On the morning of Sept. 11, not long after terrorists crashed planes into the World Trade Center and the Pentagon, the Centers for Disease Control and Prevention in Atlanta received a worrisome tip from the FBI. Another hijacked aircraft, the FBI warned, appeared headed for Atlanta and possibly the CDC, whose laboratories house some of the world's deadliest germs, including the only official repository of smallpox outside Russia.
Dr. Jeffrey P. Koplan, the agency's director, decided to evacuate. In Washington, Koplan's boss, Tommy G. Thompson, the secretary of health and human services, was concerned.
"What about the dangerous bugs?" Thompson asked his aides, according to an aide who was present. "Who's going to protect them with no one in the building?"
Thompson ordered Dr. Scott Lillibridge, an official at the centers whom the health secretary had just hired as his bioterrorism adviser, to secure the microbes. So while Koplan and the others relocated, Lillibridge, whose wife was at that moment going into labor with their first child, stayed behind, rounding up 32 security people and some highway patrol officers to guard the facility and its biosafety labs.
The incident provides a telling glimpse into the thinking of officials at the disease control centers. While Thompson and his staff in Washington worried that terrorists might have been plotting to steal smallpox from the government's labs, the country's public health leaders felt comfortable relying on existing security measures. It was a sentiment that critics inside and outside government said reflected a culture that made fighting bioterrorism a lower priority than fighting the very real threat of naturally occurring diseases.
Although the agency, at Congress' direction, started a bioterrorism initiative two years ago, nearly a dozen experts, including current and former government officials, said in interviews that leaders at the disease control centers, including Koplan, did not make the program a high enough priority. CDC officials, these experts said, viewed bioterrorism as a distraction from public health matters that involved real diseases, not theoretical threats. And they did not want to be seen as an arm of law enforcement, a perception that could create mistrust as they investigated disease outbreaks overseas.
"It was something that they got money to do, and they were doing it," said Michael Moodie, president of the Chemical and Biological Arms Control Institute, a nonprofit research organization that studied the government's bioterrorism preparedness effort for Congress in 1999 and 2000. "But in terms of grasping the attention of the leadership, and an institutionwide sense that this was important, I didn't have the feeling that was the mentality there."
In an interview on Friday, Koplan dismissed that charge as "inconceivable." Bioterrorism, he said, "is something we have all spent considerable time on, including me, taking a personal role on this since the day I arrived. It's been a priority for our laboratories, our epidemiologic capability, and our relationship with state and local health departments."
Now that anthrax has killed four Americans and sickened more than a dozen, the CDC, the nation's public health agency, has been thrust into a new and uncomfortable national security role.
In recognition of that new role for the agency, President Bush last week became the first U.S. president to visit the disease control centers while in office.
The visit was an important morale booster for an agency that has been in overdrive to respond to the anthrax threat. Laboratories have been stressed to capacity, exhausted technicians have been sleeping in the labs, and the agency's epidemiologists, the disease detectives who track microbes around the world, have been working 18-hour days.
Koplan said he was especially proud that the agency had learned how to successfully treat inhalation anthrax, a deadly form of the disease that until the recent outbreak was universally regarded as fatal. And officials both inside and outside the government say that the CDC has undoubtedly spared lives by moving quickly to contain the anthrax threat.
"They're a bunch of pros," said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, "and they're quite good at what they do."
Yet the agency has been subject to considerable criticism for its scientific and its political responses to the anthrax threat. On the scientific front, it failed to recognize that a particularly potent form of anthrax sent to Sen. Tom Daschle, the Senate majority leader, would endanger postal workers in the nation's capital, two of whom died.
On the political front, state and public health officials, as well as the news media, have complained that agency leaders were inaccessible in the early days of the outbreak, which confused the public and, more important, left doctors unsure how to respond.
Koplan, who said he has always tried to keep his contact with the press "in some kind of wraps," allowed that communications could have been better, and added that his first instinct was to focus on the science. "In the first couple of days, I did nothing, virtually, but be here and focus on working and what we were learning," he said. "I maybe should have been more visible during that time. I don't know."
Lillibridge, meanwhile, said, "We knew that communications would be important, but I don't think we knew that it would be this dominant in the response."
For example, Steven L. Abrams, the mayor of Boca Raton, where the first anthrax case occurred, said he spent an entire morning trying to locate CDC officials to determine if they were going to close down his city's post office.
In Washington, where the two postal workers died of anthrax, Dr. Ivan C.A. Walks, the city's chief health officer, said the CDC "did as good a job as they knew how to do." But he added that the federal bureaucracy was slow when it came to approving official statements and health alerts.
"My concerns have to do with how quickly they can communicate," Walks said. "We would talk about something here in D.C., they would have to send everything down to Atlanta." He added, "Sometimes that took several hours to a day."
Partly as a result of such criticism, Thompson has taken additional steps to reorganize his agency's approach to fighting bioterrorism. He has instituted daily conference calls that, one official said, have improved communications. He has hired D.A. Henderson, a Johns Hopkins University professor best known for leading the worldwide effort to eradicate smallpox, to create and direct a new Office of Public Health Preparedness.
At the same time, Fauci, who proved adept at dealing with the press during the early days of the AIDS epidemic, has emerged as the government's leading spokesman on bioterrorism.
That pleases lawmakers, among them Sen. Hillary Rodham Clinton, D-N.Y., who has been calling for a single bioterrorism spokesman. "We need authoritative information, delivered in an honest and effective manner," she said, adding that she was not certain the disease control centers was the right agency to fill that role. "They're scientists who follow up on leads," she said. "I'm not sure that the public information role resides rightly with them."
But Rep. Christopher Shays, the Connecticut Republican who heads the House Government Reform Committee's subcommittee on national security, said the CDC would have to step into the spotlight more often now.