Q&A 2 with DA

Interview 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 already taken?
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?
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 them now.

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?
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 can.

Q: Why is a new anthrax vaccine in development when one already exists?
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?
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?
[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.

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