A look back at the national crisis provoked by the intentional release of anthrax into the US Postal System in late 2001

1. ROCHESTERMEDICINE
UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY SPRING/SUMMER 2002
BIOTERRORISM: D.A.Henderson and other alumni battle the problem.
Smart bandages and more—the latest research.

2. 17
ot many associate pastors can say they spent 20 years in the dark
world. Then again, Frank Young, M.D., Ph.D., isn’t your typical
associate pastor. Young, former chair of the Department of
Microbiology at Rochester and former dean of the School of
Medicine and Dentistry and now an associate pastor in Maryland,
worked for nearly two decades within the federal government in classified
areas—known as the “dark world” to people inside the Beltway.
Young’s efforts in the ’80s and ’90s helped lay the groundwork
for the explosion of activity now under way as a result of September 11
and the anthrax attacks. His was one of the few voices in the Washington
wilderness, warning of the need to prepare for bioterrorism.
Today, that preparation is a national priority, reflected both in
the billions of new dollars being budgeted for bioterrorism defense and
War rooms,new vaccines and
meetings with the President
Experts take their places in Washington to protect the country from bioterrorism.
by Mark Liu
the sheer numbers of people now devoted to
the problem. Several Rochester alumni have
recently stepped into key leadership positions
on this new front, in the recently created Office
of Homeland Security and the Office of Public
Health Preparedness. They’re part of the new
guard in this post-September 11 world.
Young, for his part, foresaw this changed world and helped
persuade President Clinton to begin preparing for it. Young was in the
position to advise the president after a far-reaching Washington career
that included stints as commissioner of the Food and Drug Administration,
deputy assistant secretary for Health Science and Environment in the
Department of Health and Human Services (HHS), U.S. representative
N
Eric Noji, M.D., M.P.H.,
shakes hands with
President Bush in
the White House.

3. ROCHESTER MEDICINE18
to the Executive Board of the World Health Organization (a Senate-
confirmed position), and director of the Office of Emergency
Preparedness/National Disaster Medical System. Before that, Young’s
research in Rochester involved the nontoxic form of anthrax. In effect,
he has been working on bioterrorism issues for a quarter of a century.
In 1993, Young took part in a simulation that helped change the
face of bioterrorism response in this country. The event was the govern-
ment’s first full-scale biological attack simulation “in the white world,”
as Young describes it, as opposed to previous simulations held in secrecy.
The tabletop exercise simulated the response to an anthrax release in the
subway system of a major metropolitan area. More than 100 people took
part, representing the EPA, FEMA, HHS, Department of Agriculture, and
various other local, state, and federal offices. The simulation even brought
in CNN reporters to show how difficult it is to address the public in the
midst of an unfolding crisis.
Young, as the officer in charge of the public-health response to
the attack, says the key players in the simulation continued to meet over
the years because of what they discovered from that exercise.
“The dominant thing we learned was a need for command and
control,” says Young. “A clear line of authority was needed.”
It takes coordination
It’s no coincidence that, today, Washington is emphasizing command
and control centers for better communication and coordination of infor-
mation. Eric Noji, M.D., M.P.H. (M ’81), sits in one of these new centers at
the White House, in the Office of Homeland Security. Noji is on assignment
from his job at the Centers for Disease Control and Prevention (CDC) in
Atlanta, where he serves as associate director of the Bioterrorism
Preparedness and Response Program. In fact, he went immediately to
Washington after September 11, then onto assignments at the World Trade
Center site in Manhattan because of his disaster-medicine research
expertise in the toxic effects of pulverized concrete. Typically, Noji is called
to earthquake sites, which he compares the World Trade Center site to
(except that Ground Zero is in a much more concentrated area).
The day the first anthrax case in Florida came to light, Noji was
scheduled to return home to Atlanta. Instead, he found himself called to
work at the White House.
I’ve been living in a hotel since September 13,” he muses.
He’s also been working in a kind of war room, officially dubbed
the Coalition Information Center, in a former ballroom in the old
Executive Office building. Back in Teddy Roosevelt’s day it was the Indian
Treaty room, but today it’s filled with several dozen desks representing
various agencies. The Department of Defense is there, as is the Department
of the Treasury, Department of Transportation, even a London desk.
The idea is to provide some centralized coordination for what Noji—
a man who knows his way around the chaos of an earthquake— deems
an almost unbelievably complex situation.” When Noji’s boss,
Governor Tom Ridge, the head of the Office of Homeland Security,
displayed a diagram of who reports where within the various entities
involved in terrorist and bioterrorist defense, Noji says it “looked like
a quilt” because of all the lines connecting so many groups.
And that’s the real challenge facing us. Noji says that, while his
physician colleagues might be surprised to hear it, “the medical and health
aspect is the smallest part of disaster response.” For example, after the
September 11 attack, the United States discovered that incompatible telecom-
munications systems among first responders—police, fire, ambulance
services, the Red Cross—made it extremely difficult to coordinate efforts.
When other unexpected problems arose, there was no clear system
in place to deal with them. Citizens, says Noji, were donating things “out
of the goodness of their hearts,” but they didn’t know what was needed.
So they were emptying out their medicine cabinets and sending it all.
Diet pills, birth-control pills—everything imaginable was showing up in
huge piles, some of it simply addressed to “U.S. Government.” Volunteers
also were showing up, but some weren’t qualified and others didn’t even
speak English. Yet all needed a place to stay and meals to eat. And some-
body in the government had to figure out how to deal with such issues.
Noji helped coordinate information during the height of the
fighting in Afghanistan, when rumors were flying about hemorrhagic fever
and the poisoning of wells. Now, he has settled back into his primary
assignment: preparing for a smallpox attack. There’s so much emphasis
on a smallpox attack because, as Frank Young explains it, it’s a low-prob-
ability event with high-risk consequences. The low probability means that
some people didn’t take the threat seriously. But the high-risk conse-
quences—spread of a horrific disease that kills a third of its victims and
renders survivors severely scarred or blind—means that a response plan
is now considered vital.
Betting on better vaccine
Just down the street from Noji, between the Washington Monument and
Capitol Hill, Major General Philip K. Russell, M.D. (M ’58), and Jerome
Donlon, M.D. (Ph.D. ’68, M ’72, R ’73) are working on the smallpox problem,
as well. (And down the street from them, Donlon’s wife, Mildred Donlon
(Mas ’64, Ph.D. ’72) works for a government office dedicated to futuristic
defense breakthroughs; see technology story on page 20.)
Russell and Donlon are part of the new federal Office of Public
Health Preparedness, led by D. A. Henderson, M.D., M.P.H. (M ’54).
Primarily, their task is to oversee the development and storage of vaccines,
especially for anthrax and smallpox. A major project is under way to
develop a second-generation anthrax vaccine that would improve on the
current one, which is based on older production techniques. In March,
the National Academy of Sciences came out in support of such research,
saying that the current vaccine should be improved.
“Genetic engineering and recombinant technology allows for
isolating specific proteins, which would create a better specified vaccine,”
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4. SPRING / SUMMER 2002 19
says Donlon, whose regular assignment is at the Center for Biologics
Evaluation and Research at the FDA.
The better vaccine might be used to protect public health workers
and other first responders who would be in danger of infection during
an attack. The vaccine might also be useful after exposure, says Donlon,
to help the immune system produce a response to infection. The NIH has
lead responsibility for the effort, with assistance from the CDC and FDA,
and oversight by the Office of Public Health Preparedness.
Donlon and Russell spend much of their time overseeing the
government contract to produce smallpox vaccine. The job is more
complicated than it might sound, requiring coordination among the CDC,
the FDA, the private company producing the vaccine and the Office of
Public Health Preparedness. The vaccine must meet FDA standards,
which means strict protocols for clinical trials and inspections, and it has
to be effective. Because the vaccine is being prepared for the expanding
National Pharmaceutical Stockpile Program, coordinated by the CDC,
Russell and Donlon must consider practical matters such as what kind of
needles are needed and how many, and how best to package the vaccine
for rapid deployment.
Russell seems the ideal person to draw up battle plans against
a smallpox attack. After graduating from Rochester, he served in the army,
becoming director of the Walter Reed Army Institute of Research,
commander of the Fitzsimons Army Medical Center and commander of
the U.S. Army Medical Research and Development Command. His military
awards include the Legion of Merit and the Distinguished Service Medal,
and he retired a major general. Henderson considers him “one of the
nation’s most knowledgeable and respected persons in vaccine research,
development and production.”
Some critics have questioned the wisdom of devoting so many
people and so much money to prepare for bioterrorism attacks. To Donlon,
such criticism overlooks the overarching benefits of these efforts.
“The training, response plans, surveillance, lab services— it all
strengthens the public-health infrastructure,” says Donlon. “It’s not just
for bioterrorism. It’s the same public-health response, so other outbreaks
can be responded to quickly.” The same need exists for teamwork and
communication during such problems as floods, flu outbreaks, or the
discovery of West Nile virus.
Besides, the people on the front line of a potential attack are
looking for guidance.
I get literally 300 e-mails a day from concerned doctors and
nurses,” says Noji. They want to know how they should prepare, and what
they can do.
Meanwhile, Frank Young has retired from the dark world and now
deals in the light of the world. As an associate pastor, he’s working to
establish an accredited theological school. Even as he was giving his
recommendations before Congressional committees in October, and even
as his former Rochester colleagues were gathering in Washington to
hammer out plans to protect the country from biological attacks, Young
was making sure to keep working on what he has learned to be a corner-
stone of the plan: faith.
From left— Major General Philip K. Russell, M.D., Jerome Donlon, M.D., Ph.D., Mildred Donlon, Mas, Ph.D., and D.A. Henderson, M.D., M.P.H.
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