Extended Interview: Dr. Georges Benjamin
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NEWSHOUR: Let’s start with a quick overview of a year after anthrax. If the health care system in this region were to get another terrorist kind of attack, be it anthrax, be it smallpox, how is the system better prepared than it was a year ago?
DR. GEORGES BENJAMIN: Well, certainly our basic infrastructure is better this year than it was a year ago. What that means is that we have better communications systems, we have better disease tracking systems, we’ve worked together a lot more aggressively over the last year from a variety of disease threats. And I think we understand who’s making what kinds of decisions in this region a lot better this year than we did last year.
NEWSHOUR: Briefly speaking, on the major obstacles or areas that haven’t been resolved — what you see as the most daunting things a year later that we’re still grappling with in this region?
DR. GEORGES BENJAMIN: I think both in this region and nationally we’re still dealing with the issue of how best to take care of children who may be exposed to some of these disease threats. We’re look at the whole issue of how better to coordinate our activities. You know, you’ve still got three, maybe even four jurisdictions when you include the federal government, and coordinating amongst that many agencies, that many jurisdictions, that many political elements still remains a daunting task. I think that is probably the biggest issue we’ve got to still face as we go forward.
I think first of all, the issue of communication we’ve done much better over the last year. Before we would send e-mails out to folks, but we weren’t quite sure who would get them, whether or not we had the full list of people that needed to be informed on any kind of event. We refined that. We now know pretty much who should be informed.
We have e-mail listservs that we put in place to try to inform them. We’ve put together by experience lists of who should be on a conference call. We’ve worked on ways to communicate both within the immediate Washington metropolitan region and then in a broader way. Many of us have actually spent concrete dollars for improved beepers and fax machines to get out press releases to a broad variety of people.
We’ve refined our risk communication skills — that’s our ability to communicate to the public — so that we tell them what’s going on, but not scare them at the same time. We’ve done things in terms of educating, a broader way, of health care providers and the media. We’ve had grand rounds for physicians. We’ve had small settings for both the public safety individuals, for the broad medical community, includes doctors, nurses, MTs, paramedics.
So those are some examples of some of the things that we’ve done since the anthrax attacks a year ago, which I think will make us better regardless of the kind of bioterrorist threat or any other infectious threat that enters the community.
NEWSHOUR: Can there be a health official in charge of a region like this in those first couple of days? Let’s say it is smallpox, and let’s say 10 people are diagnosed with smallpox. Is there someone who can be in charge? Is that impractical?
DR. GEORGES BENJAMIN: Well, I think certainly for any kind of a disease outbreak, the public health official will be in charge initially. Because most of this will go under the radar screen of any of the public safety officials. It’s going to go right under the radar screen with most folks. Because the first group of people that are going to get sick are going to go into a medical center. So the medical community’s going to be the first responder to this event.
Now, having said that, I think what we’re trying to do, at least in our region, is get public health to work in what we call an incident command structure, so that at some point, when we recognize this is an event that will go outside of the medical community, and that may be in a matter of minutes or hours or days, that we bring in all the right people so that we have an organized command structure. Because we learned with anthrax that it just wasn’t a medical event, that we had to have EMS and police and fire and our departments of the environment. And we had to have our public relations people involved right away.
Certainly in Maryland, when we dealt with anthrax, I was the responsible public official delegated by the governor. Now, the governor’s always in charge. But he was kind enough to delegate that responsibility to us for the initial response.
Had there been a great threat, one that required a much greater police presence, we probably would have handed it off to our public safety individuals. We have to measure that according to the threat, and that’s what the incident command system does for us. It allows us to scale up, scale down, pass the ball laterally to a different agency if we need to do that as part of our process. And all of our plans are being written to allow us to respond in that manner.
NEWSHOUR: Let’s talk a little bit about laboratories. I know on several occasions you’ve talked about the need to upgrade our laboratories throughout the country and also around the Washington area. How well is that going? How much more is needed in terms of getting epidemiologists to do tracking and do some of this work?
DR. GEORGES BENJAMIN: Well, we’ve all begun to hire new people in the epidemiology line, to get our disease detective forces built up. We’ve also tried to improve our disease surveillance systems. That means either automated systems by making sure that everybody’s linked by computer so we can exchange information.
But the other thing we’ve done is we’ve tried to beef up all of our public health laboratories in the region. That is going very well, in terms of building better disease-containment labs, hiring disease scientists, training laboratorians not only in the public health sector but in the private sector to recognize some of these disease processes that heretofore most of them had only seen in a book. And that’s going very well. We’re very pleased with that.
Now, what still needs to be done is developing a greater surge capacity. That’s the ability to expand those lab capacities in case we have more tests that come in than you have people to respond to. And to have some redundancy in case your lab goes down for whatever reason — a piece of equipment goes down, your lab gets contaminated, you have to evacuate the building — and you’d have another place to go so you can continue to provide those laboratory support services to the community.
NEWSHOUR: You raised the issue of costs earlier, and for hospitals and health care system all this stuff costs money. A lot of these places if they upgrade their ventilation system, that’s going to cost money. What are the thoughts about the cost concerns here, despite all the money that’s floated into the system?
DR. GEORGES BENJAMIN: I think it’s important for us to continue to reiterate the message that we’re serious about preparedness activities. Not just for bioterrorism, for any broad range of disaster preparedness, that we need to have a prolonged, sustained effort in this area. This is not something we can fund for one year. This is not something we can fund for two years. It’s going to require a prolonged effort in terms of state funding. And we’re going to have to rethink the way we do some things.
We’re going to need to build hospitals a little differently. The way we build hospitals, we’re going to have to think now about these ventilation systems. We’re going to have to think about building quarantine systems, systems that can decontaminate individuals. We’re going to have to build those into the designs of those facilities as we go forward.
We’re going to have to look at our funding for hospital systems and make sure that we’re putting in some funding to support disaster preparedness, both in the capital proposals that they put in as well as the funding that we put in for taking care of people. And we do that for all kinds of other things in health care. We’re probably going to have to build that in. I know now is not a great time to talk about it, with the escalating costs. But it’s either to take care of it now and pay for it now, or pay for it later. So we’re going to pay for it one way or another.
NEWSHOUR: And who’s going to end up paying for this?
DR. GEORGES BENJAMIN: Taxpayers. We’re going to pay for it. We’re going to pay for it through our taxes, we’re going to pay for it through our out-of-pocket costs. It’s just unfortunately one of those costs that we’re going to have to pay for as we go forward. And there’s just no way around that. You and me and my family, we’re going to have to pay for that.
NEWSHOUR: So the feds will get more, but also the states are going to ask for more money from the taxpayers, too.
DR. GEORGES BENJAMIN: That’s right. And the taxpayers are going to have to have more out-of-pockets costs. You know, this is not something that’s going to go away. It’s going to be there. And, you know something? At the end of the day, it makes us much better prepared.
When a disaster happens and your house is burning down, you’re very glad the fire department is there. When you have a police emergency, you’re extraordinarily happy that the police are there. And when there’s a public health emergency in the community, you darn well are extraordinarily happy that the public health community is there to help.
We’re not the sole answer, but we’re part of the medical establishment. And us plus our other medical partners are there when you need us. And that does cost money. It is an investment in public safety, one that I don’t think that we can avoid, and one that I really think that we ought to do.
NEWSHOUR: This is a little simplistic, but on a scale of 1 to 10, if something were to happen tomorrow, like smallpox, like plague, grade how well this region is talking to one another–D.C. to Virginia to Maryland to the federal government. How would you rank that?
DR. GEORGES BENJAMIN: Lot of views on that. I’ve had a meeting with both the commissioner in Virginia as well as the D.C. health commissioner. My epidemiologists in all three jurisdictions have been meeting. We’ve met with HHS [U.S. Department of Health and Human Services] and …other federal partners. Do we still have a long way to go in terms of communications? Absolutely.
If something happened tomorrow, if the response that we had to West Nile virus is any indication of how well we’ll do, when we had the first human death in our region for West Nile virus, within 24 hours, very rapid conference call, consensus on how we were going to respond to it, and I think a pretty consistent message to West Nile virus.
And so I think while our anthrax response was overall okay but required improvement, our West Nile virus response in this region I think nationally was much better. And I think the next major public health disaster we have, things will continue to be better. So I think we’re improving, and I’m pretty pleased with that.