THE HOPKINS PUBLIC HEALTH SWAT TEAM:
BUILDING THE BEST DEFENSE

By Brian W. Simpson
Art by Peter Horvath

The Hopkins Public Health SWAT team relies on
science to shield the nation against future terrorism.



Founded with the belief that science offers the best defense against terrorism, the Hopkins Public Health Scientists Working to Address Terrorism (SWAT) team is strengthening national preparedness by drawing on the realms of biomedical science, policy, medical practice, epidemiology, surveillance, and environmental health. The tools of war they've chosen: seminars, conferences, clinical guides, Web pages, new synergies with the School of Medicine, and academic research.

"I think the awful experiences [of Sept. 11 and the anthrax attacks] have taught us we need a sustained effort to safeguard public health," says the group's director Thomas Burke, professor, Health Policy and Management.

Since it was founded in October by Dean Alfred Sommer, the group has organized a November symposium on anthrax issues, participated in a weeklong bioterrorism lecture series, and sent representatives to a National Academy of Sciences meeting in December that ultimately led to the availability of anthrax vaccine as post-exposure prophylaxis to those exposed last fall. It has also furthered the science on anthrax and posted guidelines on the Web for diagnosis and treatment.

In January, the group's intersession course on terrorism drew 150 local, county, and state health authorities and federal officials from the Department of Agriculture (USDA), the Environmental Protection Agency, the Department of Defense (DoD), and other agencies. The standing-room-only seminar drew on faculty experts to deliver a terrorism primer for the attendees.

A new seminar series is being planned for this spring by Burke, PhD, MPH, and fellow steering committee members professor Ron Brookmeyer, PhD; professor Don Burke, MD; professor Lynn Goldman, MD, MPH '81; and Tara O'Toole, MD, MPH '88, director of the School's Center for Civilian Biodefense Strategies. The group will bring national leaders in research, education, and policy to the School to address risk assessment, toxicology, epidemiology, preparedness, and other issues.

Additionally, Burke and his team have consulted with the Centers for Disease Control and Prevention, USDA, DoD, and other agencies on how the School can best employ its research and education capabilities in public health preparedness.

To meet the challenges of "the new world of public health," the SWAT team, which includes 40 active faculty members, has organized six working groups: Environmental Sampling and Assessment, Communications, Vaccines, Clinical Management, Law and Public Policy, and Education. Additionally, the steering committee is planning new working groups on radiological and chemical issues, as well as others concentrating on epidemiology and surveillance.

The working groups, drawn from a cross-section of departments at the School and the University, have addressed the need for dependable information by producing frequently asked questions (FAQs) and answers on terrorism issues. The FAQs, which deal with everything from how to protect your skin from anthrax to the adequacy of existing laws to deal with a public health crisis, can be reached from the School's Web site (www.jhsph.edu).

The following introduces the current working groups and their areas of focus:

Vaccines "As a general rule, vaccines are the most cost-effective strategy in public health prevention," says Don Burke, the group's chair and the director of the School's Center for Immunization Research. While vaccines already exist for most of the biological agents of concern such as anthrax, smallpox, tularemia, and others, these vaccines depend on technology available when they were developed 30 to 40 years ago, according to Burke. They have more side effects than vaccines developed with today's technology. Burke expects the group to be involved in clinical trials for new generation vaccines in the next year.

The working group is also seeking to draw attention to the nation's fragile vaccine production capability. "There are one to two manufacturers per vaccine. And there have been significant shortages of several vaccines in the last two years or delays in their production," says Burke.

Clinical Management This working group is developing algorithms for clinical diagnosis and treatment of the main biological agents of concern, according to Chair Robert Bollinger, MD, MPH '88. The algorithms essentially flow charts for doctors to follow as they examine suspected victims of bioterrorist attack - are systematic guides to diagnosis and treatment. "With the anthrax outbreak, every day brought different information. We wanted to synthesize information in a way that could be used by clinicians effectively," says Bollinger, an associate professor in the School of Medicine with a joint appointment in International Health. The anthrax algorithm, deemed top priority, has been vetted by medical and public health faculty and has been completed. The group produced a Hopkins-specific anthrax algorithm (with Hopkins contact numbers) and a generic version that can be used by any health care provider. Smallpox and botulinum toxin algorithms will be completed soon, with algorithms for plague, tularemia, and hemorrhagic fever to follow in the coming months.

Education With demand already expressed for a monograph to be published from January's intersession class and for an Internet-based distance learning course drawn from it, the need for more information and education about terrorism is obvious. "The most gaping need is for developing an expert work force and sound science and research," Tom Burke says. Burke and Brookmeyer, who works with him on the education working group, see the terrorism issue having lasting ramifications in epidemiology, health policy management, environmental health, and other School disciplines. They are also investigating other opportunities to add intersession, distance education, and other terrorism-centered seminars and courses. A concentration in public health preparedness is being planned for the MPH program that would include courses in emergency management, surveillance, terrorism, risk assessment, and communication and crisis response.

Legal Issues Chair Steve Teret, JD, MPH '79, professor and director of the Center for Law and the Public's Health, and his team have drafted model legislation that can be adopted by states to grant them the legal right to enforce public health measures such as quarantine in the event of a public health emergency. (Click here for Model State Emergency Health Powers Act story.)

Environmental Sampling and Analysis Co-chairs Lynn Goldman, and Jonathan Samet, MD, MS, and their working group have looked at the issues of surveillance, disease tracking, and how to decide when a building is safe to reenter after exposure to biological agents. Goldman and Cliff Mitchell, MD, MS, MPH '91, have been advising the postal workers' union on anthrax and mail irradiation issues. (Click here for postal workers story.)

Communications This working group is investigating the specific communication needs of different groups such as workers, parents, children, and students, according to Barbara Curbow, PhD, associate professor. Curbow and the group plan on offering effective communications guidelines for use by government and organizations in the future. A summer institute course in terrorism risk communications and a training program with Veterans Administration hospital staff are also being worked on, she says.



In This Issue of Johns Hopkins Public Health Magazine:








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