The public health lessons of 9/11, anthrax letters

The University of California Press has recently brought out a book titled Are We Ready? Public Health Since 9/11, written by David Rosner and Gerald Markowitz. In the recent issue of Science, Paul Klime offers areview of the book, and the subject it covers (we like the title of the review, too: “A Crisis Is a Terrible Thing to Waste”). Klime, by the way is at the Department of Biological Sciences at Northern Arizona University, Flagstaff, and the Translational Genomics Research Institute (TGen).

Klime writes that the 9/11 attacks, and the anthrax letter attacks which followed, concentrated the minds of many, and resulted in many U.S. biodefense leaders beginning to design a road map for infectious disease and public health efforts. “The 2001 terrorist attacks provided the political impetus to create a sustainable biodefense infrastructure and skilled workforce for the longterm benefit of public health in the United States,” he writes. The question the book authors ask is whether government authoritirs in the United States acted merely in a knee-jerk fashion, as government often do when faced with a crisis, or whether it responded to the crisis by doing something sustainable and with a long-term impact on public health. Rosner, a professor of public health and history at Columbia University, and Markowitz, a professor of history at the City University of New York, try to answer this question by examinning how New York City coped with the specter of bioterrorism which the 9/11 and the anthrax attackes evoked. The authors document that the effects of the attacks encompassed every aspect of life in the city. From high school administrators to the governor, uncertainty about the dangers and responsibilities was common. The political leadership (for example, Mayor Rudi Guliani) played a role, but Rosner and Markowitz are more skeptical than past and current sound bites about its importance. Their presentation places the events in the context of New York political and social history, and they conclude that the effectiveness of New York’s response was only partially due to the contemporary political leadership and more due to institutional structures built over many years.

Long-neglected state public health departments were suddenly in the limelight after 9/11, with newfound importance to their governments and citizens. Yet, as the initial excitement faded, the reality remained that federal funding was often targeted for highly specific bioterrorism projects (for example, smallpox vaccination),