ROCHESTER MEDICINEUNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY SPRING/SUMMER 2002

BIOTERRORISM: D.A. Henderson and other alumni battle the problem.

Smart bandages and more —the latest research.

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ot many associate pastors can say they spent 20 years in the darkworld. Then again, Frank Young, M.D., Ph.D., isn’t your typical associate pastor. Young, former chair of the Department ofMicrobiology at Rochester and former dean of the School of

Medicine and Dentistry and now an associate pastor in Maryland, worked for nearly two decades within the federal government in classifiedareas — known as the “dark world” to people inside the Beltway.

Young’s efforts in the ’80s and ’90s helped lay the groundwork for the explosion of activity now under way as a result of September 11

and the anthrax attacks. His was one of the few voices in the Washingtonwilderness, warning of the need to prepare for bioterrorism.

Today, that preparation is a national priority, reflected both in the billions of new dollars being budgeted for bioterrorism defense and

War rooms, new vaccines and meetings with the PresidentExperts take their places in Washington to protect the country from bioterrorism.

by Mark Liu

the sheer numbers of people now devoted to the problem. Several Rochester alumni haverecently stepped into key leadership positionson this new front, in the recently created Officeof Homeland Security and the Office of PublicHealth Preparedness. They’re part of the new guard in this post-September 11 world.

Young, for his part, foresaw this changed world and helpedpersuade President Clinton to begin preparing for it. Young was in theposition to advise the president after a far-reaching Washington career that included stints as commissioner of the Food and Drug Administration,deputy assistant secretary for Health Science and Environment in theDepartment of Health and Human Services (HHS), U.S. representative

NEric Noji, M.D., M.P.H.,

shakes hands withPresident Bush inthe White House.

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to the Executive Board of the World Health Organization (a Senate-confirmed position), and director of the Office of EmergencyPreparedness / National Disaster Medical System. Before that, Young’sresearch in Rochester involved the nontoxic form of anthrax. In effect, he has been working on bioterrorism issues for a quarter of a century.

In 1993, Young took part in a simulation that helped change theface of bioterrorism response in this country. The event was the govern-ment’s first full-scale biological attack simulation “in the white world,” as Young describes it, as opposed to previous simulations held in secrecy.The tabletop exercise simulated the response to an anthrax release in thesubway system of a major metropolitan area. More than 100 people tookpart, representing the EPA, FEMA, HHS, Department of Agriculture, andvarious other local, state, and federal offices. The simulation even broughtin CNN reporters to show how difficult it is to address the public in themidst of an unfolding crisis.

Young, as the officer in charge of the public-health response to the attack, says the key players in the simulation continued to meet overthe years because of what they discovered from that exercise.

“The dominant thing we learned was a need for command andcontrol,” says Young. “A clear line of authority was needed.”

It takes coordinationIt’s no coincidence that, today, Washington is emphasizing command and control centers for better communication and coordination of infor-mation. Eric Noji, M.D., M.P.H. (M ’81), sits in one of these new centers at the White House, in the Office of Homeland Security. Noji is on assignmentfrom his job at the Centers for Disease Control and Prevention (CDC) inAtlanta, where he serves as associate director of the BioterrorismPreparedness and Response Program. In fact, he went immediately toWashington after September 11, then onto assignments at the World TradeCenter site in Manhattan because of his disaster-medicine researchexpertise in the toxic effects of pulverized concrete. Typically, Noji is calledto earthquake sites, which he compares the World Trade Center site to(except that Ground Zero is in a much more concentrated area).

The day the first anthrax case in Florida came to light, Noji wasscheduled to return home to Atlanta. Instead, he found himself called towork at the White House.

I’ve been living in a hotel since September 13,” he muses.He’s also been working in a kind of war room, officially dubbed

the Coalition Information Center, in a former ballroom in the oldExecutive Office building. Back in Teddy Roosevelt’s day it was the IndianTreaty room, but today it’s filled with several dozen desks representingvarious agencies. The Department of Defense is there, as is the Departmentof the Treasury, Department of Transportation, even a London desk. The idea is to provide some centralized coordination for what Noji —a man who knows his way around the chaos of an earthquake — deemsan almost unbelievably complex situation.” When Noji’s boss,

Governor Tom Ridge, the head of the Office of Homeland Security,displayed a diagram of who reports where within the various entitiesinvolved in terrorist and bioterrorist defense, Noji says it “looked like a quilt” because of all the lines connecting so many groups.

And that’s the real challenge facing us. Noji says that, while hisphysician colleagues might be surprised to hear it, “the medical and healthaspect is the smallest part of disaster response.” For example, after theSeptember 11 attack, the United States discovered that incompatible telecom-munications systems among first responders — police, fire, ambulanceservices, the Red Cross — made it extremely difficult to coordinate efforts.

When other unexpected problems arose, there was no clear systemin place to deal with them. Citizens, says Noji, were donating things “outof the goodness of their hearts,” but they didn’t know what was needed. So they were emptying out their medicine cabinets and sending it all. Diet pills, birth-control pills — everything imaginable was showing up inhuge piles, some of it simply addressed to “U.S. Government.” Volunteersalso were showing up, but some weren’t qualified and others didn’t evenspeak English. Yet all needed a place to stay and meals to eat. And some-body in the government had to figure out how to deal with such issues.

Noji helped coordinate information during the height of thefighting in Afghanistan, when rumors were flying about hemorrhagic feverand the poisoning of wells. Now, he has settled back into his primaryassignment: preparing for a smallpox attack. There’s so much emphasison a smallpox attack because, as Frank Young explains it, it’s a low-prob-ability event with high-risk consequences. The low probability means thatsome people didn’t take the threat seriously. But the high-risk conse-quences — spread of a horrific disease that kills a third of its victims andrenders survivors severely scarred or blind — means that a response planis now considered vital.

Betting on better vaccineJust down the street from Noji, between the Washington Monument andCapitol Hill, Major General Philip K. Russell, M.D. (M ’58), and JeromeDonlon, M.D. (Ph.D. ’68, M ’72, R ’73) are working on the smallpox problem,as well. (And down the street from them, Donlon’s wife, Mildred Donlon(Mas ’64, Ph.D. ’72) works for a government office dedicated to futuristicdefense breakthroughs; see technology story on page 20.)

Russell and Donlon are part of the new federal Office of PublicHealth Preparedness, led by D. A. Henderson, M.D., M.P.H. (M ’54). Primarily, their task is to oversee the development and storage of vaccines,especially for anthrax and smallpox. A major project is under way todevelop a second-generation anthrax vaccine that would improve on thecurrent one, which is based on older production techniques. In March, the National Academy of Sciences came out in support of such research,saying that the current vaccine should be improved.

“Genetic engineering and recombinant technology allows forisolating specific proteins, which would create a better specified vaccine,”

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says Donlon, whose regular assignment is at the Center for BiologicsEvaluation and Research at the FDA.

The better vaccine might be used to protect public health workersand other first responders who would be in danger of infection during an attack. The vaccine might also be useful after exposure, says Donlon, to help the immune system produce a response to infection. The NIH haslead responsibility for the effort, with assistance from the CDC and FDA, and oversight by the Office of Public Health Preparedness.

Donlon and Russell spend much of their time overseeing thegovernment contract to produce smallpox vaccine. The job is morecomplicated than it might sound, requiring coordination among the CDC,the FDA, the private company producing the vaccine and the Office ofPublic Health Preparedness. The vaccine must meet FDA standards, which means strict protocols for clinical trials and inspections, and it hasto be effective. Because the vaccine is being prepared for the expandingNational Pharmaceutical Stockpile Program, coordinated by the CDC,Russell and Donlon must consider practical matters such as what kind ofneedles are needed and how many, and how best to package the vaccinefor rapid deployment.

Russell seems the ideal person to draw up battle plans against a smallpox attack. After graduating from Rochester, he served in the army,becoming director of the Walter Reed Army Institute of Research,commander of the Fitzsimons Army Medical Center and commander ofthe U.S. Army Medical Research and Development Command. His militaryawards include the Legion of Merit and the Distinguished Service Medal,and he retired a major general. Henderson considers him “one of the

nation’s most knowledgeable and respected persons in vaccine research,development and production.”

Some critics have questioned the wisdom of devoting so manypeople and so much money to prepare for bioterrorism attacks. To Donlon,such criticism overlooks the overarching benefits of these efforts.

“The training, response plans, surveillance, lab services — it allstrengthens the public-health infrastructure,” says Donlon. “It’s not justfor bioterrorism. It’s the same public-health response, so other outbreakscan be responded to quickly.” The same need exists for teamwork andcommunication during such problems as floods, flu outbreaks, or thediscovery of West Nile virus.

Besides, the people on the front line of a potential attack arelooking for guidance.

I get literally 300 e-mails a day from concerned doctors andnurses,” says Noji. They want to know how they should prepare, and whatthey can do.

Meanwhile, Frank Young has retired from the dark world and nowdeals in the light of the world. As an associate pastor, he’s working toestablish an accredited theological school. Even as he was giving hisrecommendations before Congressional committees in October, and evenas his former Rochester colleagues were gathering in Washington tohammer out plans to protect the country from biological attacks, Youngwas making sure to keep working on what he has learned to be a corner-stone of the plan: faith.

From left — Major General Philip K. Russell, M.D., Jerome Donlon, M.D., Ph.D., Mildred Donlon, Mas, Ph.D., and D. A. Henderson, M.D., M.P.H.

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