Controversies in Science and Technology: From Maize to Menopause

18 The States and the War against Bioterrorism: Reactions to the Federal Smallpox Campaign and the Model State Emergency Health Powers Act

18 The States and the War against Bioterrorism Reactions to the Federal Smallpox Campaign and the Model State Emergency Health Powers Act David Rosner and Gerald Markowitz Introduction The newspaper headlines were stark and eerie: “Efforts to Calm the Nation’s Fears Spin Out of Control,” “Local Public Health Officials Seek Help,” “This Is Not a Test,” “Some States Can’t Handle Bioterrorism,” “Scared into Action.” And the pictures that accompanied them were worse: space-suited investigators, smallpox-ridden children, cold stark laboratories staffed by masked personnel. State and local health departments were now supposed to be on a “war footing,” as one headline noted. The events of September 11 and the October 2001 anthrax incidents placed public health and public health agencies in the spotlight to a degree not experienced since the great epidemics of influenza, polio, whooping cough, and the like during the first fifty years of the last century. Many officials felt overwhelmed. The limitations of the public health surveillance system, laboratories, and treatment and social services became all too apparent. Beleaguered staff, limited laboratory space and supplies, 297 and the general inexperience with bioterrorism led to a profound reevaluation —sometimes naive, sometimes quite sophisticated—of the place of population health services in the country’s antiterrorism and emergency preparedness systems. Two years after the attack, many public health officials believed there was still tremendous ambiguity about what bioterrorism and emergency preparedness really mean. Some saw emergency preparedness as synonymous with strengthening the existing public health infrastructure. Some saw it as building population health services more broadly. Others saw it as narrowly focused on smallpox, anthrax, emergency care, border protection , and the like. While all these formulations are obviously complementary , they often create competing demands for scarce resources. This chapter is a contemporary history of two important initiatives that affected the various states’ public health systems in the two years after the September 11 terrorist attacks: the smallpox inoculation campaign and the circulation of the draft Model State Emergency Health Powers Act. As historians, we hope to provide the lessons learned and perspectives gleaned by the participants themselves, using a wide variety of primary sources, including published and unpublished reports, oral interviews with key participants, and government documents and popular media. Certain themes emerged from the interviews, and the primary and secondary sources that we examined: In the immediate weeks after September 11, there was widespread hope among the professionals involved that the new focus on public health would result in a revitalization of the field and dramatic improvements in the public health infrastructure; states soon faced a conflict between widespread budgetary problems and the federal mandate in late 2002 for a major smallpox inoculation campaign; and the attempt to codify and reformulate state public health laws through the distribution of the draft Model State Emergency Health Powers Act, combined with what some criticized as the poor federal handling of the anthrax episode and smallpox inoculation campaign, stimulated a broad discussion of the obligations and responsibilities of health authorities in light of the new geopolitical situation. In general, our interviews with key participants and our reading of published and unpublished reports and media coverage suggest that the early potential to reform the public health system is endangered. Those services are essential for the improvement of the nation’s efforts to address bioterrorism preparedness and the overall health needs of the population. 298 r o s n e r a n d m a r k o w i t z Smallpox Campaign Once a disease that swept through cities and towns, leaving in its wake untold numbers of casualties and disfigured people, smallpox has disappeared from the natural environment through massive inoculation and public health campaigns worldwide. Yet for decades, both the United States and the Soviet Union stored the virus that causes smallpox, distributed it to various research labs, and made other moves that ensured that this public health victory became a potential human tragedy. Not only did the two countries refuse to destroy the remaining vials of smallpox virus, but evidence exists that some scientists in both countries, working at the behest and direction of their governments, labored hard to figure out how to make it all the more deadly and immune to the very public health measures that had “eradicated” it in the first place. By genetically altering the virus and selecting out strains that will...