Environmental Exposures
Anthrax 2001: Observations on the Medical and Public Health Response
This article describes aspects of the medical and public health response to the 2001 anthrax attacks
based on interviews with individuals who were directly involved in the response. It has been more than 18
months since B. anthracis spores were discovered in letters sent through the U.S. postal system. The specific
purpose and perpetrator(s) of these attacks remain unknown.
A total of 22 people developed anthrax as a result of the mailings, 11 suffered from the inhalational form of
the disease, and 5 of these people died. Thousands of workers - including health care, public health,
environmental, and law enforcement professionals - participated in the response to the attacks. Thousands
more were directly affected, including individuals working in facilities contaminated by the attacks and
their families. The immediate and continuing medical and public health response to the anthrax attacks of
2001 represents a singular episode in the history of public health.
After-action assessments of the response to the anthrax attacks could offer invaluable opportunities to better
understand and remedy the systemic vulnerabilities revealed by America’s only experience with an anthrax
attack. Yet there still has been no comprehensive published analysis of the response to these events. In
December 2001, the Center for Strategic International Studies convened a meeting, which included high-level
government officials directly involved in managing the crisis, to discuss the response and review
lessons learned.
The report describing this meeting has been withheld from public distribution by the Department of Defense,
which supported the meeting, on the grounds that the document contains sensitive information. The
"response" to the anthrax attacks was extremely complex, and any analysis that purports to assess the
response must account for this complexity. The unprecedented nature of the attacks and the context in
which the response occurred are also crucial to understanding what happened and why.
The long-standing neglect of federal, state, and local public health agencies, and the highly stressed
condition of U.S. medical facilities, which routinely work at the limits of their capacity, are acknowledged
by virtually all informed observers. That the medical and public health institutions involved in the response
functioned as well as they did is a tribute to the extraordinary efforts of the individuals involved. Despite the
commitment and hard work of the individuals in these professional communities, what was revealed by the
anthrax attacks was an unacceptable level of fragility in systems now properly recognized as vital to
national defense.
For more information, please refer to:
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science Volume 1, Number 2, 2003
