WASHINGTON -- A little over a week ago, District of Columbia Health Director Ivan 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 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. Tom 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 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, Va., 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.
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