Waiting for Bioterror
Crisis Management in Crisis
Hauer spends much of his time in a windowless set of offices within the vast Health and Human Services Department, trouble-shooting the medical consequences of a hypothetical dirty bomb or intentional smallpox outbreak. He must also navigate the knotted bureaucracy of forty federal agencies that respond to terrorism, twenty of which play some role in bioterror response, and guide the states through infrastructure problems so severe they boggle the mind. His tactic at a meeting in Washington this August with state emergency managers was to put the fear of God into them. In the event of mass vaccinations for smallpox, the logistics are "very daunting," he told the small and sleepy group in a conference room at the Mayflower Hotel. "They will fall on emergency management, and the health departments will turn to you and say, 'You need to open 200 vaccination centers.'"
This seemed to focus the group. Before Hauer got up, these local and regional representatives had been talking about lessons learned from managing hurricanes and the best kinds of hand-held chemical-weapons detectors.
Tommy Thompson created Hauer's office after the CDC, then his lead agency on bioterror, appeared to bungle the anthrax response and the Administration found itself in a scientific and logistical quagmire. Some officials claimed the White House muzzled the CDC. Others accused the CDC of sloth and bad science for failing to realize quickly that anthrax spores can leak from taped envelopes. Hauer seemed like a good choice to find a way out of this mess: He had developed the nation's first bioterrorism response plan as director of New York City's Office of Emergency Management under Mayor Rudolph Giuliani.
Hauer told the group that his office had moved $1.1 billion to the states in ninety days and was now doing audits, offering technical assistance and helping to stage drills.
But it was the nitty-gritty of mass vaccination that really quieted the room. Training a vaccinator usually takes two hours, though it can be done in fifteen minutes; for every million people vaccinated, about two will die; the vaccinators need to be federally insured because of liability; and all those vaccinated must keep the vaccination site unexposed to others for up to twenty-one days. Who would pay the salaries of contract workers on their days off?
Few emergency managers seemed to have considered such problems. Most were still immersed in competing disaster plans and state budget battles, coping with teetering local health departments and vendors hawking "equipment that will detect the landing of Martians ten miles away in a windstorm," as James O'Brien, emergency manager for Clark County, Nevada, put it.
Hauer returned that afternoon to just such a morass: figuring out how to create a unified command for the national capital area, encompassing Maryland, Virginia and the District of Columbia, seventeen jurisdictions over 3,000 square miles, with embassies, consulates, the World Bank and the International Monetary Fund. He had assigned this problem to a team from the Office of Emergency Response (OER), the federal office under ASPHEP that coordinates medical resources during disasters, who arrived at his office to report their progress.
Each state, unsurprisingly, wanted to be the lead responder, and the team recommended that Hauer try to break the logjam and give direction. He pored over the list of those invited to a coordinating committee meeting--twenty-nine people from twenty-nine different agencies--and concluded, "We need to come away with plans, not some loosie-goosie love fest where everyone pats each other on the back and jerks each other off."
The OER team trooped out with its marching orders and the next meeting began. The CEO of the New York Blood Center, Dr. Robert Jones, with a DC consultant in tow, came to ask for money to expand the center's program of making umbilical cord (placental) blood, used for patients exposed to massive radiation. Jones said the center already had about 18,000 units of cord blood stored in "bioarchive freezers" on First Avenue in Manhattan.
"You might want to think about storing it away from Manhattan," said Hauer, suggesting the obvious, as he got out a little booklet and looked up a one-kiloton nuclear bomb. "You'd need 20,000 to 40,000 units" to begin treating a city of people, said Hauer. "What's the lead time for getting it into a patient?"
Jones, who had never met Hauer before, seemed surprised to be taken so seriously and to be crunching numbers about three minutes into the conversation. Hauer, wanting to stockpile cord blood, seemed surprised that Jones had not brought a written proposal with a dollar amount. This was no time to be coy about asking for money.
Suddenly Hauer's secure phone rang and the room fell silent. "This is Jerry Hauer," he said. "You have the wrong number."