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SUSAN DENTZER: Among the top medical achievements of the 20th century was the eradication of the deadly and contagious smallpox virus. And one of the people who did the most to accomplish that was Dr. Donald A. Henderson known as D.A. From 1966 to 1977, Henderson headed the World Health Organization’s effort to eliminate the virus, which at that time caused several million deaths a year. By 1980, that effort was declared a complete success with no known disease in patients and only small quantities of the virus remaining in laboratories. In recent years Henderson turned his attention to the threat of bio-terrorism, founding a prominent center at Johns Hopkins University on civilian bio-defense.
On November 1, amid the anthrax attacks and America’s first bout of bio-terrorism, Health and Human Services Secretary Tommy Thompson named Henderson director of the new Office of Public Health Preparedness at HHS. Henderson’s job includes analyzing information as it comes in here to the Department’s bio-terrorism war room. It’s part of an effort to coordinate multiple government agencies in responding to public health threats. We sat down with Henderson recently and asked first about what’s been learned from the anthrax attacks and investigations.
DR. D.A. HENDERSON, Director, Public Health Preparedness, HHS: We’ve had somebody out there who has produced anthrax in a form, which is… Requires some degree of sophistication. Whether it’s been produced locally or been brought in from a foreign source, I don’t see that we have much evidence one way or the other. We’ve had some surprises. We had no appreciation that powder in an envelope could go into a mail sorting area and that that powder could explosively come out of the envelope. This is a great surprise to all of us. And I think there’s criticism that people should have acted more quickly to deal with this problem, let’s say, in the Brentwood facility in Washington; but this was a brand new idea, that it would come out. What we have here is a situation where we do have a better sense of how these people got infected, where they got infected. We have one patient in New York who poses an enormous question. I think if we could find where that woman got infected, we might have the answer to everything else that has occurred.
SUSAN DENTZER: In terms of future potential bio-terrorist attack, the government is gearing up broadly now to respond to a variety of agents but specifically to the case of smallpox, why is the potential of smallpox being reintroduced into portions of the U.S. population so terrifying?
DR. D.A. HENDERSON: In 1980, smallpox was declared eradicated throughout the world. At that time it was recommended that all vaccination be stopped and it was. Now we have people under the age of 30, none have been vaccinated. Of those over the age of 30, I think there are — a fairly large proportion have no immunity now because the immunity wanes over time, particularly for those who have had only a single inoculation in the past. So we have a large susceptible population, larger than at any time and the potential for spread of the disease is there so that once it gets going, it can be a very devastating experience trying to stop this disease and particularly if we don’t have sufficient vaccine to do so.
SUSAN DENTZER: The government is making plans to stockpile enough vaccine now to inoculate every American. That being the case, why not inoculate all Americans in advance of this potential terrible bio-terrorist threat?
DR. D.A. HENDERSON: I think superficially it would seem very attractive to revert to an earlier time when we did insist on vaccination of all children at school entry so effectively everybody did get vaccinated. What people forget, however, is that this vaccine causes many more reactions, severe reactions than any other vaccine that we’ve had so that we could expect in a million vaccinations, we might expect as many as three or four deaths due to complications of vaccination. If we vaccinated everybody, we would have a number of people experiencing quite severe reactions — some fatal. And you have to say, is the risk for all… for creating this amount of medical damage greater or less than the risk of smallpox being introduced into the population? Now, my personal feeling is that smallpox is much more difficult to get a hold of than anthrax; it’s more difficult to handle; it would be more difficult to distribute. So at this point knowing what we know I would be inclined to say, let us not vaccinate and let us keep it ready to go.
SUSAN DENTZER: We then asked Henderson about weaknesses in the public health system that could undermine efforts to thwart bio-terrorism.
SUSAN DENTZER: You yourself and your colleagues at the center at Hopkins have previously urged much more devotion to the problem of manpower, insufficient numbers of epidemiologists, laboratory technicians, et cetera. How big a problem is that?
DR. D.A. HENDERSON: I would identify as probably our biggest problem are the lack of really good people and adequate numbers at state and local levels. So many of the health departments have maybe one infectious disease epidemiologist and that’s it. Many of them at the county and city level have nobody so that let us say somebody in an emergency room sees two or three unusual cases and they pick up the phone to try to call the health department, and there really isn’t anybody at the other end of the line who has an appreciation of what might be needed.
SUSAN DENTZER: The American Hospital Association says that hospitals need $11 billion in federal assistance to get ready for a bio-terrorist threat.
DR. D.A. HENDERSON: Well, I think we can say there’s absolutely no question about it, is that we become very cost conscious with our whole health care system. And so the hospitals have tried to run leaner and leaner, and trying to assure full occupancy of their beds. To the extent that when a sudden surge of cases comes even with an influenza outbreak, suddenly the hospitals are in very difficult straits. They cannot accommodate the patients so that one has to ask the question: Doesn’t it make sense as a social necessity to have some reserve capacity in our hospitals to deal with epidemics of disease or, let’s say, a large number of trauma cases or what have you — at least provide for that — and that is going to cost money, of course.
SUSAN DENTZER: You have devoted most of your life to helping to eradicate disease and now you’re in a position of having to help the nation respond to the introduction, reintroduction in some instances of these diseases by human beings for the purposes of killing other human beings.
DR. D.A. HENDERSON: Well, to tell you the truth, I find this unfortunate that we really have to spend as much time and effort as we are trying to combat diseases in which man is responsible for spreading it. There’s so much in the way of problems out there, tuberculosis and AIDS and malaria, that I really regard this as a very unhappy kind of interlude in my life to have to revert to, to this; but I think the problem is so important that as a citizen I just can’t walk away from it.
SUSAN DENTZER: Dr. Henderson, thank you very much.
DR. D.A. HENDERSON: Thank you.