The complexity of the 2001 anthrax investigation and response challenged even experienced field epidemiologists. At the state and federal levels, "incident command"-style management structures were used to address the constant emergence of new information, pursue many public health activities simultaneously across multiple investigations, and communicate effectively. These management structures, which have been adopted by the disaster management and law enforcement communities, are less familiar to public health workers. With some variation from site to site, a typical field investigation structure included local, state, and federal public health partners working on the following teams: Epidemiologic Investigation (what happened?), Intervention (post-exposure prophylaxis and follow-up), Surveillance (identify additional cases), Clinical Evaluation (rapidly evaluate suspect cases), Environmental Assessment (environmental sampling and processing), Remediation (working with the Environmental Protection Agency), and Communication (with the public, partners, and press). These teams were sometimes complemented with Federal Bureau of Investigation (FBI) liaisons; in some cases, public health officials were assigned to FBI investigation teams (12). A senior epidemiologist was also posted to FBI Headquarters in Washington, D.C. During the anthrax investigation, the public health response team was better prepared in some areas than in others. Five deaths were not prevented, but widespread illness and death was averted through early recognition of threats and prompt intervention. We applied what we knew and learned what we did not know. We gained new appreciation for communication and partnerships. For the first time, on November 8, 2001, a sitting President of the United States of America, George W. Bush, visited CDC to support the efforts of public health professionals and others who participated in the anthrax investigation and response. Leaders and individual heroes rose in the ranks of public health, clinical medicine, and law enforcement (41). The substantial role of public health in the 2001 anthrax investigation and response suggests that strong public health infrastructure supported by applied public health and basic-science research are key elements to the control and prevention of future bioterrorism threats.
Emerging Infectious Diseases (October 2002), v.8, no.10, p. 1015-18