We had begun working on the biological warfare issue in 1993, after the World Trade Center bombing made it clear that terrorism could strike at home, and a defector from Russia had told us that his country had huge stocks of anthrax, smallpox, Ebola, and other pathogens, and had continued to produce them even after the demise of the Soviet Union.
—Bill Clinton, My Life
On October 15, 2001, I was coming back from a conference when I was detained at O’Hare International Airport by the FBI. Special Agent Don Duffy took one look at my brown skin and my passport with stamps from Saudi Arabia, Yemen, Egypt, Pakistan, and must have thought, Uh-oh.
I was taken to a little room off to the side, a sort of holding cell, by four heavily armed Chicago police officers who kept telling me to keep my hands out of my pockets. Officer Thomas, one of Chicago’s finest, made sure I stayed put. Which I did, for several hours.
Agent Duffy asked me the same questions I’d already been asked, repeatedly: “What’s your birth date? What’s your age? Which countries have you visited? What was the purpose of your trip? Where do you work?”
I remember him, and various of his Chicago colleagues, scribbling notes I couldn’t see as they tried to figure out what the hell to do with me.
It turned out my name had shown up on the new no-fly list that had been put together as a response to the attacks on the World Trade Center and the Pentagon just a few weeks before. It didn’t matter to the police or the FBI that I was traveling with a US official (not my personal) passport. It didn’t matter that I had a picture ID showing that I was a federal employee at the Centers for Disease Control and Prevention, or another that I was a senior commissioned officer in the uniformed services of the US Public Health Service (also with a photo). My various travel documents didn’t impress them at all. What did impress them was that I had brown skin and a Muslim name.
So I sat in a chair in the windowless room while various officers from various agencies came and went, some just glancing in, some doing good cop–bad cop routines. Meanwhile, my flight to Atlanta was called, and it was boarded, and it took off without me, providing an opportunity to observe at close hand the nation’s heightened security precautions in a post-9/11 world.
Eventually they let me go, but only after phoning CDC back in Atlanta and speaking to Ms. Harris, the night receptionist, and asking her if she knew a Dr. Ali Khan. Fortunately, she did. She’s a lovely person with whom I’d always chatted as I came and went at all hours. But I’ve always wondered what would have happened if they’d called CDC number I’d given them and reached a fill-in receptionist who’d never heard of me. Would I have been hustled off to Gitmo? For that matter, what did they know about the woman they’d just spoken to? The phone number with the 404 area code could have been a direct line to Al Qaeda headquarters in some cave in Tora Bora, with a crafty Mata Hari standing by to answer. Asking the receptionist was not exactly a Cracker Jack–level of police work. And as for probable cause, my being detained was like an African American being stopped for DWB, “driving while black.” In my case, the offense was FWM: “flying while Muslim.” In the fifteen years (and counting) since, I’ve gotten used to the “Red Muslim” folder at immigration, and the room off to the side to await my judgment.
I was able to catch a later flight, but it was almost two in the morning by the time I made it home and crawled into bed, exhausted.
But I hadn’t even fallen asleep before the phone rang. It was a fellow epidemiologist, Tracee Treadwell at CDC.
“Ali, we need you in Washington. There’s been an anthrax attack on Capitol Hill, and you have to help sort it out.”
So in little more time than it would take to put on a cape in a phone booth, I’d gone from suspected terrorist to freedom fighter, summoned to the front lines to save the nation from a biological attack.
The sun was barely over the horizon as the CDC Gulfstream lifted off the tarmac en route to Washington. The reason for urgency was a standard 3.5″ × 6.5″ envelope that had shown up in the office of Senate Majority Leader Tom Daschle the previous day. It was prestamped with thirty-six cents’ postage, bore a Trenton, New Jersey, postmark, and was tightly sealed with plastic tape. The return address read:
4th Grade
Greendale School
Franklin Park NJ 08852
When an intern working for the senator opened the envelope, a small cloud of dust as fine as talcum powder had burst out. Some of it landed on her lap and on her shoes, and a bit more landed on the pant leg of an intern next to her. When she looked at the letter inside the envelope, she saw the words “anthrax” and “die now.” She dropped it on the floor and ran from the room, presumably in a panic.
The full message, which I doubt she had read completely, said:
09-11-01
YOU CAN NOT STOP US
WE HAVE THIS ANTHRAX
YOU DIE NOW
ARE YOU AFRAID?
DEATH TO AMERICA
DEATH TO ISRAEL
ALLAH IS GREAT
Within minutes, first responders came running into the massive Hart Senate Office Building: six from the Capitol Police, six from the FBI, one from the SAA, six from the Hazardous Device Unit. The eventual tally was thirty-eight responders in all. The Capitol Police carried handheld devices that gleamed red—preliminary verification that this powder was anthrax. What they neglected to bring were Tyvek suits, which they should have been wearing, or at least some sort of respiratory protection, along with gloves and gowns that could have been stripped off and discarded.
This mistake was compounded by the fact that, while they ordered everyone out of the building and sealed it off, they left the building’s cooling and ventilation system running for another forty-five minutes before Scott Stanley, an FBI agent with a PhD in biomedical sciences and extensive training in bioterrorism, got there and told the sergeant at arms to shut it down. As a result of that delay in containment, technicians in hazmat suits would be collecting specimens from carpeting, chairs, and ventilation ducts—even the stairwells—throughout the one-million-square-foot structure.
Stanley put the letter in a hard plastic container, and then physicians and technicians with the FBI began collecting nasal swabs from all staff members who had been on the fifth and sixth floors. They also went to work with the attending physician for the US Capitol to give affected staffers, as well as first responders, immediate doses of ciprofloxacin, the second-generation synthetic antibiotic that had been the gold standard since 1987. If we zap you with enough ciprofloxacin you’re not going to die. However, “enough” means staying on it for sixty days, and the side effects may include a ruptured Achilles tendon. So before we went too far down that road, we needed to set limits by identifying those who’d been exposed at the Capitol Building.
The Daschle letter was the lead story on all three major television network newscasts on the evening of the fifteenth, but bioterrorism was already in the news. Three weeks earlier, similar envelopes containing anthrax spores, also processed in Trenton, had arrived at the offices of the New York Post and at the office of Tom Brokaw, at that time anchor of NBC News. One of Brokaw’s assistants had opened the NBC letter on September 25.
Here again there was a photocopied message:
09-11-01
THIS IS NEXT
TAKE PENACILIN [sic] NOW
DEATH TO AMERICA
DEATH TO ISRAEL
ALLAH IS GREAT
Soon, Brokaw’s assistant was complaining of redness on her chest that eventually turned black, as well as of a low-grade fever. Dr. Sherif Zaki (with that name, you wonder how long he was detained at airports), CDC chief pathologist, examined a tissue sample from her wound and confirmed cutaneous anthrax.
On September 29, the seven-month-old son of an ABC News producer had been brought to the studio by his babysitter. By now he had developed a bright-red sore on the back of his left arm.
October 1 was the day Tom Brokaw’s assistant at NBC began taking ciprofloxacin. It was also the day an assistant to CBS anchor Dan Rather noticed that she had a mark on her face, which she thought might be from an insect bite. It was anthrax.
Even before these high-profile cases, two employees of the tabloid publisher American Media, in Boca Raton, Florida, had been diagnosed with anthrax. And even though the state had seen fewer than twenty cases of anthrax in the past hundred years, and even though most of those victims were in occupations where exposure was obvious, such as mill workers handling animal hides, and even though these unusual diagnoses in 2001 came less than a month after the attacks on New York and Washington, DC, they did not immediately trigger suspicions of terrorism. Instead, investigators focused on the fact that the first victim, Robert Stevens, a sixty-three-year-old photo editor, had gone hiking in North Carolina and taken a drink from a waterfall in a cave.
Stevens’s doctors raised the alarm after noticing the distinctive shape and color of the anthrax bacteria from his brain linings. The deadliest form of anthrax, inhalational, tends to infect the brain linings, causing a characteristic finding on autopsy called a cardinal’s cap. The local laboratory, with technicians recently trained by CDC as part of the Laboratory Response Network, confirmed the diagnosis of anthrax. This was a definitive diagnosis, but the specimens still had to go to CDC for a second verification. The FBI was engaged but terrorism was not suspected. Sometimes CDC is a little too conservative and intellectual. In medicine, they say, “When you hear hoofbeats, think horses, not zebras.” We should have been thinking zebras.
That leisurely attitude changed, however, a few days later when forensic investigators discovered anthrax spores on the computer keyboard and other places at Stevens’s office. They realized that Stevens had most likely received a contaminated letter without noticing the puff of spores that would kill him a few days later. They never found the letter, but a joint FBI–Postal Service investigative task force, named Amerithrax, was born. That initial diagnostic stumble was a harbinger of a response that always seemed slightly out of sync, and always trying to catch up with, the fluidity of the evolving situation and the pace of new information.
CDC epidemiologists began to comb through databases of suspicious infections elsewhere in the United States. And now, only a few weeks after the initial shock of 9/11, people around the country were starting to panic all over again.
On October 4, a few days before the environmental samples tested positive and Mr. Stevens’s diagnosis was confirmed by the state lab, Health and Human Services Secretary Tommy Thompson held a news conference. In it, he said that while sporadic cases of anthrax did occur, this one might “be a result of the heightened level of disease monitoring being done by the public health and medical community.” Three times Thompson emphasized, “The system works.” Six times he said, “In fact this was an isolated case.” Pressed by journalists, Thompson specifically ruled out terrorism and mentioned the swig of water from the stream inside the cave in North Carolina.
Robert Stevens died the next day. A second American Media employee, seventy-three-year-old mail sorter Ernesto Blanco, died the same week.
On October 12, senior Senate staffers met with the Senate sergeant at arms, Al Lenhardt, to discuss security concerns. The chairman of the Senate Judiciary Committee, Patrick Leahy, announced that he was no longer accepting deliveries of any US mail. What neither he nor anyone else knew at the time was that his very own anthrax letter, also mailed from Trenton, had already arrived and been sitting in his office, unopened, since October 9.
When I arrived in Washington at nine thirty on the morning of October 16, CDC had virtually no experience responding to biological terrorism. At that time I was CDC’s chief science officer in parasitic diseases, but I hadn’t been rushed to the scene because of my close acquaintance with parasites. The reason they wanted me was because I had cofounded the US Bioterrorism Preparedness and Response Program at CDC two years earlier, and I knew the people with expertise in the field. I also had experience managing outbreaks.
Before this time, if you had wanted to buy, say, bubonic plague, either over the counter or through the mail, the only thing you would have been asked was “VISA or MasterCard?” A microbiologist named Larry Wayne Harris—who was also a white supremacist, as it turned out—actually had ordered and received plague through the mail in 1995. Which underscored a more ominous threat than terrorists taking up biology: their most likely victims would be themselves—and that was biologists taking up terrorism.
Then again, it doesn’t take a genius, or a chemist, like Breaking Bad’s Walter White to do serious damage with an agent like ricin, a highly lethal poison made from an extract of castor beans. All it takes is the beans and some acetone—and there is a history of disgruntled truckers, for instance, extracting it and mailing the lethal powder to judges who’d pissed them off.
However, when it comes to committing murder and mayhem on a massive scale, Bacillus anthracis is definitely the weapon of choice. Usually associated with cattle, or hides, or soil, anthrax can form dormant endospores that are able to survive in the harshest conditions, as indicated by the fact that anthrax spores have been found on every continent, including Antarctica. When these spores are inhaled, ingested, or come into contact with a skin lesion on a host, even after centuries lying dormant, they can reanimate and multiply rapidly. And they come in a size that’s just right for penetrating deep into your lungs.
While anthrax does not spread directly from one infected animal or person to another, the spores can move around all too easily on clothing or shoes, or just on the wind. The body of an animal that had active anthrax at the time of death is highly infectious, and spores remain at burial sites for decades. Disturbed gravesites of infected animals have caused reinfection after more than seventy years.
It’s this kind of hardiness that makes anthrax a natural agent to be weaponized. During World War II, the Germans were experimenting with organophosphorous nerve agents—tabun, sarin, and soman—and the Allies had to keep up. But anthrax is a living thing, and so the question remained, was this bug hardy enough to be delivered by way of an explosive device, as in a bomb or an artillery shell? To find out, the British Army’s Royal Engineers, in 1942, conducted a notorious experiment on Gruinard Island, an isolated spot off the coast of Scotland. They staked out eighty sheep in a circle with an explosive shell in the center. The shell contained a strain of anthrax called vollum 14578. As hoped, the anthrax bacillus remained lethal. The shell exploded, the sheep died, and the island remained quarantined for the next forty years.
During those four decades, a movement called Operation Dark Harvest took hold, with activists, including some scientists, demanding that the government decontaminate the island. The group went to Gruinard (in hazmat suits, presumably) and collected three hundred pounds of contaminated soil, samples of which they threatened to leave “at appropriate points that will ensure the rapid loss of indifference of the government and the equally rapid education of the general public.” One sealed package was left outside the Porton Down military science research facility in Wiltshire; another was left in Blackpool, where the ruling Conservative Party was holding its annual conference. A cleanup began, and in 1990, after almost half a century, the island was declared safe. Once again, the lesson is that disgruntled scientists can be dangerous. But this was a lesson gravely misapplied when it came to the anthrax letter attacks in DC.
During World War II, the United States established its own biological and chemical weapons facility in what had been home to the US Army Air Corps 2nd Bombardment Squadron, outside Frederick, Maryland. Once the flyboys deployed to England, also in 1942, Detrick Field became Fort Detrick, home of the US Army Biological Warfare Laboratories.
American scientists studied various agents, including anthrax, until 1969, when President Nixon announced that the nation would unilaterally end its biological weapons program. At the same time, the US Army set up USAMRIID, the US Army Medical Research Institute of Infectious Diseases, to do defensive research—developing vaccines and other countermeasures to protect US forces in the event of a biological attack.
Also during the Nixon era, the Soviet Union agreed to suspend biological weapons research, but the treaty they signed in 1972 provided no means for verification. Seven years later, outside the city of Sverdlovsk (formerly, and now again, Yekaterinburg), approximately a hundred people, as well as livestock grazing underneath the track of a plume of anthrax, died of anthrax. Soviet authorities blamed the deaths, along with butchers’ subcutaneous exposure, on ingestion of tainted meat. But while that might cause the gastrointestinal and cutaneous form of anthrax, it would decidedly not cause the inhalational form that killed the townsfolk. The medical records were sequestered or destroyed.
In 1979, it became obvious that Sverdlovsk harbored a research facility. Built just after World War II, it had continued efforts begun by the wartime Japanese to grow anthrax concentrations impervious to antibiotics. In March of that year, a technician in Sverdlovsk removed a clogged exhaust filter from the anthrax drying machines and, though he left a note explaining why he had temporarily shut down the equipment, his supervisor recorded nothing in the logbook. When the next shift supervisor came in, he simply turned the machines back on.
Before the machines could be stopped and the filter replaced, as much as ten kilograms of anthrax wafted up into the sky oh so near—but happily missing—the city of 300,000, in what has been called the “biological Chernobyl.” The incident was reported to military command, but local party bosses, including future president Boris Yeltsin, colluded to cover up the accident in blatant violation of the Biological Weapons Convention. Within a few days, workers in a ceramic plant across the road were dying.
The full, scary truth did not emerge until 1992, when Harvard molecular biologist Matthew Meselson took in a team of inspectors. Their most frightening determination was that, had the winds been blowing in the opposite direction, hundreds of thousands of people could have died.
During the time of Meselson’s visit, the Soviet Union was disintegrating, and a Colonel Kanatzhan “Kanat” Alibekov, deputy director of Biopreparat, the Soviet biological weapons program, decided on a career change. He emigrated to the United States and became the subject of a terrifying New Yorker profile, after which he published (as Ken Alibek) a chilling book called Biohazard, detailing just what the Russkies had been up to at their research facilities hidden in the Ural Mountains, about nine hundred miles east of Moscow. It seems the folks in Sverdlovsk had come up with a particularly nasty agent called anthrax 836, destined for warheads that would sit atop the SS-18 ICBMs then targeted at American cities. In Brave New World, published in 1932, Aldous Huxley described “the explosion of anthrax bombs hardly louder than the popping of a paper bag.” The Russians had finally caught up with Huxley’s dystopian imagination. They’d also treated the Biological Weapons Convention like a loan document that you might sign without bothering to read.
By 1997, President Clinton had been thoroughly briefed on all the above, and Secretary of Defense William S. Cohen announced that vaccination against anthrax would become mandatory for most US service personnel. There is still controversy about the vaccine used, and whether or not it gave rise to Gulf War syndrome. That decision to vaccinate also gave rise to a multibillion-dollar industry producing—and destroying upon their expiration date—tons of prophylactic materials for dealing with anthrax, plague, and botulism, among other deadly agents.
But then President Clinton read The Cobra Event, Richard Preston’s thriller about a biological attack on the United States, which very dramatically made the point that when it came to biological agents, America’s bald eagle was a sitting duck.
Appropriately spooked, Clinton pressured Congress to appropriate money to establish the national public health biodefense program, which included $156 million for the US Bioterrorism Preparedness and Response Program at CDC, with Scott Lillibridge as the first director, and me as his deputy.
One of the first and most important things we did in this new program was try to determine exactly what we might be up against should anyone get the notion to attack us with living things. So we assembled people from universities, people from the intelligence community, and people from government, and we put together a three-tiered critical agent list. Naturally, every scientist wanted the toxin he or she specialized in to be on the A list: those with the most likely impact, and for which we needed dedicated antidotes and public health systems. Despite the lobbying pressure, for critical agents A we settled on anthrax, smallpox, botulism, plague, tularemia (rabbit fever), and the viral hemorrhagic fevers caused by Ebola and the Lassa family of viruses. (I admit—those last two made the cut mostly because I was in special pathogens. Viral hemorrhagic fevers probably didn’t need to be in category A.)
Category B included some other agents that had been used for bioterrorism in the past, such as rickettsia and Q fever. It also included bugs such as the salmonellas that could easily contaminate food and water supplies, as evidenced from numerous natural outbreaks.
The first significant biological attack in the United States was in 1984, when the Rajneeshee sect actually used salmonella in a trial run to contaminate salad bars in The Dalles, Oregon. They wanted to see if they could get enough people sick to stay at home during a local election. They managed to sicken over seven hundred people, though I’m not sure how many were registered voters. And there are examples too numerous to mention of disgruntled employees spiking the break-room donuts with pathogens. (Just a word to the wise.)
Category C was emerging pathogens: things we were keeping an eye on that could potentially become widespread. Some of the scariest zoonotic diseases of all, these were unlikely agents because so little was known about them, but they deserved attention as future contenders.
My routine FBI contact during the DC anthrax outbreak was Scott Decker, an agent I’d gotten to know while assembling the bioterrorism response program. Having these previous relationships turned out to be a crucial element in our effectiveness, enhancing our ability to rapidly exchange information and coordinate patient visits.
I remember, when CDC was first establishing the bioterrorism defense program, an early meeting with some of the heads of the National Security Council that included Ken Bernard, Richard Clarke, Sandy Berger, and Peggy Hamburg, then the assistant secretary for planning at the Department of Health and Human Services and their lead for bioterrorism. We talked about some of the things that make biology such a great option for terrorists, including multiple delivery systems and the ability to choose your scale from one individual to mass casualties, and from death to disabilities. There is good science and simple logistics that can allow you to produce these agents at low cost, and defending against them is difficult. They also don’t damage the physical infrastructure. Essentially, you wipe out the people, and then, depending on the agent, walk into the deserted city with everything else good to go. Biological agents are also easy to conceal. Unless somebody specifically says “I did it,” it’s very difficult to attribute a biological attack to a specific country or terrorist group.
In June 2001, we’d already been discussing the asymmetrical nature of the threat, and the disproportionate number of deaths that bioterrorism can cause, compared to other means of causing havoc, when five months into a new administration and just four months before 9/11, Vice President Cheney instigated Operation Dark Winter, a senior-level bioterrorist attack simulation that scared the pants off everybody.
This tabletop exercise simulated a localized smallpox attack on Oklahoma City, with subsequent attacks in Georgia and in Pennsylvania.
It focused on evaluating the inadequacies of a national emergency response, which were (and still are) numerous. In other words, the simulation was designed to spiral out of control, creating a contingency in which the National Security Council would have to struggle to determine the origin of the attack, then try to contain the pathogen.
Because the United States was not able to keep pace with the disease’s rate of spread, a new catastrophic contingency emerged in which massive civilian casualties overwhelmed America’s emergency response capabilities, then exacerbated the notable weaknesses of the US health care infrastructure in its inability to handle such a threat. In the simulation, governors closed borders between states, which foreshadowed events fifteen years later when Governor Christie of New Jersey forged his own path for quarantine of Ebola responders returning from West Africa.
What the simulation conclusively demonstrated was that, when it came to something like an anthrax attack on Washington, we had no idea what we were doing.
When I arrived in Washington on the morning of October 16, the Capitol Building was strung with crime scene tape and crawling with FBI agents. There’s always a lot of confusion at the beginning of a major disease outbreak, but here we had the added mayhem of a criminal investigation, compounded by the overlapping local and federal agencies trying to understand what was going on, compounded by the recent infusion of 9/11 World War III paranoia.
Our first meeting was with the sergeant at arms, and then with Sherry Adams, chief of the Emergency Health and Medical Services of the Health Department for DC. But as Dr. Adams made clear to us, her jurisdiction as a city employee didn’t extend to the Capitol or to other federal buildings. This gave us our first inkling of the complicated bureaucracy we were going to have to negotiate to get anything done. We also met with Dr. John Eisold, the Capitol physician who played a critical role in tending to Congress and their staffers. We also met with the Federal Emergency Management Agency (FEMA) and with the Environmental Protection Agency (EPA).
Our overall CDC team leader was Dr. Rima Khabbaz from Viral Diseases (obviously another “real American” from solid and trustworthy Anglo-Saxon stock), an excellent senior manager and extremely critical thinker who had to deal with, among other things, the political maneuvering and the media. I was the team’s operational head, the guy down below in the engine room keeping things running.
We were treating the letters as an assault, and despite all the uncertainties, we had no choice but to make decisions—life or death decisions. That’s a highly stressful position to be in, which is why you need to keep your mind as clear as you possibly can. But I had been awake for two full days, and I’m not sure I could have slept if I’d tried. I was too busy trying to figure out what in the world was going on.
The weapon used in the assault was a deadly disease, and amid the mayhem previously described, we had to calmly identify who had been exposed, who might yet be exposed, and who was already suffering the effects. We also needed to put safeguards in place, because anthrax spores could be anywhere.
And anthrax is a particularly deadly weapon. A teaspoon of powder in a letter-sized envelope can contain billions of spores, yet it only takes about five to fifty thousand to kill half of the people exposed. A dozen or so spores would be enough to do in some folks. What kills you isn’t the anthrax bacillus itself, but the fact that as it multiplies it releases toxins that cause your blood pressure to drop and swelling to settle in.
You can become infected by inhaling the spores, or by getting them on your skin, where they cause black, painless lesions that people often mistake for spider bites. (The name anthrax actually derives from anthraki, the Greek word for “coal,” as in “black as coal.”) Or, as is often still the case in Africa, you can become infected by eating tainted meat. Oddly enough, recent victims in the United States are often traditional drummers. They get drumheads made from animal hides from Africa, the hides turn out to be infected, and banging on the drums releases the spores into the air. In Europe you can get infected from injecting infected herion.
We determined that there had been 67 people working in the immediate vicinity of room 216 where the envelope with the “4th Grade, Greendale School” return address was opened, and 301 people overall on the fifth and sixth floors. The incubation period for anthrax, whether the spores have been inhaled or put in contact with the skin, is from one to seven days but can be as long as sixty days. Which is why you have to take prophylaxis for two months.
We had no idea how many people had been present in the building as a whole when the spores began to circulate, but thanks to the ventilation system that had not been shut off, our lab tests found thousands, if not millions, of spores in offices, corridors, and stairwells. We got swabs from furniture on every floor of the building, and we hustled them off for testing. But the priority was not the furniture, it was the people.
Which meant that we wanted cultures from everybody, which resulted in long lines waiting for nasal swabs. We did 150 tests on Monday, 1,350 tests on Tuesday, and 2,000 on Wednesday, then farmed out this flood of samples to the National Institutes of Health (NIH), to Walter Reed, to the Armed Forces Institute of Pathology, to Fort Detrick, and to Analytical Services, a lab near CDC in Norcross, Georgia. It ultimately added up to 7,000 human samples.
Meanwhile, we were setting up an epidemiology team, a clinical team, a surveillance team, an environmental health team, an intervention team, and a communications team to manage press conferences, write press releases, and generally interact with the public. We were briefly headquartered in the Capitol Building itself, but as our group expanded we moved to offices in the US Botanic Garden, which, conveniently, had been closed for renovations.
Our structure in the field and at headquarters was still rudimentary, because our Bioterrorism Preparedness and Response Program was still figuring out what an emergency operation center should look like. Most of our previous responses had been done on an ad hoc basis, but now we were evolving toward more of an incident command system that resembled how various fire and law enforcement agencies managed a fire. This was a fixed organizational structure that would support finances, planning, operational and logistical activities, an incident manager reporting to the CDC director, and then the specific scientific unit.
By 1:00 a.m., October 16, the first lab tests came back positive for anthrax. In the end, almost everything tested from room 216 came back positive.
We immediately put 227 people on ciprofloxacin. The final tally for positive nasal swabs was 20 of 30 individuals in the vicinity of the mail in interconnecting offices; 2 people from an adjacent office; and 6 responders. But given the ability of anthrax spores to travel far and wide, we had to look beyond the immediate and the obvious.
Working with the local health jurisdictions, CDC quickly established enhanced passive disease “monitoring” in emergency rooms (we were careful to use that term instead of the more common “surveillance,” because surveillance meant something different to our FBI colleagues). This meant that we went around asking, “You have anything that looks bad? Fever of unknown origin, maybe? Difficulty breathing?” Another colleague, Scott Harper, began looking for new and previous cases of meningitis (brain inflammation) or lung infections that could be anthrax. The presenting illness could look like various things, but then you would realize that the victim worked at the Capitol and—bingo.
Later, we would bring up people from the National Institute for Occupational Safety and Health to help with the environmental teams scouring the building, running multiple samples a day through the ventilation system. They found spores in seven of twenty-six buildings tested in the vicinity of Capitol Hill, and ultimately the EPA spent $27 million to scrub them down.
After this immediate triage, the more forensic phase of the investigation was based not on “follow the money,” but “follow the mail.” Relying on time stamps, and working with the US Postal Service, the FBI traced the Daschle letter back through the mailroom pigeonholes and the unstrapping machines for unbundling mail, following each stage in its movement from Trenton on the ninth, to the Washington P Street facility on the twelfth, to the Dirksen Building mailroom of the Hart Senate Office Building, to room 216.
Meanwhile, reports were coming in from Bethesda Naval Hospital and from NIH that there were more and more positive cultures, with heavy, rapid growth in each—meaning a hell of a lot of spores. But some of the early tests had been done quick and dirty using Tetracore crime scene kits, so we sent these samples to CDC for confirmation. We also consulted with serious anthrax researchers back in Atlanta, especially Arnie Kaufman, to tell us what to do with all the information that was coming our way. Ironically, two years earlier, CDC had been all set to shut down the anthrax program, but it had gotten an eleventh-hour reprieve with the emergency bioterrorism funding.
I briefed the congressional staff and met with health officials from Maryland and Virginia. There was a lot of cell-phone calling back and forth—and by the way, cell phone reception in the Capitol is horrible.
By now we had taken 1,081 environmental samples from the Capitol. We were using high-efficiency particulate arrestance (HEPA) to vacuum out the Hart building and the Ford building where a machine to sort mail for the US House of Representatives had tested positive, and we replaced the air filters. We also removed all the mail. There were soon other environmental swab samples positive from the Dirksen building, where all the mail of the US Senate was handled, as well as from three offices in the Longworth House building.
On October 17, Speaker Dennis Hastert shut down the House of Representatives for five days. The Hart Senate Office Building was already closed. Mail delivery was halted at the White House, and the nine justices of the Supreme Court vacated their building for the first time since the structure was opened in 1935.
On October 18, the White House mail facility tested positive for anthrax, and tests confirmed another anthrax infection of the skin, this on the right middle finger of the newsroom assistant at the New York Post.
On October 19, a Washington police car was swabbed for anthrax and tested positive.
Overall, the laboratory response network laboratories tested more than 125,000 environmental specimens alone, which represented over a million individual laboratory tests.
On October 25, the Senate approved the USA Patriot Act.
By this time, we had ten EIS officers working with us, and CDC had similar teams working with the networks in New York, with the newspapers, and on the two cases in Florida. We were looking at the census of emergency rooms, looking for unexplained deaths. We were looking for sepsis, respiratory disease, gastrointestinal disease, unspecified infections, neurologic diseases, even rashes, because anthrax causes a black skin rash.
We were deep within the fog of war, combined with CSI, mixed with elements of 24—that Kiefer Sutherland show where the clock was always ticking. If somebody got a real good snootful of the spores, the incubation period could be as little as two days. We were overwhelmed by conflicting demands and different bureaucrats and wondering who was in charge and who was being officious and who was obstructing and who was helping—and still having to act. If you take the wrong action in our line of work, people die.
BRENTWOOD
On October 19, fifty-six-year-old Leroy Richmond arrived at the emergency room of Inova Fairfax Hospital in Falls Church, Virginia, with respiratory problems. The attending physician suspected pneumonia, and she was all set to send him home with some antibiotics, but he was tenacious and said something about where he worked: Brentwood, the postal facility that processes all mail heading to Capitol Hill.
The Virginia state officials were alerted to what was going on, and we sent Scott Harper over to investigate. He found Mr. Richmond sleeping comfortably and breathing room air. The patient had lost six or seven pounds in the last three days, and he’d had cramps. But he had no external lesions.
He had increased white cells, but a relatively normal chest X-ray. Luckily, his astute emergency room physician had given him a CT scan, which showed a widening of the mediastinum, the space between the lungs—a symptom associated with anthrax. The scan also showed a slightly increased liver, mediastinal lymphadenopathy (enlarged lymph nodes in the center of the chest), patchy lung infiltrates, and a unilateral effusion, which means fluid on one side of his lungs. The enlarged lymph nodes suggested the possibility that Leroy could have lymphoma. He did not initially have a fever, but he developed one later that evening, and his blood cultures were positive for anthrax the next day. He never had any growth on his nasal swab. The emergency room doctor put Richmond on intravenous ciprofloxacin; she later added rifampin and clindamycin.
The previous day, another Brentwood employee, fifty-five-year-old Thomas L. Morris Jr., had gone to Kaiser Permanante, presenting himself with specific concerns about anthrax but mild illness. But he was not so lucky. His general practitioner called the health department and was told that anthrax posed no danger for postal workers. The Kaiser doc sent the patient home and told him to take Tylenol for his cold symptoms and return if the symptoms got worse. Three days later, just hours after calling 911 with labored breathing and describing himself as a victim of anthrax poisoning, Morris died.
The day after the mayor announced the case of anthrax from Brentwood, another Brentwood employee, Joseph P. Curseen Jr., drove himself to Southern Maryland Hospital Center in Clinton, Maryland. He had passed out at mass a day earlier, refused EMS help to finish taking communion, and gone to work that evening before arriving home early in the morning with complaints of upper abdominal pain, nausea, and diarrhea. His X-ray appeared normal, and he was diagnosed as having stomach flu, after which he was given fluids for suspected diarrhea and, after he stated that he was feeling well, sent home. No one asked where he worked. He died the next day.
We hit Brentwood in true CSI fashion, with swabs, wipes, and vacuum filtration. The 400,000-square-foot facility at 900 Brentwood Road in northeast Washington employs seventeen hundred people who process the mail for Congress and federal agencies. Meanwhile, a similar story was being played out in New Jersey with postal workers from the Trenton facility where state health authorities had seen their first case the day before; the facility closed and put the workers on prophylaxis.
The curious thing was that we had not seen any cases from the postal facilities, even though we knew that all the letters, even those arriving in Florida, had gone through the US Postal Service. This sustained the false perception that only those who opened the letters were at risk.
Here’s what we discovered:
When you seal the back of an envelope, there’s always open space where there’s no glue at the edges of the flap. That’s because envelopes go through sorting machines that flatten them for machine reading of the zip code. Brentwood’s sorting machines process up to thirty thousand envelopes an hour, exerting thousands of pounds of pressure per square inch on each envelope. By pressing down so hard and so fast, these machines would have done a great job of causing the spores to poof out the sides.
These machines are also cleaned daily with highly pressurized air, and that maintenance alone could have shot spores as high as thirty feet into the air.
We ended up closing down the place for more than two years. When all was said and done, the anthrax contamination would cost almost $320 million to clean up.
By October 23, we realized that mail from Brentwood didn’t just go to government agency mailrooms as we’d thought. Instead, it went to 352 other places, including ordinary post offices, corporate mailrooms, and a great many embassies. We developed a chart of how Brentwood related to the rest of the world, showing how all the mail went through the facility to and from various zip codes, in and out, and where it went via which couriers.
So now we deployed people in full protective equipment, in the middle of the night when they wouldn’t freak people out, to start swabbing all the post offices in the city. We took 3,281 samples on Sunday, 1,500 samples on Monday, and 1,300 samples on Tuesday.
Meanwhile, the FBI was secretly swabbing mailboxes all over the Northeast, trying to find the exact box in which the perpetrator had deposited the letters.
Then there was another unwelcome development: several colonies of the anthrax bacillus were discovered in the P Street mail facility in Washington. We tested all five hundred mail-handlers who worked there. The question was, should we start all of them on a sixty-day regimen of antibiotics?
At just about that time, I was scheduled to be part of a videoconference arranged by the National Medical Association, a leading African American physician’s group. Fortunately, the evening before the big stream, I had dinner with some of the organizers, one of whom had been an associate dean back when I was at Downstate Medical Center. Talking with this group the night before helped me avoid getting ambushed, because they made me realize just what a lousy job we’d done in terms of communicating with the African American community. The black doctors started telling me about the issues as they saw them, in particular their distrust and concern about the allocation of prophylaxis.
Some opinion makers around Washington had begun to suggest that we—CDC and the city’s health department—were focusing an inordinate amount of time and energy on protecting and treating the elected officials and their staffers on Capitol Hill. Were we being as conscientious in our attention to the thousands of people working in the city’s post offices? Given that many postal workers in DC are African American, it was an issue with clear racial overtones.
Some were going so far as to say that the rich white people on Capitol Hill—and even their dogs—were getting ciprofloxacin, but that the poor had to settle for old doxycycline. In truth, the two drugs are equivalent. (The dogs receiving medication were the law enforcement dogs sniffing for drugs and explosives.) But mistrust can grow into a huge problem when people fear that a disease outbreak could suddenly turn into a deadly epidemic.
We were now getting positives from environmental swab samples taken at postal facilities at the CIA, the Capitol Building, the Department of Justice, the Supreme Court, even the White House. And given the events of 9/11, which had taken place just a few weeks prior, we had to confront the possibility that this was not only a nationwide attack, but an indication of the “new normal.” This was very stressful and anxiety provoking for some responders. Many people in the midst of a war—or if they think Armageddon is coming—would prefer to be closer to their loved ones. We had at least one public health person who asked to be sent back home to Atlanta to be with his family.
The FBI had sent cerebrospinal fluid taken from Robert Stevens, the Florida photo editor, to the laboratory of Paul S. Keim, a plant geneticist in Flagstaff, Arizona, who had developed a DNA fingerprinting technique. In the early 1990s, Keim had worked on a project for the CIA in the town of Al Kakam, forty miles southwest of Baghdad, where United Nations inspectors had found hundreds of large paper bags thought to contain anthrax. The powder turned out to be Bacillus thuringiensis, or Bt, a similar bacterium, not lethal to humans and used for pest control. It had been treated with a drying agent called bentonite.
The FBI then took photographs from an electron microscope showing these bentonite-coated spores of anthrax from Iraq and sent them to Keim as well. The Iraqi samples did not match the samples found in the recent attacks. Instead, Keim determined that the anthrax that had been sent to Washington was Ames, a domestically produced strain widely used by bio defense researchers. John Ezzell, a PhD microbiologist at the US Army Medical Research Institute of Infectious Diseases (USAMRIID) in Frederick, Maryland, had previously determined that the strain taken from the offices of Tom Brokaw was Ames as well. And it turns out that Ames strain was used in only eighteen labs worldwide, fifteen of which were in the United States, with one each in the United Kingdom, Sweden, and Canada.
Even so, retired colonels now moonlighting as commentators, former commanders of USAMRIID, and the news media in general continued to opine about how this outbreak must have originated overseas.
Ezzell, in speaking to his superiors, had referred to how frightening it was to be seeing “weaponized anthrax.” Technically, this would mean that the spores had been encoded with a chemical additive to prevent clumping and to facilitate their dispersal into the air. But that wasn’t the case. This was Ames strain, pure and simple.
The initial impression of weaponization was likely because of accumulating data that these spores were spreading very effectively to other envelopes and were very “bouncy,” meaning that they were capable of being reaerosolized when tested in the original contaminated office in the Hart building. The dogma had been that natural spores would be very “sticky” because of electrostatic charges. This was yet another outbreak where dogma, preconceived notions, and the standard playbook needed to be thrown out the window,
Unfortunately, although it was inaccurate, Ezzell’s comment went viral, as it were, repeated endlessly at the Pentagon, at Health and Human Services, and at the White House. For those in the Bush administration who were itching for a war against Iraq, “weaponized” came trippingly on the tongue. Otherwise, the word “weaponized” was struck from the lexicon, and the populace was reassured that all the anthrax in government labs was accounted for.
The FBI set about collecting samples from each of the eighteen labs known to work with Ames to see if they could identify anything distinctive.
ABC News contributed to keeping the rumor alive by saying that the presence of bentonite in the anthrax was a trademark of Saddam Hussein’s biological weapons program. The fact that the White House tried to downplay some of these assertions only seemed to egg them on. Meanwhile, Peter Jahrling, an exemplary virologist and scientist at USAMRIID, mistakenly began to describe the spores as having been treated with silicon, another chemical additive sometimes associated with Iraq. Again, studies would specifically rule out that possibility.
Spore samples were sent to the Sandia National Laboratories in New Mexico, where engineers analyzed them with specialized software and electron microscopes and identified the presence of silicon. Silicon, of course, is second only to oxygen as the most common element in the Earth’s crust. Moreover, the silicon detected at Sandia was under the external surface of the spores, meaning that it had been incorporated naturally rather than as the result of some artificial treatment.
Dwight Adams, the director of the FBI laboratory, confirmed that the spores contained no additives, and that the anthrax was not antibiotics resistant. But ABC News and the Wall Street Journal editorial page kept referring to “weapons grade” anthrax, and that the spores had had their electrostatic charges eliminated in order to facilitate aerial spreading. The Wall Street Journal specifically tried to implicate Saddam Hussein, along with “bin Laden and his Al Qaeda network as a front or ally” (despite the fact that there was no relationship between the two at all). This was all in an effort to try to explain the fine nature of the powder in the Daschle letter, which was quite fluffy and bouncy. Previous dogma held that the spores would adhere to a surface from electrostatic charge.
For its part, the FBI went a long way down this dead-end path, even traveling to sites in Kandahar, Afghanistan, where Al Qaeda supposedly had tried to develop biological weapons, collecting more than four hundred samples, but still finding no evidence of Al Qaeda or Saddam Hussein’s involvement in the attacks.
USAMRIID had as many as seventy staffers working in support of Amerithrax. But by the end of 2001, the FBI was asking these government weapons scientists to take lie detector tests. In the months ahead, the FBI would distribute subpoenas to each of the fifteen labs researching anthrax in the United States, requiring each scientist involved to submit a sample of his or her strain.
But the FBI already had the culprit in their sights, or so they thought. His name was Dr. Steven Hatfill, a virologist who from 1997 to 1999 had worked at USAMRIID doing research on Marburg virus and monkeypox. He had also worked at NIH. He had a medical degree from the University of Zimbabwe, but he’d claimed to have earned a PhD in microbiology, and to have been a member of a British medical society—neither of which was true. These prevarications, coupled with his propensity to speak cryptically and to wear long trench coats to create the aura of a secret agent, evidently triggered the Bureau’s suspicions. This, despite the fact that Hatfill had never worked on anthrax and, in fact, had spent his entire career working on viral disorders. Once again: anthrax is a bacterium.
In 1999, Hatfill had gone to work for Science Applications International Corporation, a company that did contract work for the military and the CIA. While there, he gave PowerPoint presentations to local public safety officials urging greater preparedness against biological attack. He had also written an unpublished novel in which a wheelchair-bound man attacked Congress with plague bacteria.
A month after the letter attacks, molecular biologist Barbara Hatch Rosenberg, who taught environmental science and health at the State University of New York at Purchase and served as the chair of the Federation of American Scientists Working Group on Biological Weapons, told a Biological and Toxin Weapons Convention conference in Geneva that the anthrax used was derived almost certainly from a US defense laboratory. She promoted the theory that the anthrax mailings were an inside job, perpetrated by a scientist who “has the right skills, experience with anthrax, up-to-date anthrax vaccination, forensic training, and access to USAMRIID and its biological weapons [alluding to but not specifically calling out Hatfill] as part of a secret and illegal US bioweapons program.” She was dead wrong, but the “inside job” theory was gaining traction.
Under the glare of television lights, the FBI searched Hatfill’s apartment and found nothing of note. In his car, though, they found a hand-drawn map of a wooded area with several spring-fed ponds just a few miles northwest of Fort Detrick, which led to an extensive search, complete with bloodhounds, of the seven-thousand-acre Frederick Municipal Forest. All they found was a clear plastic box with large-diameter openings, which gave rise to a theory that Hatfill might have waded into the shallow water of the pond and put anthrax into the envelopes while using the box as a partially submerged, airtight chamber. A bit far-fetched.
But that night, ABC World News reported on the investigation as a major development. It was, in fact, ABC News that first publically identified the suspect as Hatfill, who had taken a $150,000-a-year job at Louisiana State University teaching public safety personnel how to respond to terrorism. The university quickly terminated his contract. And the piling on continued.
New York Times columnist Nicholas Kristof wrote five pieces about the investigation, noting that the suspect had up-to-date anthrax vaccination as well as the ability to make anthrax because of his working knowledge of biowarfare agents—both wrong. Before ABC News blew Hatfill’s cover, Kristof alluded to him as a shadowy “Mr. Z” alleged to have used anthrax against black citizens of Zimbabwe. In later sworn testimony, Kristof admitted that much of his reporting was based on hearsay.
On November 5, I took a break from all this craziness and went home for a while. When I came back on the sixteenth, I met with the EPA to begin the challenge of cleaning up the Hart Building, long since closed and cordoned off, along with all the reports and red tape filed inside. Eventually, we put a gigantic tent over the whole building (shades of Walter White once again) and decontaminated it with chlorine dioxide. It would not reopen until January 22, 2002.
November 16 was the same day an FBI team sorting through 280 barrels of quarantined mail bound for Capitol Hill found the anthrax-laced letter addressed to Senator Leahy. It too had been postmarked in New Jersey on October 9, but was inadvertently rerouted to a State Department mail facility in Sterling, Virginia.
It was at this time that the postal service began using electron-beam technology to radiate mail. At first they overdid it, and for a while the mail showed up pretty crispy. But then they dialed it back, and also limited the treatment to mail going to government facilities.
By now we knew of twenty-two anthrax cases and five deaths. The cases were evenly divided between inhalation and cutaneous infections. Oddly, the victims included two people with no obvious connection to the targeted sites or to the mail routes. On October 31, Kathy Nguyen, a sixty-one-year-old Vietnamese immigrant and hospital stockroom worker in the Bronx, died of inhalation anthrax, but no trace of the bacterium was ever found in her workplace or in her apartment. There were three tense days in New York City, with discussions of swabbing the subways—a subway release seen as a potential source of exposure—and possibly putting the whole city on prophylaxis. The fact that we found no additional cases, and that despite aggressive monitoring, did nothing to reel us back from that precipice.
If that case was not unusual enough, Ottilie Lundgren, a ninety-four-year-old widow in Oxford, Connecticut, died of inhalation anthrax on November 21. Tests showed that the sorting machines at the Connecticut postal facility that processed bulk mail for Lundgren’s carrier route were contaminated. If spores could fly out of an envelope onto another envelope, they could surely fly into somebody’s lungs. And she might have been one of the few people who only needed one spore to get infected and die.
The FBI then went off on another tangent, using a technique called whole genome amplification to test a piece of dead skin found on the envelope addressed to Senator Leahy, an effort that would take about two years to complete. Ultimately, the skin was traced to a technician at the FBI lab who had accidentally contaminated the evidence as soon as it arrived.
The FBI was still trying to find anything that would differentiate the DNA from the bacterium that killed photo editor Robert Stevens from that of the original Ames strain of anthrax. (The name “Ames” is actually misleading. In 1981, army biologists at Fort Detrick were looking for new strains of anthrax to be investigated. Per the army’s request, scientists at Texas A&M forwarded a sample scraped from the organs of a cow that had died on a ranch in Jim Hogg County, Texas. They sent it in a prepaid mailing label with the return address of the National Veterinary Services Laboratories in Ames, Iowa, and thus the Ames strain was born.)
The FBI asked USAMRIID to send some of the Stevens sample to Paul Keim’s lab in Arizona, hoping to find some distinctive marker. Keim was able to extract DNA from the anthrax, but it turned out to be plain vanilla Ames. But Keim knew that, aside from the original dead cow from Texas, Ames had never been observed in the wild. His conclusion, which he shared with the FBI, was that the source of this infection came out of a laboratory.
In a separate line of inquiry, one scientist from USAMRIID noticed that some of the anthrax from Senator Daschle’s office gave rise to irregular colonies called morphotypes, which had a yellowish color not associated with Ames. So here was the distinctive marker they were looking for.
But it took them almost four years to discover that the perpetrator they were looking for had been right under their noses all along. And it was not Robert Hatfill or, for that matter, Saddam Hussein.
In January, on the day we were supposed to reopen the Hart Senate Office Building, somebody broke through a temporary wall and found nine used hazmat suits in the basement near the loading dock. This is where workers during the initial investigation had stripped off the suits and air hosed themselves—a perfect way to aerosolize everything in the room!
So now we had to start over, taking nasal swabs and putting the forty-nine people there for the opening, including a police captain and several officers, on prophylaxis.
But if there were a larger lesson to be derived from this episode, it would be that Murphy’s Law should never be underestimated.
Clearly, we still didn’t know how to properly remediate buildings. Anthrax in a large area is a regional denial weapon. If you spread these spores in New York or Washington, you infect millions of people, but worse, you could make it unsafe for anyone to set foot there ever again. It’s like the ancient custom of strewing salt over the soil of a defeated city, to make sure that it remains defeated, not unlike the fate of Gruinard Island.
As a postmortem, we met at the Capitol with some of the key people from the local area, including the city health commissioner, to discuss what went right and what went wrong. From our partners in the locality we listened to complaint after complaint about how we, the Feds, had not kept them in the loop. This was the big outbreak when people started to ask who the heck was in charge.
We were told that we needed regional integration of public health, and hospitals, and the population at large. We also needed to do more to recognize the diversity of the population and master the art of cross-cultural communication. In other words, we needed to become more human, and we needed to make friends before the fact.
But the biggest issue remained postexposure prophylaxis and vaccination. It had been done on the fly and not done very well, and the frustration was increased by the confusion over the use of ciprofloxacin versus doxycycline. We also left too much discretion to the individual, and different localities had different recommendations, which confused people and, frankly, pissed them off. If CDC, with fifteen thousand of the best scientific brains in the world, couldn’t come out with a straightforward guideline for treating anthrax, how could an ordinary citizen know what to do?
In our sessions there were also more wonkish recommendations about horizontal coordination, identifying best practices, and setting up platform-independent communications. And here the overriding question was, where does federal responsibility begin and end?
There is markedly improved regional coordination in the Capitol now than there was in those days. We now have now much more clarity about who’s in charge—namely the Department of Homeland Security, with the FBI in charge of any criminal investigations. But others might suggest that the White House is in charge. When it really hits the fan, decisions get pushed up to the national security advisor and the president.
Four years later, in 2005, we were still trying to sort out these issues when another disaster struck New Orleans, and it was Hurricane Katrina that brought about the sweeping transformations required. After that crisis we did a complete rethinking of emergency response in the United States.
And yet, it’s not as if our systems are bulletproof.
It was not reassuring when, over a period of months in 2014 and 2015, military personnel at the supersophisticated, super-secret Dugway Proving Ground in Utah mistakenly shipped live anthrax samples, sometimes via FedEx, to twenty-four labs in eleven states and two foreign countries. Or when CDC shipped a culture of nonpathogenic avian influenza that was cross-contaminated with the highly pathogenic H5N1 strain of influenza to a BSL-3 select-agent laboratory operated by the United States Department of Agriculture.
This kind of thing can only happen when there is lack of accountability; that is, nobody gets fired when stupid things happen. Because these are not inherently stupid people. At least they have PhDs.
It’s just that people do sloppy work when they think they can get away with it, and this is not a problem you can regulate yourself out of. The only way to avoid mistakes like this is to create a culture of safety, enforced by strict accountability.
The other enduring truth is that crazy people will always be with us, and that law enforcement needs to be intellectually and emotionally flexible and attuned in order to avoid biases and preconceived notions, and to withstand pressure from politicians with agendas.
Psychologists talk about two completely different ways in which the mind solves problems. System 1 thinking is quick and superficial, based on the rules of thumb and easy answers called heuristics, which include what’s known as “prejudices” and “preconceived notions.” System 2 is deeper and slower, more agile and reflective. From what I observed, I would say that the investigation of these anthrax attacks was based way too much on system 1 thinking.
Part of this was “the headquarters effect,” which means busywork and checklists rather than taking time for real creativity and insight. Agents were encouraged to interview anyone and everyone, and to report back almost daily, which led to pointless intrusions into the lives of tangentially related people and engendered resentment within the scientific community. Most of all, it completely missed the big picture, which some would say was pretty obvious. It was as if no one ever took twenty minutes to sit back, look around, and connect the dots. This was, after all, the same FBI that had disregarded warnings that bin Laden had sent extremists to the United States to take flying lessons.
Assigned to lead the anthrax investigation was thirty-two-year veteran Van Harp, the same agent who had led the flawed review of the FBI’s disastrous 1992 standoff against survivalist Randy Weaver at Ruby Ridge.
Van Harp’s choice to examine the envelope from Senator Daschle’s office was a researcher at Fort Detrick named Bruce Ivins, who worked with highly purified Ames anthrax. But, of course, examining this specimen to determine the density of spores per gram in the same biosafety level 3 containment facility that he routinely used for other anthrax experiments compromised the FBI’s sample.
Ivins had been with the US Army Medical Research Institute since 1980. He’d done his thesis on diphtheria toxin, and he’d worked on chlamydia and cholera. In 1991, with the outbreak of the Persian Gulf War, he began working with Bacillus anthracis. He was listed on the patent application as a coinventor of a next-generation anthrax vaccine known as recombinant protective antigen, or rPA. The old vaccine had been blamed for serious side effects, including immune system disorders, but congressional funding came and went with the budget cycles. Meaning that Ivins had hopes for a big score, but no certainty.
If anyone had bothered to look, they would have found myriad emails from Ivins expressing concern that federal support for anthrax research, including his next-generation vaccine, was losing ground. A curious investigator—even a rookie Hollywood screenwriter—would have noted as well his conspicuous enthusiasm for a perceived biological warfare threat. One of his bosses described his interest in the subject, and his general demeanor, as “squirrelly.”
Ivins, in other words, had the classic motivation (not to mention the psychological profile) of a classic villain out of Spider-Man. Didn’t the FBI ever watch movies?
By the spring of 2000, still hoping for a windfall, Ivins was testing his new rPA on rabbits, subjecting them to aerosolized anthrax.
As soon as the Stevens case from Florida hit the news, Ivins emailed an acquaintance at CDC, Arnie Kaufman, offering to help with the investigation. Kaufman would later describe Ivins as being “agitated” over the “mountain stream in North Carolina” theory. Kaufman said that Ivins seemed to take the case personally. Did he, perhaps, have a personal interest in keeping the theory of the case centered on terrorism?
Later, when the FBI searched the Frederick Municipal Forest for evidence against Hatfill, one of the locals who volunteered to help was Bruce Ivins. He was like the Woody Allen character Zelig, popping up everywhere.
Bruce Ivins had grown up in Ohio as a classic science geek, awkward but eager for approval, and very smart. He worked hard at being likable: he could juggle fruit and play the piano. But the fact is, Ivins had been hired for his supersensitive position as a bioweapons researcher with no evaluation of his psychological state, and with no knowledge that he’d been under intense psychiatric care. And not just for depression or marital troubles or feelings of inadequacy. Among other things, he had confided to his psychiatrist that he’d burglarized a sorority house, and that he’d been thinking about murdering one of his colleagues. As his shrink would later reveal to authorities, he fantasized about obtaining cyanide to poison a neighbor’s dog and ammonium nitrate to make a bomb. He told members of his group therapy sessions that he’d been carrying a gun for years hoping a mugger would give him shit. He spoke of feelings of isolation and desolation, and he thought of himself as an avenging angel of death. His psychiatrist later described him as creepy, scary, spooky.
She put him on Valium (antianxiety) and Celexa (anti-depression), and later Zyprexa, an antipsychotic drug for schizophrenia and/or bipolar disorder. Yet he still had around-the-clock access to Fort Detrick’s biocontainment labs and the deadly pathogens stored there. On his annual army checkup he acknowledged having memory changes, trouble making decisions, hallucinations, and anxiety. He also said he was receiving outpatient psychiatric treatment for what he described as job-related stress.
Ivins had made his first known threat while still an undergraduate at the University of Cincinnati, telling a roommate who’d broken into his stuff, “I can drop something in your water.” He also experienced rejection from a member of the Kappa Kappa Gamma (KKG) sorority, but rather than simply recalibrate his search image for the girl of his dreams, he became obsessed with KKG.
In the early 1980s, shortly after taking his job at Fort Detrick, Ivins drove for three hours to West Virginia University, broke into the KKG house, and stole the sorority’s book of rituals. Earlier, while still a postdoc in North Carolina, he had met graduate student Nancy Haigwood, and upon learning that she was a member of KKG, stole a lab notebook she needed for her dissertation, then anonymously returned it a few days later in the main post office. After she got her degree and took a job as a virologist in Gaithersburg, Maryland, she discovered the initials “KKG” spray-painted on her fence, on the sidewalk in front of her house, and on the window of her fiancé’s car. Instinctively, as she would later report, she knew it was Bruce.
Meanwhile, he was having creepy, overly intimate conversations with another female lab worker, stole her computer password, and read her email. As Ivins’s own daughter would later reveal, he was inordinately taken up with the O. J. Simpson case, the Oklahoma City bombing, and the JonBenét Ramsey murder. He wrote numerous letters to various newspaper editors about the arrest of Ted Kaczynski, the Unabomber.
One of the letters Ivins wrote was to the editor of the Frederick Post defending sororities signed “Nancy Haigwood.” Then he sent a copy of the same letter to a mother whose son had just died in a fraternity hazing accident. He subscribed to a bondage magazine and had it delivered to a post office box under the name of Nancy Haigwood’s husband.
When the FBI sent out a mass mailing asking for help with the Amerithrax investigation from the thirty thousand members of the American Society for Microbiology, Nancy Haigwood called the FBI immediately and fingered Bruce Ivins. The Bureau took down her name, and they interviewed her, but it would take seven years for them to put her tip to use.
This mentally unstable stalker was the same Bruce Ivins who, on October 22, 1997, had received a thousand milliliters of purified Ames anthrax bacteria suspended in liquid from the army’s Dugway Proving Ground in Utah. These he combined with Ames anthrax spores cultured at Fort Detrick for use in upcoming experiments. He stored the spores in his lab and listed the batch as “RMR-1029” on an army reference material receipt record.
By 2001, the military had commissioned the traditional anthrax vaccine to be produced by a company called BioPort (later Emergent BioSolutions), but it would take millions of federal dollars to get them ready to produce the vaccine. Meanwhile, development of Ivins’s own vaccine was being blocked, and interest seemed to be shifting to other biowarfare pathogens such as smallpox, glanders (caused by Burhholderia), tularemia, and plague. For a man trying to sell a solution, a crisis could never have been more conveniently timed.
In August 2001, Ivins began spending night after night and weekends alone in his laboratory. He continued to maintain an erratic schedule of solitary work at all hours throughout the period during which the anthrax samples were created, packaged, and sent.
Later, it would be discovered that the mailbox in which the anthrax letters were dropped was at 10 Nassau Street in Princeton, immediately adjacent to an office of the KKG sorority. This was nearly two hundred miles from Fort Detrick, but the round trip could have been made in less than eight hours.
It was also discovered that the $0.34 federal Eagle envelopes used to send the anthrax spores had certain defects that identified them as being exclusive to a shipment on sale in only five post offices in Maryland and two in Virginia.
Ivins could never satisfactorily explain the string of late nights he spent alone in the high-containment facility at his lab immediately before the mailings. He also had no alibi for the periods of time when he could have driven to New Jersey to mail the letters.
Most damning, though, was that the anthrax-laced letter sent to Senator Daschle had carried the return address “4th Grade, Greendale School.” Just before the attack, Bruce Ivins had begun contributing to the American Family Association, a Christian advocacy group involved in a federal lawsuit contesting corporal punishment of a fourth-grade student at Greendale Baptist Academy in Milwaukee.
Six months into the anthrax investigation, the army assigned a medical officer from outside Fort Detrick to conduct an investigation. It became known that Bruce Ivins had failed to report contamination of his office by anthrax spores into late 2001. Of the twenty-two offices that technicians had scoured for spores, the only one containing Ames strain anthrax belonged to Ivins. But neither Ivins nor anyone else was disciplined. The media did not pick up on it, and nobody followed up on any of the inconsistencies and implausible statements Ivins had made.
Around this time, all anthrax researchers were required to submit samples of the strain used in their labs. Ivins did so, logging in his sample as “RMR-1029.” But he had placed his sample in the wrong kind of test tube and the Bureau rejected it. Shortly thereafter, Ivins submitted a second sample of Ames.
In May 2002, the outside investigator who worked for Fort Detrick delivered a 361-page report concluding that the available information pointed toward no clear answers.
Six months after that, FBI Inspector Richard L. Lambert took the place of Inspector Van Harp. At just about the same time, Congress voted to approve the Iraq War resolution.
In February 2003, Secretary of State Colin Powell held up a vial of white powder in a speech before the United Nations saying that less than a teaspoonful of dry anthrax in an envelope had shut down the US Senate. He made the association with Iraq—the fact that in the 1990s the Iraqis had possessed eighty-five hundred liters of liquid-form anthrax.
And although smallpox was eradicated worldwide in 1980 and resided in only two repositories, Iraq had never certified that it had no residual smallpox virus. Iraq had also worked on camelpox (a local disease), had a freeze-drier labeled “Smallpox” in Arabic during a UN weapons inspection in 1984 (to make vaccine, according to Iraqis), and could have bought some smallpox (variola) virus on the black market from a rogue Russian scientist with access to samples in the declared smallpox repository, or the clandestine biowarfare program. Those accumulated flimsy facts and speculations were enough for the US Defense Department to reintroduce smallpox vaccination for the military. CDC also “assisted” in this war effort by establishing a national smallpox vaccine campaign for health care workers (for an illness that you can prevent by vaccinating people up to a week after exposure). But early reports of serious adverse reactions associated with the smallpox vaccine—in the form of serious rashes, fevers, and cardiac arrests—ended the campaign that must not be named.
But no stockpiles were ever found in Iraq, and Saddam Hussein’s mobile germ warfare labs turned out to be fictitious. Powell’s statements did not jibe with the findings of the engineers at Sandia National Laboratories, who said that the anthrax used in the attacks had not been chemically treated. It had been known as early as the fall of 2001 that the anthrax came from the Ames strain, indicating that its most likely source was Fort Detrick, or one of the other very few centers in the US biodefense network that used Ames anthrax.
In March 2003, the Defense Department awarded Ivins its highest honor for nonuniformed personnel, the Decoration for Exceptional Civilian Service. The award was for his efforts to revive the long-troubled anthrax vaccine.
Five days later, on March 19, 2003, President Bush launched the war in Iraq.
On December 5, 2003, the Brentwood postal facility reopened and was renamed in honor of Thomas L. Morris Jr. and Joseph P. Curseen Jr.
In March 2004, with encouragement from Vice President Dick Cheney, officials decided to purchase 75 million doses of a next-generation anthrax vaccine. This would provide a three-dose treatment regimen for 25 million people. These doses would be held in a civilian strategic national stockpile. It was also a way of keeping the manufacturer of such a vaccine going so that it could be ramped up as needed. As part of this effort, a company called VaxGen was awarded a contract worth $877 million, payable as soon as it began to deliver the 75 million doses of rPA, the vaccine that Ivins had patented.
As a codeveloper of the patent, Ivins received checks totaling more than $12,000.
Agent Lawrence Alexander joined the anthrax investigation in January 2004. By the end of the year he had concluded that Hatfill had nothing to do with the attacks. At long last, he began to focus the Bureau’s attention on Bruce Ivins.
VaxGen had arranged for animal experiments to be carried out by a subcontractor, the Battelle Memorial Institute of Columbus, Ohio, and Ivins was summoned to the Pentagon to provide up-to-date information about the new product’s effectiveness. It was noted that Ivins sent Battelle anthrax spores from the highly purified mixture he had labeled RMR-1029.
Alexander knew that Ivins had limitless access to RMR-1029, and that he was highly proficient in handling anthrax. He also suspected that Ivins had thrown the FBI a curve by submitting a bogus sample in April 2002. Alexander also had the evidence of Ivins’s highly erratic email messages, concluding that he was not merely eccentric, as his colleagues had described him, but mentally unstable.
The FBI seized Ivins’s flask of RMR-1029 in the summer of 2004. It appeared that when Ivins had provided a sample in response to a subpoena in 2002, the sample was bogus. When confronted with this suspicion, Ivan said that his senior lab technician had provided the sample, not him.
His account of submitting the sample of RMR-1029 did not add up. His inventory book left 220 milliliters of anthrax RMR-1029 unaccountably missing. His only explanation was that he was not good at math.
Shortly thereafter, Ivins began to throw away suspicious materials such as his list of Kappa Kappa Gamma chapter addresses.
In 2006, the government terminated the $877 million contract with VaxGen due to stability issues, ending Ivins’s hopes for his next-generation vaccine.
That fall, Ivins bought a device that would detect bugs on his phones, as well as a tracking device so that he could see when his emails were received and opened and to whom they were forwarded.
In May 2007, Ivins was summoned before a grand jury in Washington, DC. He immediately hired a former state prosecutor as his lawyer.
The Amerithrax investigators had followed up on over a thousand samples of anthrax in four countries and determined that only eight samples, each evidently descended from Bruce Ivins’s flask of RMR-1029, matched the anthrax found in the anthrax letters. The Institute for Genomic Research demonstrated that the genome signature matched the RMR-1029 anthrax to the letters.
In April 2008, almost seven years after the attacks, Ivins was detained by investigators while his home was searched. Amid his juggling gear they found a bag of materials that he used for cross-dressing. Later, they found bondage pictures on his computer, as well as a large cache of handguns, a bulletproof vest, and homemade body armor. He’d been using his basement as a firing range.
That spring, federal prosecutors drafted a formal prosecution memo, the first step toward seeking a grand jury indictment of Ivins for the five anthrax murders. The army had already taken away his lab privileges. Meanwhile, Ivins seemed to be deteriorating, drinking more and more heavily.
In June 2008, the Justice Department and the FBI agreed to pay Steven Hatfill a $5.82 million settlement. Hatfill also sued Kristof of the New York Times but lost, the court deciding in favor of the journalist on the theory that Hatfill, at that point in time, was a public figure.
Because of Ivins’s bizarre behavior at group therapy and elsewhere, he was apprehended and taken to Frederick Memorial Hospital for psychiatric evaluation.
Shortly after he was released, he filled three prescriptions: the antidepressant Celexa, the antipsychotic Seroquel, and Depakote for mania and migraine headaches. He also picked up a package containing seventy tablets of Tylenol PM. He was later found at his home lying in a pool of urine, cold to the touch.
At the time of Ivins’s death, Senator Leahy was still insisting that even if Ivins was guilty, he could not possibly have acted alone, asserting that others had to have been involved in the plot. And on August 5, 2008, Richard Spertzel, the retired USAMRIID deputy commander and UN bioweapons inspector, wrote an op-ed in the Wall Street Journal still insisting that the anthrax in the letters had been altered to be more lethal, and that it was too sophisticated a product to have been produced by a solitary scientist in a US lab.
Making biological weapons is still not simple for the would-be bioterrorist. While the apocalyptic cult Aum Shinrikyo had success with the Tokyo subway sarin attack in 1995, it was unable to create anthrax as a bioweapon despite significant resources. Unfortunately, however, every year since 9/11 it has gotten easier to produce anthrax as a biological weapon, and terrorists remain actively in pursuit of talented microbiologists with evil in their hearts.