On Tuesday, Dr. Leonard Cole of Ridgewood, the director of the program on terror medicine and security at Rutgers’ medical school in Newark, spoke to the House Committee on Homeland Security.
He testified alongside Tom Ridge, the Republican former governor of Pennsylvania, who was the United States’ first secretary of Homeland Security, and Joe Lieberman, the Democrat-turned Independent former Connecticut senator who also was the first Jewish candidate for vice president. The two men, co-chairs of a bipartisan blue ribbon panel, had just completed overseeing a new report, “A National Blueprint for Biodefense.”
It was, Dr. Cole reported, “an exemplary display of bipartisan agreement.
“I think that Lieberman and Ridge are very much intent on having something happen as a result of this report,” he said. “Everyone knows about reports being issued, and everyone says yes, yes, yes, and the nothing happens. They really want to see something happen. They want to have something enacted as a result of this report.”
Dr. Cole, who was sent an advance copy of the report, spoke to bolster its findings, which of course would advance that goal.
There are three major observations that the report makes, he said. First, the possibility of a biological threat is real, and “a worst-case scenario could be catastrophic.” Naturally occurring pandemics have had disastrous results; the flu pandemic of 1918-19 killed an estimated 50 to 100 million people across the world, and in the first half of the 20th century, smallpox killed about 300 million. (In what was probably “the greatest public health victory in human history,” smallpox was eradicated by 1980, he added, but smallpox is unusual in that it exists only in human beings. Anthrax, on the other hand, can survive, as an inert, hard spore, “virtually forever.”)
Not only is it necessary to guard against bioterrorism, Dr. Cole added, but measures that protect people from it also are likely to protect against other disease epidemics as well. For example, the recent outbreak of Ebola was not an act of terrorism, but the virus itself “is a potential bioterrorism agent,” he said, and “the medical needs would be the same whether the genesis of the disease was deliberate or not.” And the response to the Ebola threat was unimpressive; Newark University Hospital, which was said by a World Health Organization official to be “a model for other hospitals,” could treat a grossly unimpressive two patients at a time.
The report’s second point is that scores of government agencies handle all sorts of biodefense activities, but those activities are not coordinated, are often redundant, and do not serve the public well.
Therefore, the report suggested, one person, someone very high up in the government and granted authority directly by the president, should oversee and coordinate all of the country’s biodefenses. Dr. Cole was gratified by the response to this point. “Committee members, Demcrats and Republicans, support appointment of a czar on biodefense issues, who speaks with the authority of the president,” he said. “Otherwise , the concern is that the Blueprint recommendations will sit on a shelf, with no action taken.”
According to Dr. Cole, the report’s greatest weakness is its top-down nature. “It states all the things that can be done on the federal level, and pushing down, you might have cooperation on a state or local level. I think you’d want bottom-up motion too.” That’s where his experience in teaching terror medicine comes in.
“The field of terror medicine, which includes aspects of disaster and emergency medicine, focuses on distinctive features of a medical response to a terrorist attack,” he wrote in a summary of his statement to the committee. “A healthcare provider is likely to be the first professional to identify a patient’s illness as potentially related to biological terrorism. This was illustrated in 2001, when victims of the anthrax letter attacks began to show up in doctors’ offices and hospital emergency rooms.” That was soon after the terrorist attacks on the World Trade Center and the Pentagon made the entire country realize how vulnerable we all were, and set everyone even more on edge with its personal, intimate threat — death not from the skies but from within.
“Yet even years after those attacks, many physicians, nurses, and others in the medical community feel unprepared to deal with medical or other forms of terrorism,” Dr. Cole continued.
“For the past two years, the Rutgers New Jersey Medical School has offered a course on terror medicine to fourth-year medical students. The curriculum includes lectures, videos, and hands-on simulation exercises involving biological and other terror threats.” Students who have taken the course are enthusiastic about it, he added, and he hopes that administrators and legislators will take the idea seriously. “Familiarizing the medical community throughout the country with the essentials of terror medicine would provide a bottom-up approach” that would combine with the goals of Mr. Ridge’s and Mr. Lieberman’s report to protect the country both from the top down and the bottom up, Dr. Cole told the congressional panel.