shook his head no and in a southern accent that harks back to his Florida childhood answered:

Morse and Kellogg were occupied with coordination of laboratory services around the country. By the time of the anthrax letters, the CDC had established a laboratory network in which 80 state and local public health laboratories were participating. These laboratories had received instructions and materials for testing several likely bioterrorism agents. The laboratory in Jacksonville, where Phil Lee confirmed Robert Stevens’s anthrax, was part of the network. But all the laboratories, no matter how well instructed, were experiencing a crushing surge in demand. Physicians, hospitals, and law enforcement agencies were sending in so many samples that even the best-prepared laboratories could not keep up.

In October and November 2001, more than 120,000 specimens were tested for anthrax, an average of 2,000 per day; but all told the number of laboratories involved—in the military, the Federal Bureau of Investigation, at CDC, and in the national public health response network—totaled less than 150. Round-the-clock efforts by laboratory personnel were heroic but pointed to the need for a more expansive testing capability. (A year later the number of labs in the national response network alone had increased from 80 to 120.)

I asked Morse and Kellogg if they or their families treated their mail differently during the anthrax scare. “No,” Morse answered. “The only thing I did was make sure we had a supply of Cipro in the house.” Kellogg did the same. “We already had our own ministockpile in our travel kits. I just gave my wife the packet and said, ‘here you are, just in case.’”

Were they ever worried personally? “I’ll tell you when I was worried,” Morse answered, then shifted the focus back 3 years.

Morse knew that laboratories nationwide lacked assays to test for potential germ weapons—that is, the chemical reagents that could confirm the presence of organisms like anthrax and plague bacteria. “I was so worried that something was going to happen before we got the laboratory response network up and running.”

Kellogg joined in:

He offered a half smile: “It was fortunate that the perpetrators waited until we were ready.”

An hour into the conversation, Scott Lillibridge joined us at the table. His round face is boyish, a nice match for his dry wit. But his current assignment is deadly serious. For the past year he has been at HHS, as an adviser on bioterrorism to Secretary Thompson. “Actually, now I’m working with D.A. Henderson to move grant money for bioterrorism preparedness programs to the states,” he said. I asked Lillibridge what he thought when he learned of the first anthrax case: “My reaction was—bioterrorism. I was thinking, ‘Will they be putting it into the air ducts of a federal building?’ I was surprised they only used five or six letters.”