Working Paper Anthrax In America: A Chronology and Analysis of the Fall 2001 Attacks November 2002 Center for Counterproliferation National Defense University Research Washington, DC The opinions, conclusions, and recommendations expressed or implied within are solely those of the Center for Counterproliferation Research, and do not necessarily represent the views of the National Defense University, the Department of Defense, or any other U.S. Government agency. This publication is cleared for public release; distribution unlimited. Portions of this work may be quoted or reprinted without further permission, with credit to the Center for Counterproliferation Research, National Defense University. For additional information, please contact the Center directly or visit the Center’s website at http://www.ndu.edu/centercounter/index.htm ii Anthrax in America Executive Summary Introduction On September 11, 2001, terrorists linked to Osama bin Laden’s al-Qaeda terror network hijacked four airliners. Two of the planes crashed into the World Trade Center towers in New York City, and a third into the Pentagon in Washington, DC. A fourth plane crashed in rural Pennsylvania en route to its suspected target, the U.S. Capitol building. The attacks and their dramatic demonstration of American vulnerability created an atmosphere of apprehension and uncertainty. Further attacks were anticipated, although there was a great deal of uncertainty as to when those attacks might occur and what form they might take. Against this backdrop, on 4 October 2001, health officials in Florida announced that Robert Stevens, a tabloid photo editor at American Media, Inc. (AMI), had been diagnosed with pulmonary anthrax – the first such case in the United States in almost twenty-five years. Initially, the patient’s condition was attributed to a natural source. However, after two of the victim’s co-workers fell ill and anthrax spores were discovered throughout the building in which they worked, these initial assessments soon gave way to apprehension. Other cases began to appear at media outlets in New York City. These new cases revealed the possible source of the exposure: almost all of those infected in New York had come into direct contact with letters containing a mysterious powder. In mid-October, the crisis reached Washington, DC, when an anthrax-laden letter was opened in the office of Senator Tom Daschle (D-SD). Several workers at the postal facility that processed the letter fell ill with pulmonary anthrax. Congressional office buildings were evacuated and virtually all federal government mail delivery in the nation’s capital was halted as a result. An additional letter, addressed to Senator Patrick Leahy (D-VT), was found during a search of quarantined mail, bringing the total number of anthrax-laden letters sent to at least four.1 With the realization that these infections stemmed from a deliberate act, what originally started out as a public health response increasingly became a law enforcement investigation. By the end of November 2001, it appeared that the outbreak had run its course, and no additional letters were discovered. The results were sobering: a total of twenty- two people had been infected with either cutaneous or pulmonary anthrax, and five of those infected with the pulmonary form died.2 Beyond the toll in human lives, the attacks 1 Four letters have been recovered by law enforcement personnel, although some observers suggest that as many as seven were sent in two distinct “waves.” The first wave, postmarked on 18 September, may have included the following letters: 1 to AMI (not recovered), 1 to The New York Post (recovered), 1 to NBC (recovered), 1 to CBS (not recovered), 1 to ABC (not recovered). The second wave, postmarked on 9 October, consisted of the letters to Senators Leahy and Daschle (both recovered). 2 The official total of the Centers for Disease Control and Prevention (CDC) is 22 cases, 18 of which were confirmed and 4 suspected. Some have recently challenged the CDC’s official tally of cases, suggesting 1 also carried a significant cost in terms of disruption and decontamination. Select congressional office buildings were closed for periods of up to several months. More than a year later, postal facilities in Washington, DC, New Jersey, and Connecticut, and the AMI building in Florida remained closed. The costs of decontaminating congressional offices and postal facilities will easily run into the tens of millions, if not higher. In addition to these costs stemming from direct remediation efforts, there are additional (not tabulated) economic costs that resulted from the disruption of the postal system. Finally, the idea of an unknown killer dispensing death through the postal system brought even more fear to a nation that had been profoundly shaken by the tragic events of 11 September. The first bioterrorist attack on the United States in the 21st century is revealing in many respects. The government’s response to the attacks proved to be a difficult undertaking characterized by a significant amount of on-the-job learning by law enforcement and public health personnel, as well as senior government officials. From the unconventional delivery mode and conflicting estimates of exposure to questions over the appropriate timing and nature of treatment, government agencies frequently provided substantially different, sometimes contradictory, information and advice to those potentially exposed, to the media, and to the public as a whole. Law enforcement officials have reported that the attribution process (tracking and identifying the perpetrator) has been a learning experience as well, forcing the Federal Bureau of Investigation (FBI) to develop new investigative techniques and to reach out to expert communities for assistance. Although they had been preparing in theory for a bioterrorist incident for several years, in practice, public health workers faced substantial diagnostic and medical treatment issues. And in several cases, these preparations were found to be lacking – for example, as the high demands for sample testing met with only modest capability to process them clearly suggests. Perhaps the most important issue area, and the one that requires the most improvement, was the importance of effectively and accurately communicating the nature of the threat and the status of the response efforts to the public. This document provides a one-year snapshot of the attacks and subsequent response. It examines these issues through a chronological listing of the significant events associated with the anthrax attacks and the statements made by government officials, health and law enforcement specialists, and other individuals involved in responding to the attacks. All of the sources used in the preparation of this chronology are publicly available, including major national and international newspapers as well as those from the areas directly affected by the attacks.3 that the total number of cases is higher. See, for example, Aaron Hicklin, “Anthrax Toll May Have Been Higher Than Reported,” The Herald (Glasgow), 5 October 2002, p. 4. For an explanation of CDC definitions of “confirmed” and “suspected,” see: http://www.bt.cdc.gov/documentsapp/faqanthrax.asp or http://www.ph.ucla.edu/epi/bioter/detect/antdetect_definitions.html . 3 A listing of the sources consulted appears in Appendix C. 2 Government Response The announcement of the case in Florida was a wake-up call for local, state, and federal responders. Preparations for dealing with bioterrorism had been a significant issue for several years prior to the attack, with both considerable funding and several exercises being conducted to test responses at various levels. At first the response effort was primarily public health-oriented, since there was apparently only one case, initially presumed to have stemmed from natural causes. Law “The good news is that enforcement personnel, while on the scene, were involved there are many agencies only tangentially. The character of the response was soon working on all of these affected by the realization that the sole known case in issues. The bad news is Florida was not, as originally hoped, an isolated that there are many occurrence; additional cases appeared in Florida, New federal agencies York, New Jersey, and Washington, DC. Rather than a working on all of these single case stemming from natural causes, responders were issues.” dealing with several cases that increasingly appeared to - Sen. Fred have resulted from the deliberate spreading of anthrax Thompson (R-TN) spores. When this became apparent, what started out as a public health crisis rapidly merged with a nascent law enforcement investigation, as the FBI began the process of attempting to identify the perpetrator(s) and bringing them to justice. The large number of federal (and state and local) agencies involved in the public health and law enforcement response efforts led to some confusion over who exactly was in charge of which part of the evolving response. Although there were subsequent allegations of strains between the various agencies involved, those agencies nevertheless appeared to improve their ability to work together as the response unfolded over time. As the character of the response shifted, so too “People are somewhat did the actions of responders and officials as they surprised we’re learning this gathered additional information. Clearly, there were on a day-to-day basis. some initial gaffes and missteps, including the failure to That’s really no different