Building the Case
Interview by Richard M. Cohen, former CBS News Senior Producer
In December 2001, Richard M. Cohen and D.A. Henderson discussed the smallpox virus, world governments, anthrax, and fighting bioterrorism and disease. Dr. Henderson is one of the founding directors of the Johns Hopkins University Center for Civilian Biodefense Strategies and is the director, Federal Office of Public Health Preparedness.
Richard M. Cohen: The press has made a lot of the disagreement you have with the Bush administration with regard to the destruction of existing smallpox. What is the potential for the existing smallpox to be used in a positive way in what you're doing?
D.A. Henderson: Well I think the primary reason for retaining the virus is to be able to evaluate anti-viral potential, anti-viral drugs that might be used in the therapy of smallpox or possibly preventing people who might have immune deficiency disorder from acquiring smallpox if they were in a situation.
Cohen: Are you satisfied that there is adequate security to safeguard it?
Henderson: I think both in Russia and in the United States it's very tight, very secure, and both of those centers are not only overseen by US authorities and Russian authorities, respectively, but they're regularly visited by WHO people as well, and the committee that's been set up by the World Health Assembly, at the request of the World Health Assembly also does that. So I'm confident that those are pretty secure.
Cohen: But do you think that justified keeping those viruses alive?
Henderson: Well, I think it's a judgment call, and it's been a judgment call that's been there since we first took up the question. And the judgment call on one side, as we formulated it, is the fact that is it possible that at some time in the future we would want to have the intact virus to undertake certain research studies which we could not otherwise undertake. And perhaps using devices and approaches that we don't now know. I think everybody's been in full agreement that that is possible, very possible.
Cohen: It seems to me there's an irony here because you're widely known for eradicating smallpox, and yet I question whether there is such a thing as eradicating smallpox because it's governments that keep it alive.
Henderson: Well, I think we tackled this way back when, at the very beginning of the program in 1966, when there were people who wanted us to set the goal of eradicating smallpox virus from the face of the Earth, and we said, "There's no way in the world we're going to be able to look into all of the deep freezers around the world and be sure that no one has the smallpox virus." It's very easy to keep in a very small ampoule at the bottom of a deep freeze and keep it probably forever. So we defined eradication as being the interruption of transmission in the human population and that the absence of human cases would define the accomplishment of the eradication, and it's the only way we could do that. So at no time do we ever anticipate that we would be able to say with confidence and that there's no virus anywhere because of the fact that one can preserve the virus very simply.
Cohen: So you see it as a public health problem always knowing that you had to trust the governments who kept it under lock and key.
Henderson: That is correct.
Cohen: Do you still trust the governments? Because isn't it true that we don't even know what governments control what quantities?
Henderson: Well, let's put it this way. It's impossible to know whether, for example, Iran or Iraq, which had outbreaks in 1972 and they isolated the virus at that time — we're aware of that — did they really destroy the virus? They wrote and said they did. Do we know they did? No, because there's no way in the world we could possibly validate that, no way that we could imagine. And so this is where we've always been.
Cohen: But your mission goes beyond smallpox. Your mission is much wider, so I assume that you don't see smallpox as the single most...the central or pivotal point of what you're doing.
Henderson: Well, my concern now is with all of the potential biologic agents, any biologic agent that might be a problem. And indeed what we're looking at in preparation is preparation of a public health system and medical system to deal with any acute major infectious disease issue.
Cohen: But do you see smallpox as the most dangerous component?
Henderson: I think I would rate it as the...should it occur, it could probably represent a greater catastrophe than any other agent that could be released. But at the same time I think it's...I think we must quantify that by saying that we would all agree that it's unlikely that it's going to be released, but were it released it could really be a catastrophe.
Cohen: How do you compare or contrast it to anthrax?
Henderson: Well, anthrax doesn't spread from person to person, first of all. But on the other hand anthrax is rather more accessible as an agent to be produced. It's easier to handle, it's easier to grow and multiply and probably somewhat easier to disperse. So that where it's a more likely agent to be used, we would worry more about the smallpox because of its capability to spread from person to person.
Cohen: Do you have any theories about where this anthrax is coming from?
Henderson: Well, I think there's evidence on two sides on this. One, certainly there is the cause of the people targeted for the way the envelopes have gone, the fact that these have had a very limited distribution so far...there are a few other lesser characteristics which would suggest somebody has done it in the United States. The thing that concerns me is that the material that was in the Daschel envelope was a very concentrated product, what I guess the bio-weaponeers would call a very good product indeed. And to get to that stage, it seems to me from what I know, that an individual would have to have had a fair amount of practice. That is to say, you don't just turn out that material on a first pass. Producing things like this is an art form as well as a science, so whatever your instructions you will inevitably have a fair amount of work to do to get it to that degree of excellence. And so it seems to me that it's been somebody but really probably some operation that has had a fair amount of practice and has been involved in this in a fairly active way. It seems to me less likely that that's going to be one individual working sort of by himself like some sort of kitchen, some sort of simple operation. It really sounds to me much more like a product of a fairly well organized program of manufacture. So that's the thing that holds me back from saying that I'm that confident that it's a domestic product.
Cohen: It seems to me that part of your work must involve getting scientists to talk to each other — you know, integrating the various disciplines of science?
Henderson: Oh, truly.
Cohen: But isn't it true also that you need to talk to law enforcement, that that's part of this?
Henderson: Yes.
Cohen: Do you see this as a question of science? Do you think science is going to be the answer as opposed to policing and law enforcement?
Henderson: I think it's going to be both. I think you need elements of both, although sometimes as an epidemiologist you're involved in an investigation of an outbreak, you're really doing a lot of things that would be common in law enforcement or you'd think of it as law enforcement. As you try to run down the culprit, it's much, much like the work that police would do, except we don't get involved with some of the more technical legal issues of chain of custody and a variety of other things that are important to them because they are thinking in terms of eventually bringing somebody to justice.
Cohen: Do you have the resources that you need, and are you confident that in the future those resources will be there?
Henderson: Well, right now we could use more resources, particularly at state and local levels, and more resources to have the hospitals better prepared. There are additional resources slated for this year and projected for next year. There are anticipations that they will increase further. It's going to take a concerted effort over a number of years to build up the capacity at state and local levels to be able to run an effective operation. This is not a one-time shot. This is not something you can put a huge amount of money on then walk away from it because it's going to involve trained people who are knowledgeable and responsive. So the question is, what is the long-term commitment? That's impossible to ascertain because of course, the Congress works on an annual budget. But it is my hope, my expectation that we will be able to educate those who are involved as to what is really needed, and they've been very responsive so far.
Cohen: If you look back at the so-called energy crisis and there was a great national movement to conserve and to expand production, and then when there was the perception that the problem went away, so did the national commitment. And I guess I wonder….
Henderson: Well, that's what I worry about, too. There's no doubt about that, that you can see that this is a tendency we have is to relax once the crisis is fixed. No doubt about it.
Cohen: But, you know, it seems to me that September 11th changed life presumably forever, certainly in the long haul. There's a new rule book, this is a new era, and doesn't it take an extraordinary commitment to deal with these problems?
Henderson: Well it does and I would say I would agree with you. For a great many people there's a recognition that life will never quite be the same again. And I think there are other things that we're realizing, too, and that is that the whole area of the microbes is something that is different. The challenge is different from what it used to be, and specifically it's not only that we have the potential for man releasing organisms, but we have the threat of these new and emerging infections...there are many, many more than there were. We have now a huge population in the cities such as we've never had before, living in poverty very close together, limited sanitation, that any time a microbe mutates a bit and can get a foothold in a very fertile environment, we're going to be facing a lot more in the way of organisms. And then we've got people traveling extensively as they didn't before, and children, who are particular vectors of disease. We are going to see a lot of challenges, microbial challenges where I think we lived for probably a good 30-40 years thinking we're on the verge of doing away with infectious diseases, and some have even said that. It's quite clear that we've got some big ones out and we're not well prepared to deal with them. Witness AIDS, which is really a global disaster, and despite going well over $2 billion a year, we don't have a drug, we don't have a vaccine.
Cohen: But what is the intersection between fighting bioterrorism and simply conquering disease?
Henderson: Well, there's an intersection here. It's not so much conquering — it's contending with disease.
Cohen: Okay.
Henderson: The things we're doing in bioterrorism, if you will, in everything from having a better prepared public health sector, a hospital with a greater surge capacity, a better base in the research mode to look at new drugs, and new vaccines — all of these are equally as valid for the new and emerging infections as for bioterrorism.
Cohen: So it sounds like you believe that the public response has been somewhat intelligent versus hysterical.
Henderson: Yes, I would, I would. We've had specific problems with the anthrax where I think there's been an hysterical reaction, where I don't think we've done as well as we could do in getting a message across to quantitate the risks that are out there. I hope, with another event, that should it occur, that we are going to be better prepared to communicate than we were, and that we'll do a better job of getting a balanced message out there and good information to a broad audience.
Cohen: As horrible as it sounds, it seems to me that another event drives this home as a reality.
Henderson: Well somebody pointed out it's like vaccination. You have a primer dose, which gives you a boost in antibody which fades. Then you get a booster dose and you get a very big boost in the antibody and it stays there for a very long time. So that indeed, I think your observation is right, that a second event, which certainly we don't welcome, would indeed probably drive this home in a unique manner.
Cohen: Ultimately, isn't this an international problem?
Henderson: Yes, it is. It certainly is.
Cohen: And are you satisfied that there's a level of cooperation and that this is a joint venture, if you will?
Henderson: There is growing cooperation, but we've got a long way to go yet.
Cohen: What has to happen next?
Henderson: We've got to do much more in building a set of relationships between laboratories and scientists around the world. So basically to have a great deal more in openness in terms of research and communication.
Cohen: One has to wonder, though, if bioterrorism is containable as long as there are pirate states out there that aid and abet people that want to spread it around.
Henderson: Well, I would agree the fact is what we've got here is a weapon that is inexpensive, can be readily used and can have devastating effects, and I think this is going to be with us for a very long period of time. And the only way we're going to do this is, one, with a moral commitment, and two, a lot better intelligence. It's going to have to be human intelligence — you're not going to be able to spot this with a lot of fancy technology.
Cohen: Isn't this what you really have to distinguish: between long-term and short-term objectives?
Henderson: Yes, I think that's fair enough. But I think we need to have a long-term view of this and a long-term focus on it, because this is not going to go away.
Cohen: Are the short-term objectives simply dealing with the anthrax and the threat of smallpox?
Henderson: There are other organisms which could be used. Though to us, anthrax looks like the one that is the most likely and smallpox the most devastating, I think we're going to at times be faced with a question of possibly mutant organisms. I think that there are ways that are being perfected whereby you can take some of these organisms and encapsulate them so that they would be more effective, and that's going to pose some problems. It's going to be a changing scene and we're going to have to keep working to keep up with it.
Cohen: Do you see this as a new area between the public and private sector in terms of dealing with it?
Henderson: Yes, I think so. Defense has spent quite a lot of money but it's primarily on weaponry, standard weaponry and chemicals — very, very little on the biological side. And the types of things that we need to deal with — let's say counter-terrorism material sensor devices, for example, and a variety of other things of that sort — there's been a very limited interaction between government and the biotech industry and the Defense Department, and the Defense Department and the biotech industry, and the Defense Department and the academic world. And yet this is where our biotechnology, our expertise lies — in academia and in the industry. So that I think what is needed is primarily a joint DOD and HHS initiative working with industry to try to identify a research agenda that is going to be effective.
Cohen: Has such an effort been launched?
Henderson: Yes, it has.
Cohen: And with initial success?
Henderson: I've been surprised at what a tremendous response we've had from pharma on interest in really helping out in a number of different areas.
Cohen: It really is amazing, isn't it, what impact September 11th had on the institutions and just attitudes all over the country?
Henderson: It has indeed, absolutely. I'm trying to recruit a few key people for this new office, and it's amazing. I call up somebody and say I need some help, and the next thing I know the individual has thrown up everything he's done and has signed on, saying, "You need me? I'm there."