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| Volume 46, Number 3, Winter 1998-99 |
by Laurie Garrett
In February, just three weeks after President Clinton addressed the subject of biological terrorism in a speech before the National Academy of Sciences, some 1,100 public health leaders spent a day in Washington role-playing a war-games scenario. In their scheme, terrorists released smallpox viruses at a northeastern university during a speech given by the vice president of the United States. Two weeks passed before the participants guessed the cause of their mini-outbreak of fever, fatigue and rashes, and though they identified smallpox as the culprit comparatively early in the game, the nation’s top public health officials “blew it,” by their own estimation and within months 80 million people were dead, stock markets had crashed, law and order collapsed in the US, and martial law was imposed in cities all over the world.
Pretty horrible, no? Well, here’s the kicker: Who do you think took most of the blame in the day-long war game and discussion: the terrorists? smallpox? the government?
No. You and I, the media, the press.
We, the Fourth Estate, are the real enemy in the eyes of most of those who deal with such public-health crises, real or imagined. And it is interesting to note that as the public health community embraces the bioterrorism issue it is following a course vis-à-vis the media long pursued by the Department of Defense.
Back during the Reagan administration, for example, the Department of Defense staged similar war games aimed at preparing a response to a domestic nuclear-weapons accident. I participated in one such NUWAX (or Nuclear Weapons Accident Exercise), and the very first action taken by the military was to round up all the reporters and throw them in jail. (I recall that David Perlman of the San Francisco Chronicle reminded the NUWAX organizers that day that “military intelligence” was an oxymoron.)
In the February 17th bioterrorism scenario, organized by the Center for Civilian Biodefense Studies, at Johns Hopkins University, officials tried to conceal discovery of two smallpox cases in a university hospital while imposing quarantine on the facility. Needless to say, someone tipped off local TV, radio, and the press.
“The first one on the scene is going to be the media,” Minnesota State Epidemiologist Dr. Michael Osterholm said. “And the media is going to ask BANG, BANG, BANG—‘Is this terrorism? Are there other cases?’ Look, we have watched communications in our state…go into panic over just three cases of meningitis. Law enforcement would come in full gear, which people like yourselves [the TV media] with a satellite dish would love to see.”
What frustrates the public health community is that well before they’ve had time to sort out the science in an epidemic—natural or man made—and determine appropriate policy, the media is on the scene, demanding answers and raising speculation. The more sophisticated public-health leaders are quick to draw distinctions between “the science and medical media” versus “the irresponsible or ill-informed” reporters. The implication is that it would be easier to work with the sorts of reporters who are members of NASW—if only the media would send the proper folks in those situations.
Well, gee, democracy really gets in the way in a crisis, doesn’t it? Authorities can’t control the media, or dictate what sorts of reporters cover a story, bemoaned former Minnesota Governor Arne Carlson—though it would be nice if they could, he added.
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Though dozens of packages have been mailed and threatening calls placed, all claiming to involve anthrax or the plague, so far hoaxes have been the norm in the US. (In the last four years there have been 47 anthrax hoaxes in the US alone, according to the Council on Foreign Relations.) Top law-enforcement officials and international intelligence experts say true terrorists no longer issue warnings or hang the threat of mass homicides over governments’ heads in order to gain access to a bully pulpit and plead their cases. Those sorts of actions typified motives of guerrilla groups and terrorists 20 years ago. However, the so-called “postmodern terrorist,” as CIA officials call them, is motivated by the action itself, not publicity. Aum Shinrikyo had no intention of warning the Japanese people of its impending bioterrorist attacks in Tokyo, nor of claiming credit once epidemics broke out. And that, experts say, is the new reality.
If true, that means a bioterrorist event will not be noted until days after the microbes have been released, incubation time has elapsed and the first index cases of an epidemic have shown up in doctors’ offices and hospital ERs.
Even then, inappropriate diagnoses and scattered sites of treatment will prevent health officials from spotting a disease trend for additional hours or even days, depending on luck and local infectious-disease sophistication. If the disease symptoms are sufficiently disturbing—for example, if apparently life-threatening “flu” strikes college-age kids—hospitals may call in an infectious disease consultant and order extensive pathology.
And some physician may eventually notify the local health department, which, if the agency has enough adequately trained personnel, may start an investigation that will ultimately bring in the Centers for Disease Control.
That’s a lot of “ifs,” some of which might come to your attention well before the CDC and FBI come into the picture. Hospitals are notoriously “leaky” during crises, particularly if low-level employees fear for their own safety. Someone may call you directly with an anonymous tip: “A deadly germ has shown up here and the place is going under quarantine.”
It’s equally possible that the first tip to your news organization will come from a police source, ordered to enforce quarantine or “avert panic.” In such a case, the first reporter on the scene will be from the “cop shop,” not the science desk. Few science reporters, if any, routinely monitor police and fire band transmissions, as do cop-beat journalists and local TV and radio news operations.
In all likelihood, science and medical reporters would have to play second fiddle to police and general-assignment journalists off the city desk. And unless the science writer aggressively pushed for leadership within his or her news organization, the worst-case fears of public-health authorities would be realized: the media would make mistakes and contribute to public panic.
As a native Californian, I can’t help but reflect on earthquake coverage. The state’s news organizations have over the years differed sharply in their reportage—with the better among them leaning heavily on their staff science reporters to explain what had happened along the Pacific tectonic plate, and the worst media organizations focusing on little more than numbers of dead and pictures of collapsed shelves and floors littered with objects formerly found along the walls. Fear following earthquake is a continuous thing, jolted by every aftershock, sleep deprivation, rumors of government incompetence, and exaggerated death and destruction reports. Explanations help demystify horrible events, lowering public panic levels.
The well-prepared science writer is more likely to be able, in a catastrophe, to define his or her news organization’s perspective and tone of coverage.
What is to be done? Each science reporter needs to examine the bioterrorism issue closely, asking these questions: Is the threat genuine? Has modern molecular biology heightened justifiable concern? How likely is it that my community or beat region will be subjected to such an attack? What would be the likely sources of terrorism?
If after such an intellectual exercise, you concluded that public-health authorities are correct in saying, as Health and Human Services Secretary Donna Shalala did, that bioterrorism is a “low likelihood but high-impact event,” you may then wish to do the following:
Finally, science reporters are more likely to be able to call the editorial shots in their organizations in the event of a bioterrorist attack if they have previously written about the issue, examining its potential, local preparedness and scientific possibilities. Ignoring the issue today only increases the likelihood that media coverage will fulfill the worst-case nightmares of the public-health community, sparking mass hysteria and undermining faith that authorities can bring the epidemic under control.
And that, of course, would play perfectly into the terrorists’ hands.
Sources on Bioterrorism: the August 6, 1997, Journal of the American Medical Association was devoted entirely to the threat of biological weapons. Though now a bit dated, it is an excellent resource. See JAMA Vol. 258, No. 5, Aug. 6, 1997. Also, a group on infectious diseases has a terrific Web site that contains, among other things, a fabulous biological weapons bibliography and some full-text articles. Included on the site is the complete text of the historic 1997 Pentagon report on the topic. Go to www.outbreak.org and click on the biological weapons section. The site requires registration, but it’s painless and fast.—Laurie Garrett
Laurie Garrett, medical writer for Newsday and a past president of NASW, is author of The Coming Plague, published by Farrar Straus & Giroux.