Q&A 2 with DA
by Brian W. Simpson
Photos by John Dean
While the after-midnight calls and emergency meetings
on anthrax have subsided, D.A.
Henderson, MD, MPH '60, continues to work relentlessly to prepare
the nation for future bioterrorism attacks. On a Saturday morning
in late January with a still-decorated Christmas tree beside him
in his Baltimore living room, Henderson, director of the U.S. Office
of Public Health Preparedness, talked about the nation's pressing
short-term needs and long-term challenges.
Q: What steps in preparedness has the government
A: The first order of business was to fund the purchase of a
smallpox vaccine in large quantity and to expand our stockpile of
antibiotic drugs. The second thing is to move quickly now in support
of state and local health departments and to look to planning regionally
for hospitals so they would be in a position to suddenly deal with
large numbers of casualties.
Q: Why has communication between hospitals and health
departments become a weak link in the public health infrastructure?
A: Over the last 40 to 50 years, the capacity we've had to deal
with infectious diseases has gradually diminished because we've
had vaccines and antibiotics [that have] done away with a number
of diseases. We have been feeling increasingly complacent that we
don't really have a problem with infectious diseases. [But] then,
of course, AIDS came along and West Nile virus. There are many of
Q: More than a billion dollars was allocated to the
states for bioterrorism preparedness less than three weeks after
the President signed the budget in mid-January. Why move so quickly?
A: I think there are those who would suggest we should take
the time and develop a needs assessment, and kind of worry this
through, and maybe spend six months in planning, but I think our
concern is we just can't afford to wait. Things could happen in
another month or two, and we need to be as prepared as we possibly
Q: Why is a new anthrax vaccine in development when
one already exists?
A: The vaccine we have now requires six doses of vaccine. The
thought is to make the vaccine in a different way [so] that it should
be able to be given in not more than two or three doses. And secondly,
you do get local reactions with the present vaccine, which can be
painful and can cause arm swelling. That should be negligible [with
the new vaccine].
Q: What should the Johns Hopkins Bloomberg School
of Public Health be doing to help in terrorism preparedness?
A: The School of Public Health really occupies a very critical
central position because this is not strictly a medical problem.
It involves many other considerations. There's going to be a lot
in the way of education and training of people for the program.
Certainly you've got epidemiology, questions of health services
administration [such as] how to put together a program, how to organize
a vaccination campaign. There is a lot to be done with regard to
vaccines and the testing of new vaccines. There is a big need to
determine what provisions of laws are needed to deal with an epidemic.
There is a big area here in biology and molecular biology in understanding
how organisms cause disease, how the body protects itself, and what
we can do to enhance immunity and so on. There is a whole series
of things. And the School of Public Health should be at the hub
of what's going on.
Q: How would you characterize the government's initial
comments on anthrax last fall?
A: [It was] a normal reaction that I've seen again and again
in an epidemic circumstance. The civil authorities feel that if
we don't tell the public anything or [say] that everything's just
fine, that this will be reassuring and it will reduce panic. [However],
experience shows that you should make information available as it
comes in and try to provide a reasonable interpretation of this
information on an ongoing basis.