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Last Updated

11 Dec 2002

Source: Wall Street Journal, July 1, 2002.


Homeland-Office Plan Splinters, Public-Health Duties, Critics Say


WASHINGTON -- As terrifying as last fall's anthrax attacks were, they offered an odd sort of reassurance to the nation's health community. Improving the public-health system had become a matter of national security.

But now some health experts fear the chance for improvement may be lost in the bureaucratic scramble set off by President Bush's announcement of a new cabinet-level Homeland Security office. The administration's proposal could actually weaken the system, they say, by splintering responsibility between the new department and the system's old home at the Department of Health and Human Services.

"They appear to be splitting up functions rather than consolidating them," says Tara O'Toole, director of the Center for Civilian Bio-Defense Strategies at Johns Hopkins University in Baltimore. A new report from the General Accounting Office notes that Mr. Bush's proposal "is not clear on how the public-health and homeland-security objectives would be balanced."

Those concerns, in turn, are fueling skepticism on Capitol Hill, notwithstanding the initial flush of enthusiasm for Mr. Bush's proposal two weeks ago. Republican Rep. Richard Burr of North Carolina, who says he supports the proposal, wonders whether the administration has "thought through exactly the consequences" of dividing health functions. Democratic Rep. Henry Waxman of California is more blunt: "We may find we've undermined rather than enhanced our nation's security."

The stakes in the debate -- and the weaknesses of the existing system -- were put on frightening display in last fall's anthrax attacks. HHS officials in Washington hadn't established clear lines of communication with state and local officials across the country. The result was widespread confusion about safety procedures and treatment protocols, leaving those officials relying on sketchy information from the same news broadcasts being viewed by ordinary Americans. "Health people didn't know a thing about what the threats were," recalls Mohammad Akhter, executive director of the American Public Health Association.

But the static the administration now faces on public health illustrates doubts arising on a series of fronts as lawmakers pore over the fine print of the massive government reorganization requested by Mr. Bush. In proposing to create the first new federal cabinet department in a quarter-century, the administration has triggered debate on matters as big as the fate of the Federal Bureau of Investigation and as small as which department's clerical workers should process visa applications in foreign countries.

Homeland Security Director Tom Ridge assured Congress last week that the administration is listening. He called the reorganization plan "a work in progress." But the tinkering already underway shows how difficult it will be to speed the proposal through Congress by the Sept. 11 target date that House Democratic Leader Richard Gephardt and Mr. Bush have both embraced.

On public health, Mr. Ridge promises a "distinct tear line" between functions that would shift to the new department and those that would remain under the control of HHS Secretary Tommy Thompson. For instance, HHS would hold onto functions such as maternal health and childhood immunization; it would lose the Office of Public Health Emergency Preparedness, and workers at the Centers for Disease Control who oversee the National Pharmaceutical Stockpile and a laboratory registration program for dangerous biological and chemical agents. In all, the new department would absorb some 151 workers from HHS, administer a new grant program to fund state health-system improvements, and set research and funding priorities related to bioterrorism.

But most public-health experts say they can't see the "tear line" that Mr. Ridge has spoken of. The CDC surveillance systems that would identify a biological attack, under the auspices of the new department, are the same ones that track natural diseases, a function of HHS. Bioterrorism research being conducted by the National Institutes of Health often resembles research conducted on natural diseases. In fact, many pathogens that could be used by terrorists also occur naturally.

Seeking improvement through division is a "puzzling premise" of the administration's proposal, says Dr. O'Toole of Johns Hopkins. Another example: Some of the food-safety functions of the Department of Agriculture would move into the new agency. Meanwhile, HHS's Food and Drug Administration isn't mentioned in the White House proposal—even though it regulates 80% of the food supply and would have to approve any bioterrorism-related treatments and vaccines.

Mr. Ridge, for his part, disputes the notion that the administration plan will dilute public-health functions. The White House plan "will end up having dual value ... in combating terrorism and making the public-health system more robust," he says.

How this would work in practice is far from clear. For example, HHS would continue to determine what supplies should be included in the pharmaceutical stockpile. But Homeland Security would decide when and where to deploy them, even in naturally occurring incidents such as hurricanes, floods and natural disease outbreaks. The new agency also would maintain operational control over the teams of medical professionals from around the country that until now HHS has overseen, including doctors, nurses, morticians and mental-health workers.

To Mr. Akhter of the public-health association, meanwhile, all of the attention to the details of the federal bureaucracy misses the real key to improving the response to biological attack. State and local health departments need to be beefed up, he says. "It doesn't really matter where you move the pieces in Washington."