HOPKINS PUBLIC HEALTH SWAT TEAM:
BUILDING THE BEST DEFENSE
By Brian W. Simpson
Art by Peter Horvath
The Hopkins Public Health SWAT team relies
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
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,"
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
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,
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.