The cases of inhalational anthrax in Florida, the first epicenter, were  thought to have resulted from proximity to opened letters containing  anthrax spores, which were never found. Local and State Public Health Officials Identified Strengths in Their Responses as Well as Areas for Improvement

Local and state public health officials across the epicenters emphasized  the benefits of their planning efforts for promoting a rapid and  coordinated response, stressed the importance of effective communication  throughout the incidents, and reported that their response capacity was  strained and the response would have been difficult to sustain if the  incidents had been more extensive. Epicenters Had Engaged in Some Response Planning but Had Not Anticipated the Full Extent of Coordination That Would Be Needed

Local and state public health officials reported that they had typically  planned for coordination of their emergency response but had not fully  anticipated the extent to which they would have to coordinate with a wide  range of both public and private entities involved in the response to the  anthrax incidents, both locally and in other jurisdictions. They also reported that dealing with the media  and communicating messages to the public were also challenging. Experience Showed Aspects of Federal Preparedness That Could Be Improved

CDC led the federal public health response to the anthrax incidents, and  the experience showed aspects of federal preparedness that could be  improved. While local and state officials reported that CDC’s  support of their responses to the rapidly unfolding anthrax incidents at the  local and state levels was generally effective, CDC acknowledged that it  was not fully prepared for the challenge of coordinating the public health  response across the federal agencies. In addition to straining CDC’s resources, the anthrax incidents  highlighted shortcomings in the clinical tools available for responding to  anthrax, such as vaccines and drugs, and a lack of training for clinicians  on how to recognize and respond to anthrax. CDC Provided Support to Meet Heavy Resource Demands from Local and State Officials

CDC effectively responded to heavy resource demands from state and  local officials to support the local responses. In addition, NIH provided  scientific expertise on anthrax. CDC received a tremendous amount of information  via e-mail, phone, fax, and news media reports from such sources as the  agencies and organizations in the epicenters of the incidents, public health  departments not in the epicenters, other federal agencies, and  international public health organizations. The lessons identified fall into three general categories: the  benefits of planning and experience; the importance of effective  communication, both among those involved in the response efforts and  with the general public; and the critical importance of a strong public  health infrastructure to serve as the foundation from which response  efforts can be mounted for bioterrorism or other public health  emergencies. The agency has taken steps to improve future performance,  including creating the Office of Terrorism Preparedness and Emergency  Response within the Office of the Director, building and staffing an  emergency operations center, enhancing the agency’s communication  infrastructure, and developing and maintaining databases of information  and expertise on the biological agents the federal government considers  most likely to be used in a terrorist attack. DOD highlighted that lessons learned from its support of the  public health response could aid in the development of expanded  capabilities within the civilian sector to improve the nation’s public health  preparedness. Bioterrorism: The Centers for Disease Control and Prevention’s Role in  Public Health Protection. Bioterrorism: Review of Public Health Preparedness Programs.
Why GAO Did This Study

In the fall of 2001, letters containing anthrax spores were mailed to news media personnel and congressional officials, leading to the first cases of anthrax infection related to an intentional release of anthrax in the United States. Outbreaks of anthrax infection were concentrated in six locations, or epicenters, in the country. An examination of the public health response to the anthrax incidents provides an important opportunity to apply lessons learned from that experience to enhance the nation's preparedness for bioterrorism. Because of its interest in bioterrorism preparedness, Congress asked GAO to review the public health response to the anthrax incidents. Specifically, GAO determined (1) what was learned from the experience that could help improve public health preparedness at the local and state levels and (2) what was learned that could help improve public health preparedness at the federal level and what steps have been taken to make those improvements.

What GAO Found

Local and state public health officials in the epicenters of the anthrax incidents identified strengths in their responses as well as areas for improvement. These officials said that although their preexisting planning efforts, exercises, and previous experience in responding to emergencies had helped promote a rapid and coordinated response, problems arose because they had not fully anticipated the extent of coordination needed among responders and they did not have all the necessary agreements in place to put the plans into operation rapidly. Officials also reported that communication among response agencies was generally effective but public health officials had difficulty reaching clinicians to provide them with guidance. In addition, local and state officials reported that the capacity of the public health workforce and clinical laboratories was strained and that their responses would have been difficult to sustain if the incidents had been more extensive. Officials identified three general lessons for public health preparedness: the benefits of planning and experience; the importance of effective communication, both among responders and with the general public; and the importance of a strong public health infrastructure to serve as the foundation for responses to bioterrorism or other public health emergencies. The experience of responding to the anthrax incidents showed aspects of federal preparedness that could be improved. The Centers for Disease Control and Prevention (CDC) was challenged to both meet heavy resource demands from local and state officials and coordinate the federal public health response in the face of the rapidly unfolding incidents. CDC has said that it was effective in its more traditional capacity of supporting local response efforts but was not fully prepared to manage the federal public health response. CDC experienced difficulty in managing the voluminous amount of information coming into the agency and in communicating with public health officials, the media, and the public. In addition to straining CDC's resources, the anthrax incidents highlighted both shortcomings in the clinical tools available for responding to anthrax, such as vaccines and drugs, and a lack of training for clinicians in how to recognize and respond to anthrax. CDC has taken steps to implement some improvements. These include creating the Office of Terrorism Preparedness and Emergency Response within the Office of the Director, creating an emergency operations center, enhancing the agency's communication infrastructure, and developing databases of information and expertise on the biological agents considered likely to be used in a terrorist attack. CDC has also been working with other federal agencies and private organizations to develop better clinical tools and increase training for medical care professionals.