Public Health

pon making Scott Lillibridge the top government official for responding to bioterrorism attacks, Health and Human Services Secretary Tommy Thompson said, "In May, I told Congress about the need to strengthen the coordination of the nation's anti-bioterrorism efforts . . . I can think of no one better qualified for this critical responsibility than Dr. Lillibridge. He will provide leadership to ensure we can respond swiftly and decisively should a vicious act of bioterrorism be inflicted upon the American people."

Indeed, Lillibridge has a long history of helping public health officials prepare for an attack. Lillibridge joined the Centers for Disease Control and Prevention in 1990. He led the U.S. medical delegation to Japan after a Sarin gas attack killed 10 people in the Tokyo subway. He also served as senior physician on a CDC team that went to Oklahoma City following the bombing of the Murrah Federal Building. In 1998, Lillibridge initiated and developed CDC's bioterrorism preparedness and response program, which included some of the first specialized training for public health officials. The initiative also created the Health Alert Network, which provides assistance to states developing their own alert systems; and the National Pharmaceutical Stockpile, which ensures that health officials have rapid access to pharmaceuticals, antibiotics, and medical and surgical supplies in case of a disaster, including a chemical terrorist attack.

In his role as special assistant to the secretary, Lillibridge will continue his efforts to improve the nation's ability to respond to a bioterrorism threat. A large part of his job is coordinating similar activities within the department as well as governmentwide.

Jerome Hauer
Director
Office of Public Health Preparedness
Health and Human Services Department
(202) 401-4862

erome Hauer's resume speaks for itself. He's been a special adviser to President Bush on bioterrorism, and from 1996 to 2000 he ran New York City's Office of Emergency Management, where he was credited with developing one of the nation's first bioterrorism response plans. And he was one of six scientists to brief President Clinton on biological terrorism. He also served on an Institute of Medicine committee studying ways to improve the civilian medical response to bioterrorism.

Despite these accomplishments, Hauer may feel a little bit like the guy trying to replace Cal Ripken or Michael Jordan. On May 3, Hauer was named director of the Office of Public Health Preparedness. He's replacing a living legend-Donald Henderson. Between 1966 and 1977, Henderson directed the World Health Organization's effort to eradicate smallpox. Henderson also was instrumental in initiating a global immunization program that vaccinates more than 80 percent of the world's children against six major diseases.

Still, Hauer is part of Health and Human Services Secretary Tommy Thompson's so-called "dream team of scientists and emergency management experts making sure HHS and its state and local partners are ready to respond to a bioterrorism attack."

Hauer takes charge of an office created in October when anthrax-tainted letters were dropped into the nation's mail stream. His appointment marks a critical stage for the office-moving it from the developmental phase to one with a more permanent leadership course, Thompson says.

In the event of a bioterrorist attack, Hauer will be that spokesman on public health matters. His office is responsible for coordinating messages coming from several HHS agencies, including the Centers for Disease Control and Prevention and the National Institutes of Health. State and local medical communities will continue to get information directly from the CDC.

"Jerry is a proven and aggressive leader who gets the job done and one of the world's preeminent experts in emergency preparedness and bioterrorism. He will make sure we are coordinated and prepared for emergencies within HHS, but more importantly, with state and local public health professionals," Thompson said after appointing Hauer.

Steven Bice
Director
National Pharmaceutical Stockpile Program
Centers for Disease Control and Prevention
Health and Human Services Department
(404) 639-0730

teven Bice has to act quickly. Witness Sept. 11. Less than 10 minutes after the second plane crashed into the World Trade Center, Bice was on the phone talking with officials from the National Security Council. Roughly four hours later, 50 tons of emergency medical supplies and medication were on the ground to help emergency responders. Another shipment of so-called push packages were being flown in from the West Coast. They arrived by nightfall, despite the fact that all commercial flights had been grounded.

Sept. 11 was the first test of the nation's National Pharmaceutical Stockpile program. Created in 1999, the stockpile was set up to ensure that the nation has enough medical supplies and pharmaceuticals in the event of a disaster, including biological or chemical terrorist attacks. Housed at the Centers for Disease Control and Prevention's Office of Emergency Preparedness and Response, the little-known program is now at the center of government's homeland security efforts. During its first three years, CDC spent $150 million purchasing goods for the stockpile. This year, program spending is expected to reach $644 million.

Bice is the man in charge. It's not an easy job. He has to create a stockpile without fully knowing when, where or what the next attack will be. Indeed, who could have known that one month after the terrorist attacks in New York and Washington, Bice would have to contend with another form of terrorism. As anthrax-tainted letters contaminated the mail system, Bice added more than 100 million doses of Cipro to the stockpile, at a cost of nearly $95 million.

Despite keeping a tight lid what's in the stockpile-CDC officials say full disclosure would give terrorists details on the nation's vulnerabilities-the program has pushed smallpox to the top of the list. Although the disease hasn't been around for 25 years, Bice says the government will have a vaccine stockpiled by early 2003.

Copying a system employed in the private sector, Bice has adapted a just-in-time method for managing the stockpile. Rather than having perishable supplies sit in large warehouses, more than 80 percent of the stockpile's provisions come from vendors across the nation who can, at a moment's notice, respond to the government's needs.

Bice, who joined CDC in 1971, also is working with state and local leaders to develop plans for distributing the contents of the stockpile if another attack takes place.

Dr. David Fleming
Acting Director
Centers for Disease Control and Prevention
Health and Human Services Department
(404) 639-7000

ast fall, the Centers for Disease Control and Prevention was under siege because of its handling of the anthrax attacks. Investigators spent months in the field trying to determine whether the strains were susceptible to antibiotics and whether all the envelopes sent in the mail contained the same type of bacteria. In the interim, five people died-a Florida newspaper editor, an elderly Connecticut woman, a New York hospital worker and two postal employees in Washington.

As CDC's deputy director for science and public health, Dr. David Fleming played a key role in the anthrax investigations. In the months following the attacks, Fleming led the move to create a new grant program to improve state and local preparedness and infrastructure to enhance the nation's response to public health threats.

"Our ability to respond as a nation is only as strong as the weakest health department," the 18-year public health system veteran told the House Appropriations Subcommittee on Labor, Health and Human Services and Education in March. "If any of us is at risk, we are all at risk."

Fleming took over as acting director of the agency when former CDC Director Jeffrey Koplan retired March 31. Fleming is part of a four-person management team created by Health and Human Services Secretary Tommy Thompson to lead the agency until a new director is chosen.

An Atlanta resident, Fleming serves on the Global Alliance for Vaccines and Immunization, oversees publication of CDC's Morbidity and Mortality Weekly Report, leads the development of the National Electronic Disease Surveillance System and chairs the CDC Information Council Executive Committee. Fleming earned his medical degree from the State University of New York Upstate Medical Center in Syracuse.

Dr. Doug Hamilton
Director of the Epidemic
Intelligence Service Program
Centers for Disease Control and Prevention
Health and Human Services Department
(404) 639-4774

s director of the Epidemic Intelligence Service, Dr. Doug Hamilton runs the government's medical version of the CIA. Created in 1951 during the Cold War in response to the threat of biological warfare, the two-year, post-graduate program is the training ground for many of the government's future top researchers and policy-makers. The service's alumni include Dr. David Fleming, acting director of the CDC, and Dr. James Hughes, director of CDC's National Center for Infectious Diseases.

Hamilton, who worked for the Indian Health Service for four years before joining the Epidemic Intelligence Service in 1991, selects about 70 of the country's top health professionals each year to work as disease detectives. Epidemic intelligence officers research, investigate and track infectious diseases all over the world, often working closely with state health departments. Within a week of the Sept. 11 terrorist attacks, the CDC dispatched 48 of the officers to New York City to help hospitals and the city health department monitor diseases and look for health problems such as allergic reactions.

President Bush's fiscal 2003 request for the CDC includes funding for more epidemic intelligence officers to assist states in need of specially trained epidemiologists.

Hamilton, who has directed the Epidemic Intelligence Service since 1998, received his medical degree and doctorate in microbiology from Vanderbilt University in Nashville, Tenn.

Dr. Edward Baker
Director of the Public Health
Practice Program
Centers for Disease Control and Prevention
Health and Human Services Department
(770) 488-2402

uring last fall's terrorist attacks and anthrax crisis, state and local public health agencies relied on the Centers for Disease Control and Prevention's electronic Health Alert Network for official information updates. Four hours after the attacks on the World Trade Center and the Pentagon, the CDC fully activated the network and began transmitting information to the top 250 public health officials in the country.

Dr. Edward Baker, director of the CDC's Public Health Practice Program, is responsible for maintaining that vital information link between the federal government and public health agencies in communities across the country. Baker, an assistant surgeon general who has served as director of the program since 1990, graduated from Baylor College of Medicine in Houston, and studied public and occupational health at Harvard. He also trained as a disease detective in the CDC's Epidemic Intelligence Service, where many of the agency's top doctors and scientists began their federal public health careers.

The CDC would get $119 million under the administration's fiscal 2003 budget proposal to provide more training for the country's public health workforce, strengthen information technology systems and develop performance standards for health departments and laboratories.

"Like our military system, our public health system must be at a constant state of 'battle readiness,' with a skilled professional workforce, robust information and communication systems, and a strong network of local, state and federal agencies, and laboratories, effectively linked and working together," Baker said during a hearing before the House Government Reform Subcommittee on Technology and Procurement Policy in December.

The CDC is expanding its Web-based, secure communications system that enables public health officials and military health personnel to share intelligence on disease outbreaks and health events related to bioterrorism.The agency also is refining its electronic disease surveillance system to detect public health threats and help local health departments map the location of cases and track them over time.

One of Baker's major challenges will be making sure all health departments, especially those with limited resources, are part of the information loop.

Dr. James Hughes
Director of the National Center for
Infectious Diseases Centers for Disease
Control and Prevention
Health and Human Services Department
(404) 639-3401

ix weeks before the Sept. 11 attacks, the director of the National Centers for Infectious Diseases testified before a House panel on the Centers for Disease Control and Prevention's Bioterrorism Preparedness Program. "In the past, an attack with a biological agent was considered very unlikely; however, now it seems entirely possible," Dr. James Hughes told a House Government Reform subcommittee in July 2001.
Hughes, an expert in food-borne disease and infection control, has directed the National Center for Infectious Diseases since 1992. The center houses the Division of Global Migration and Quarantine, which tracks diseases among immigrants, refugees and travelers crossing international borders. Hughes told the House panel in July that the country needed a major plan for quarantining the population in the event of an outbreak because "wide-scale federal quarantine measures have not been implemented in the United States in over 50 years."
The National Center for Infectious Diseases-one of 12 centers within the CDC-conducts lab research and epidemic investigations and closely monitors global diseases, including HIV/AIDS. Hughes, who first joined the CDC in 1973 as a disease detective in the agency's Epidemic Intelligence Service Program, received his medical degree from Stanford University.

Dr. Anthony Fauci
Director of the National Institute of
Allergy and Infectious Diseases
National Institutes of Health
Health and Human Services Department
(301) 496-1124

ioterrorism is a clear and present danger that will be with us in the long haul," Dr. Anthony Fauci told an audience at the National Press Club in January. That straightforwardness won Fauci praise from his peers and the public last fall during the anthrax outbreak. Fauci, who has directed the National Institute of Allergy and Infectious Diseases since 1984, calmed a nervous nation when he and other public heath officials provided people with timely and accurate medical information on anthrax.

Fauci, a pioneer in HIV/AIDS research, oversees 1,600 employees and a $2.4 billion annual budget, but still finds time to visit his patients at least once a week. Under his leadership, the institute has become the third largest of 27 organizations at the National Institutes of Health, and President Bush is seeking $4 billion for its fiscal 2003 budget. Of that $4 billion, about $1 billion would go to boosting the institute's bioterrorism research and preparedness programs.

The lead institute on immunology and infectious diseases research at the National Institutes of Health unveiled its bioterrorism research agenda in March. The initiative will continue the study of serious diseases that are easily spread, including anthrax, smallpox and plague, and the immune system's response to treatments and vaccines. According to Fauci, the additional funding for such research is critical and will help scientists fight other diseases, such as tuberculosis and influenza. "People lack immunity to emerging diseases, and effective treatments are not always known," he said in March. Researchers at the National Institute of Allergy and Infectious Diseases already have developed new vaccines for smallpox, anthrax and the Ebola virus, and testing is under way.

Fauci, who majored in the classics and philosophy as an undergraduate at the College of the Holy Cross in Worcester, Mass., often credits the Jesuits for his work ethic and methodical approach to problems. "I think the Jesuits played a major role in helping to formulate what I am and what I do now, my modus operandi as a scientist, as a clinician, as an administrator, as a leader," Fauci told Government Executive in July 2001.

Maj. Gen. Lester
Martinez-Lopez
Commander
Army Medical Research and
Materiel Command
Defense Department
(301) 619-7613

rmy Maj. Gen. Lester Martinez-Lopez has had some crucial assignments in his nearly 25-year military career. He was part of a multinational force in Lebanon following the 1982 Israeli invasion, in 1995 he was the chief medical officer when U.S. forces were sent to Haiti, and three years later he oversaw military relief operations for 8,500 victims of Hurricane Mitch in Central America. However, the military physician now may have his most challenging duty-overseeing the Army's germ warfare defense laboratory.

In May, the Puerto Rico native was tapped to head the Army Medical and Research Command at Fort Detrick, Md. His new responsibilities include overseeing the Army Medical Research Institute of Infectious Disease, which develops antidotes and vaccines for diseases soldiers might face on the battlefield-including anthrax. The laboratory has been under tight scrutiny in recent months following an accidental spill of anthrax spores in April and last fall's anthrax mailings. The FBI has relied on the laboratory's expertise in trying to determine who mailed the anthrax and has even investigated whether someone trained at the lab or with access to it could have purloined and mailed the deadly spores.

"We have good systems, but we're going to make them even safer," Martinez-Lopez said in a May interview with the Associated Press.

Martinez-Lopez said the work done at the laboratory is not only useful for the military, but could benefit public health as well. "The issue is how do we capitalize not only on our work, but on the work that everybody is doing around the world and use it in such a way that we can focus that new technology on systems that can really make a difference-to the soldier on the point and, in the long run, for the good of everybody," he said.

Aside from overseeing the germ warfare laboratory, Martinez-Lopez manages more than 4,600 civilian, military and contract facilities at the Army's six medical research laboratories and institutes across the country and six units that support those centers through contracting, medical logistics management, health care facility planning and information technology management.

Thomas Day
Vice President, Engineering
U.S. Postal Service
(703) 280-7002

nder normal circumstances, Thomas Day would be concerned about moving new sorting machines, mail tracking technology and other equipment into Postal Service processing plants. But delivering the mail is no longer normal.

Since last October's anthrax attacks, Day's attention has turned to polymerase chain reaction and chlorine dioxide. The former is a technology the Postal Service will deploy at 292 facilities to detect biohazards in the mail. Chlorine dioxide is a chemical the agency used to clean large mail processing plants in Washington, D.C., and New Jersey that were contaminated with anthrax.

As vice president of engineering, Day is responsible for ensuring that the Postal Service has the right technology in place to not only detect, but also remove, biohazards in the mail stream. That's no small task. More than 680 million pieces of mail enter the mail system every day. The mail is funneled to 335 processing plants and shepherded to 38,000 post offices, stations and branches.

Day has also become one of the agency's most visible officials, trying to assure employees and the public that the mail is safe. It's an unusual role for someone who heretofore rarely garnered much media attention. But agency observers have been impressed with Day's ability to take a complicated and confusing subject and explain it to the public. In the end, that may be one of his most important tasks. Should the public lose confidence in the safety of the mail system, the financially troubled agency could enter a tailspin and never recover.

A graduate of the U.S. Military Academy at West Point, Day is a third-generation postal employee, having joined the Postal Service in 1984 as a management associate in the Northeast Region. He represented the agency as a Sloan Fellow at Stanford University's Graduate School of Business, where he earned a Master of Science degree in Management.