Vaccine Plan Revives Doubts on Anthrax Policy

By Ceci Connolly
Washington Post Staff Writer
Monday, December 24, 2001; Page A01

A little over a week ago, D.C. Health Director Ivan C.A. Walks flew to Atlanta for a series of meetings with federal officials billed as "lessons learned in the anthrax attacks." His message was characteristically blunt: We don't need another Brentwood, referring to the confusion, resentment and racial tensions sparked by the government's early handling of the outbreak.

Yet Walks said he is reliving those same frustrations as he attempts to decipher the Bush administration's plan to offer anthrax vaccine on an experimental basis to thousands on the East Coast.

"I thought everybody agreed that clear messaging across a diverse population is how you build and protect public confidence," he said. "If people don't have confidence in their public leadership, they may hesitate or ignore you and that may cost lives."

Over the past week, it's become clear that many of the people directly affected by the vaccine plan do not have confidence in federal health leaders. Once again, the government's response to the anthrax attacks appears to local officials and postal workers to be uncertain, indecisive and, perhaps worst of all, captive to political winds.

If the nation faces another bioterrorist attack, public health experts say, the federal government must find a way to overcome the problems that have plagued the response to this relatively mild one. Otherwise, they will fail to effectively protect the public health.

"The one thing you can't lose is trust," said Beverly Sauer, a professor at Carnegie Mellon University who specializes in crisis communication. "That's the one thing you can't recover in a crisis."

Federal officials say the confusion and frustration is the result of scant and developing scientific understanding, not bias, and deny that Capitol Hill employees have ever gotten preferential treatment over postal workers.

Yet even the many policy analysts and local leaders who accept that defense argue that the scientific uncertainty is little excuse for a series of political and rhetorical missteps that have reopened racial wounds and may have lasting health consequences.

"I don't fault them for the still-developing science," said D.C. Delegate Eleanor Holmes-Norton (D). "Scientists aren't God. But I don't see how people can make informed decisions with contradictory advice."

Federal health officials failed to lay the groundwork necessary to win public confidence, and have simply told citizens too little too late, Sauer said.

"They knew the 60 days would come up and they didn't talk to people early on," she said, referring to the 60-day course of antibiotics that thousands of workers began after they were exposed to anthrax spores from contaminated letters.

Even now, nearly one week after the Bush administration publicly detailed why vaccination may be needed as additional treatment for up to 3,000 people in Washington, New Jersey, Florida, New York and Connecticut, it is difficult to discern where the nation's top physicians stand on the issue. Federal health officials have refused to offer specific recommendations to those at risk -- most notably postal workers -- saying the decision is theirs.

The result is a "double message," said George J. Annas, a medical ethicist at Boston University. "All your actions say you're recommending it, whatever the words on paper say."

Immediately after the bioterrorist attacks began, officials at the Centers for Disease Control and Prevention in Atlanta started working to ensure that they would have available as a possible treatment the anthrax vaccine used by the military to protect soldiers. The thinking was the attacks might continue, and that antibiotics might not work.

About a month ago, officials began to realize that they might need to vaccinate those who already had been exposed to spores from anthrax-laden letters mailed to Sens. Thomas A. Daschle (D-S.D.) and Patrick Leahy (D-Vt.). New research indicated that the workers may have inhaled far more spores than anyone had thought. Spores could be lingering in people's lungs, and could make them sick once their antibiotics were done.

Eight days ago, a gathering of experts assembled by the CDC recommended that Health and Human Services Secretary Tommy G. Thompson approve the vaccinations, and Thompson announced the move last Tuesday.

The vaccine would be made available on an "experimental" basis because it had not received final Food and Drug Administration approval and there wasn't enough evidence to know how effective it might be.

On Capitol Hill, where doctors John Eisold and Greg Martin had been discussing the possibility of vaccination with those high-risk workers for more than a month, the announcement was welcomed and the reaction was orderly. On Thursday, after receiving individual counseling, 48 of the 70 congressional aides offered the vaccine took the first shot.

But elsewhere, confusion reigned. State and local leaders and postal service officials complained of being left out of the decision-making.

Charles Konigsberg, Alexandria health officer and chairman of the health committee of the Metropolitan Washington Council of Governments, said he learned about the program in news reports last week. Noting that many District workers live in Virginia and Maryland and that hospitals in his city treated some of the victims, he said it makes no sense to leave local health officials "out of the loop."

"People are seeking consistent messages and we need to be in a position at the local level to help articulate those messages," he said.

Health officials from New Jersey, where about 1,000 workers at the Hamilton, N.J., postal facility are being offered the vaccine, also were not consulted.

"The communication has been less than ideal in many ways," said state epidemiologist Eddy A. Bresnitz, who also learned what happened from newspapers. By then, he said, the policy was effectively set. "Once you hold a meeting in public on something that important, where the press is invited, you're basically already heading down that path."

But nowhere are the feelings more intense than in the District, especially among the men and women at the Brentwood Road postal facility, where two of the five people who died from inhalational anthrax in the attacks had worked.

Using words like "guinea pigs" and references to the Tuskegee experiments, postal workers, many of whom are African American, said that two times now the Bush administration has relegated them to second-class status.

"These are the same guys that told us when the Daschle letter went through that it was perfectly okay to go into Brentwood," said Azeezaly Jaffer, the Postal Service's vice president for communications.

Walks and D.C. Mayor Anthony Williams flatly recommended against the vaccine, citing the possibility of side effects and the lack of proof it would help.

"There was a public perception that people on Capitol Hill got treated quickly and effectively and lost no one, while the perception at Brentwood was that people were ignored and lost two co-workers," said Walks. "The most egregious error of all, especially in light of what happened two months ago, is that vaccine is available on the Hill and if you don't work on Capitol Hill, we'll get back to you."

Thompson has refused interview requests on the proposal, but his deputy, Kevin Keane, said that for several days leading up to the announcement, Postal Service and union officials were briefed.

"We're reaching out and being very proactive with the union and the Postal Service," he said, voicing his own frustrations over the reaction to the plan. "A lot of times when we talk to their senior management and we raise public health issues, they weigh it against their bottom line. What's this going to do to sales in the Christmas season?"

Julie Gerberding of the CDC said she met on Dec. 13 with postal officials to inform them of the possibility of vaccinations. "I personally met with several postal officials and said we're going to have to look at this vaccine," she said.

Walks, Norton and others do not accuse federal leaders of racial or class inequities but say it is increasingly difficult to urge their constituents to trust the federal government.

"This has incited concern among postal workers again that the people on the Hill are getting a forthright recommendation to take this vaccine and the people in the environment where anthrax actually killed somebody are not," said Norton.

"It is very important it doesn't look like the standard of care is different for Congress than it is for postal workers," said Sen. Bill Frist (R-Tenn.), a surgeon. "To the best of my knowledge it's not," but perception matters, he added.

Federal officials say the perception was a result of the fast pace of developments and of logistics.

"It's one thing to have several physicians advocating for 70 people and another thing to try to educate 9,730 other people who are located up and down the coast and don't have the same doctors," Gerberding said.

But Walks said that still doesn't excuse the lack of clear recommendations.

"Leadership leads," said Walks. "You have got to be brave enough if you're going to be a leader to make a decision and tell people what you think. People allow us to be human but they will not allow us to abdicate leadership."

Staff writers Dale Russakoff and Mary Pat Flaherty contributed to this report.