strengthening the capacity of public health and medicine to deal with new and emerging infections including those presented by terrorism. Although some additional resources were provided to the Centers for Disease Control and Prevention in response to these reports, these were limited. Over the past decade the overall condition of the public health system in America has continued to erode. Many of these weaknesses were graphically displayed during the anthrax episodes. Laboratory capabilities, adequate staff for investigations, the relationship and responsibilities of public health to law enforcement and, especially for purposes of this hearing, the effectiveness of communications to the public and to health professionals about the anthrax terrorism were found wanting.

Key to the role of public health is education and information for the public and for health professionals. Whether an epidemic is a naturally occurring one such as that involving West Nile virus, or whether produced by a terrorist, public health professionals and public health departments around the United States need timely, accurate, and reliable information.

Every epidemic results in new knowledge as it is studied and understood. In the case of anthrax, information about the inhalation form of the disease was limited to a very small number of cases over an extended period of time. Medical practitioners and public health officials in the United States never had direct experience with inhalation anthrax. Not only is it important to learn in an ongoing way as such an epidemic develops, but it is also important to rapidly translate that knowledge into reliable guidance to health professionals and to the community.

In this testimony I will focus on two critical methods of communication about these issues in the 21st century: verbal communication—particularly via television—and the Internet. I begin with remarks concerning verbal communication.

Within the Department of Health and Human Services, there must be a single credible medical/public health expert spokesperson who reports regularly, most likely daily, to the American people in regard to any outbreak with national significance. This is analogous to the situation in local communities where there is a need for such an individual to communicate on behalf of the local health department. Several months before the anthrax outbreak, uninformed statements on local television in a community with two cases of meningococcal meningitis resulted in thousands of individuals taking antibiotics or seeking immunizations that were not indicated. Local stores of antibiotics were depleted and many people were subjected to risk from unnecessary treatment. This episode emphasizes the need for credible medical/public health information during natural events, as well as during those that are produced by terrorism.

In the case of the anthrax episodes, the media responded by interviewing countless numbers of individuals. Among them was a self-professed pundit who announced he was an expert on the “anthrax virus.” Anthrax is a bacterium, not a virus. In many cases, well-intentioned infectious disease specialists who knew a good deal about the literature on anthrax could provide accurate retrospective information, but when pressed about the current events, they were not privy to



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