The Anthrax Scare and Bioterrorism

Transcript

MR. STEPHEN HESS: Good morning. I'm Stephen Hess of Brookings. I welcome you along with my co-host, Marvin Kalb, the Executive Director of the Washington Office of Harvard's Shorenstein Center. This is the sixth program of the Brookings/Harvard forum on the role of the press in the present crisis. Our topic today could hardly be more topical, more topical than the lead story on the front page of this morning's Washington Post. "U.S. offers anthrax vaccine to thousands." This happens to have been written by one of our panelists, and says, "The federal government will begin offering anthrax vaccine as an experimental treatment to thousands of people potentially exposed to the deadly bacteria during the series of attacks this fall, Administration officials announced yesterday."

We have, I believe you can say, seen the future, a bit of it, and it's scary, and it's important. We have a panel of four who are going to help us get through the question of what the role of information is and should be. Two journalists who now cover this subject who are at truly the top of their profession, the person from the government who has major responsibility under him for public information in this field, and a scholar who has devoted his life to this particular field of bioterrorism.

The two journalists, Ceci Connolly of the Washington Post, who's better known I guess now to you in Washington as the person who covers presidential campaigns. It is a real statement about the ability of journalists to move from field to field. She was the person who told us what we had to know about Vice President Gore during the presidential campaign; four years before she trailed Robert Dole, the Republican, around the United States.

The other journalist with us, Susan Dentzer, heads the award-winning unit of the NewsHour with Jim Lehrer, the health unit, that is. Before that she was the chief economics reporter/correspondent for US News and World Report and, by the way is the Chairman of the Board of Dartmouth College.

Kevin Keane is the Assistant Secretary for Public Affairs of Health and Human Services. He comes to Washington, along with the Secretary, Tommy Thompson. He had been the Governor's Executive Assistant and Chief of his Office of Communications back in Wisconsin.

Finally, Jonathan Tucker. His title has to be read. I've got to get this absolutely right. He directs the Chemical and Biological Weapons Nonproliferation Program at the Center for Nonproliferation Studies of the Monterey Institute of International Studies.

MR. JONATHAN B. TUCKER: You have to say that very quickly. (Laughter)

MR. HESS: I was also impressed as I read his brief resume that he was at one point a biological weapons inspector in Iraq under the auspices of the United Nations Special Commission. And most important at the moment, we must give a plug for his new book. If you have read "Germs", now you must read, "Scourge: The Once and Future Threat of Smallpox," which is just out and is published by Atlantic Monthly Press.

MS. SUSAN DENTZER: And perfect for Christmas giving. (Laughter)

MR. HESS: Yes. From Scrooge to Scourge.

MR. TUCKER: That's right, and most of the people will confuse it with Scrooge. (Laughter)

MR. HESS: We wish you much success.

As usual, we'll open our conversation with some thoughts or questions from my co-host, Marvin Kalb.

MR. MARVIN KALB: Not many thoughts, but a lot of questions this morning. As Steve pointed out, here's the Washington Post with its lead story, and the New York Times is not leading with it, but it's putting it on the front page. "U.S. will offer anthrax shots for thousands."

Now this story jumps at me, I must say, and I'm sure it did at a lot of other people, because for the past month it has not been a front page story, it has not been on the evening news programs, to the best of my knowledge. When it has appeared, it's been inside the newspapers. There does not appear to be an immediate large, new, direct threat to the American people. So what's going on here? Why is it suddenly onto the front page? Explain that?

MS. CECI CONNOLLY: I guess, Marvin, I would start with a couple of things on this specific story. First of all, it's an unprecedented decision by the federal government to use unlicensed vaccine in a post-exposure treatment. There are a number of very unusual medical aspects to this story, first of all.

Second of all, this story has been building over some period of time. We actually at the Post started asking questions about this five weeks ago and did not initially get much in the way of answers. Last week we had inside the paper a little bit of a buildup that this was being considered. And finally, I think you have to keep in mind our readers. This is a very important local story as well for the Washington, D.C. area. You have the Capital Hill workers and all of the postal workers in this area who are the primary focus of this program. So for all of those reasons I think it got that kind of play in our paper.

MR. KALB: Susan?

MS. SUSAN DENTZER: I think the main reason it's back on the front page is it's literally a timing issue.

What happened is that in fact people now are coming to the end of the initial 60 days cycle of antibiotics that they were initially instructed to take if they had been exposed to the anthrax spores, both in the case of Brentwood and the case of the workers on Capital Hill. So the 60 days are now coming to an end.

What's happened in the interim is that the federal health officials have gone back and looked at the literature. Literature in this case is a fancy word for two studies. (Laughter) Two studies that in fact were done on monkeys. One of them as recently as 1956, the other one 1993. Where literally a small group of monkeys were given anthrax and then, as they say, challenged—I should reverse that. They were given either the vaccine, the anthrax vaccine that we had made at that point, and then challenged with bacteria, and those monkeys in fact had spores in their lungs. And even after getting the vaccine and even after getting antibiotics continued to have small amounts of spores in their lungs for a number of days afterwards. That number of days more or less coincides with the number of days that has now elapsed since people were exposed to anthrax.

So putting all of this together, government officials have said gee, if a bunch of monkeys could have a spore in their lungs 60 and 75 days out, even after having been treated with antibiotics and vaccine, maybe we'd better give people the option of protecting themselves further beyond the 60 day period.

So what actually happened yesterday is the government said not only is the vaccine going to be available, but we also want to encourage people to think about taking another 40 days of antibiotics, or both. Or nothing. Because in the end, as they stressed yesterday, the scientific evidence of this is very very thin. It's these two studies.

I was sort of amused, one of the nation's major newspapers, not Ceci's, said this is based on a handful of studies, that's like five. It's not. It's two, in '56 and '93.

So all of us are sort of groping our way through this uncertainty but in fact that's what it was. It was the timing issue that drove this decision now on the vaccine being made available.

And the interesting thing is, Ceci's paper got it right. The headline is "U.S. to offer" the vaccine. The fact of the matter is, we don't know how many people are going to take the vaccine. It could in fact be a very small number of people who elect this choice. It's just going to be made available to them.

MR. KALB: So Kevin, for our purposes you're Mr. Government.

What you're doing, in effect, is taking... You don't know really a great deal about what is happening now with these spores that have been inhaled, whether after 60 days they will actually lead to an infection. You don't know. We're operating on a "cover your backside" basis, aren't we?

MR. KEVIN KEANE: You could look at it that way, but I think what you need to look at, though...

MR. KALB: How else would you look at it?

MR. KEANE: Let me explain. You've got to look at it not just on this issue but any of the anthrax issues. This is new. We haven't had this happen to our country before. We haven't had humans attacked by a release of anthrax, so there's not a textbook. The CDC and the NIH and our best scientists are literally writing their textbooks as each day passes and they're learning more. This is kind of the evolution of dealing with the anthrax attack.

We focused first of all with treating the people who were initially exposed in the initial attack. Then you had some ancillary incidents flare up. So it's a natural evolution of okay, what do you do after the 60 days of antibiotics are up? Because the best science has at times told us, okay, 60 days of antibiotics should be effective in treating the disease, and it has been. We haven't had... People who have been on antibiotics have been served well by those antibiotics and they're doing well because of those antibiotics. But as the scientists went back and reviewed what they knew, reviewed the studies Susan referred to which are slim, and thus frustrating to our scientists because there haven't been more studies, and frankly, I expect there hasn't been a need to have more studies because we haven't had these types of attacks. Not just in America, but in the world.

What they came to realize is yes, there's a theoretical risk that once you go off the antibiotics you could have a spore still in you and that spore could germinate and...

MR. KALB: Had you just learned about that?

MR. KEANE: No, I think they always knew how the anthrax spores worked and germinated, I think scientists have known that. The question has been how do you deal with it?

MR. KALB: But you're dealing with it now why? Has anything new developed?

MR. KEANE: Well sure, the newness that developed is we started with the initial protocol of the 60 days of antibiotics, and okay so what's the next step, what happens after that 60 days? There are some studies that have shown theoretically you could have a spore in you after that 60 days. After 100 days it's unlikely. But after 60 days theoretically there could be a spore in you.

So two options that scientists have decided to make available to folks is you can have another 40 days of antibiotics which takes you up to the 100 days, or you can get the shot, the vaccine. And again, you say it could be to cover your backside. We would say it's out of an abundance of caution, to make sure that people know that those options are out there, to make sure that people know they can have that extra protection if they choose to take it.

There's a decision that needs to be made. D.A. Henderson, who is probably one of the most respected scientists in the world, he eradicated smallpox and now he's working in our department as our lead scientist. And Jeff Koplan, who helped him eradicate smallpox, again, a brilliant man. And Tony Faucci, who is our lead guy on AIDS. I mean these are brilliant men, the best scientists we have in the country. And they just want to be safe. They just want to make sure all options that are available to them, as doctors, are then presented to the public.

Again, we're dealing with a very limited population and that population of those who were exposed to anthrax. So you're talking about roughly 10,000 people.

MR. HESS: Can I interrupt just a second? Forgive me, Jon.

You described an important decision made by scientists. At what point are you or your colleagues as the public information people called in to discuss the ramifications of this, the need for information?

In other words you said earlier on you've known about this for some time, but are you, do they call you after the plane is ready to take off the day before yesterday? Or are you actually involved in setting the policy on information as you go along?

MR. KEANE: I think as the scientists started to come to a sort of path that they were going on, then we became more involved. It was more in the sense that you're not going to go there and question the scientists. What you may do is add a little bit of pragmatism to make sure they're thinking through some of the pragmatic ramifications of this and how the public may see it. How do you communicate with the public, how do you educate them on their options? That was one of the big things we raised with them is we've got to make sure that when you go this route we let the people know the options and the risks, and that's part of what's going to happen with the vaccine.

You can't just come in and get, say I want this vaccine and you're not going to be educated. You're going to come and you're going to say I'm interested in your vaccine. Or even if you say I want the vaccine, you're going to have to sign an informed consent because it is still an investigational drug for this type of use, the post-exposure use. You're going to have a physician, we're encouraging everybody to make sure you have a physician with you to help you make an educated choice and understand what the pros and cons are. I think HHS and its scientists are very involved in that process too, and making sure they're available to physicians to health leaders... The Ivan Walks' to NBC, to the Postal Union, to the Hill, to the folks down at AMI in Florida, to answer their questions and make sure they can make informed decisions.

You have some examples, Ceci had some good examples in her story today of real folks. You had one gentleman who frankly had stopped taking his antibiotics, and then he's wondering why would I go get the shot? If you stopped taking the antibiotics and nothing's happened to you, if you talk to your doctor, your doctor may tell you you're doing okay, why don't we just let it go and if you have any symptoms come see me right away and we'll get you back on antibiotics and treat you.

MR. KALB: Let me get Jonathan in on this. How do you, if this is experimental, this vaccine has been used on the military, pre-infection, pre-exposure. Now this whole thing is experimental, we don't know how it's going to work, and Kevin says you just go to your doctor.

I don't know that my doctor has any knowledge of this. Do most doctors have knowledge of this?

MR. TUCKER: Definitely not.

MR. KALB: Then how would you get an intelligent answer out of a doctor?

MR. TUCKER: Presumably the people who are administering the vaccine, which are government physicians, will have the informed consent form...

MR. KALB: But is the average guy who is a postal worker is going to have access to a government doctor?

MS. DENTZER: In fact what we were told yesterday was that the postal workers in particular are far from decisive on the subject of whether they're going to get the vaccine or not, and in fact they have asked for a week-long educational period where various experts are going to come before them and presumably be subject to a lot of serious questions and answers about this because their comfort level... Needless to say the Brentwood postal workers above all, have a very low level of confidence at the moment in what they're hearing from all aspects of government and particularly from the Postal Service. So they want a week of information first.

MR. TUCKER: I think this is one of the reasons why CDC and HHS are erring on the side of caution, because they came under such severe criticism for not predicting that the postal workers would be at risk from the sealed envelopes. In 20/20 hindsight perhaps they should have been aware of that eventuality. I think it's a little unfair to criticize them for predicting something that had never occurred before. But in any event they came under severe criticism, so now I think HHS, having been chastened by that criticism, is now erring on the side of caution and wanting to take every step to prevent people from developing anthrax down the road because of latent spores that are not killed by the antibiotics. So it's sort of an insurance policy, both medical and political, I think inoculating HHS from criticism as well as inoculating people from the disease.

MR. KALB: Ceci, from a journalistic point of view, were there questions that you're aware of now that you feel you should have asked two months ago? You were all in this together, as it were, journalism as well as the government and the scientists seemed to be exploring new terrain. That's correct, isn't it?

MS. CONNOLLY: Sure. Absolutely.

I think this ties in with the discussion of timing that you all were bringing up.

One of the questions that we have yet to get an answer to is why HHS and CDC began this effort on the vaccine in late October. It was October 24th that Secretary Thompson asked the Pentagon for the vaccine. It was on October, I believe, 26th that CDC went and filed a 100 page document, it's referred to as an IND, investigational new drug, it's called. Has filed this 100 page document with FDA asking for permission to essentially use this in a new and different way, post-exposure.

That was late October. I remember having a conversation with David Flemming of the CDC on October 26th in which he said we want enough vaccine for a thousand of our CDC workers. So we have persistently been asking what is this all about, and I'm not certain what the answer is to that, Marvin.

MS. DENTZER: They were pretty straightforward about this yesterday. I mean nobody knew at the end of October whether we were on the cusp of 20,000 anthrax-contaminated letters being disseminated around the country, or whether it was going to stop.

So basically what the government had to do... Unaccustomed as I am to defending the government officials, standing in their shoes they had to make sure that they had something out there, anything, other than Doxycycline and Cipro and other antibiotics with which to potentially combat a much larger scale outbreak than they had. So it was, and just as is being done now with smallpox, stockpiling smallpox vaccine—which frankly, if there were a smallpox scare tomorrow, that would also be administered on an investigational new drug stipulation because it hasn't been approved.

Same thing. You had to get ready for the worst case scenario.

MR. HESS: Susan, respond as well to Marvin's question to Ceci which is what questions you now know you would have asked then. Indeed, even in a broader sense, which is really what you as journalist have learned, not about anthrax the substance but about anthrax the story, that you would have moved forward, with what you are now planning in your unit at the NewsHour for how you would approach bioterrorism.

MS. DENTZER: I think all of us who were covering this were quickly made aware of the huge scientific uncertainties surrounding almost everything about anthrax, and in part it was because of what was observed earlier, we haven't had to cope with this before so there was no reason to accumulate reams of information about it. But the fact of the matter is we didn't have it.

I think that early on we were told certain things by government officials which we took at face value, I think a lot of us doubted the underlying scientific basis of them, and I wish we had pushed them further to admit to complete uncertainty. Let me just give you an example.

Early on when, there was of course the initial deaths from inhalational anthrax, and then there were these cases that appeared to be unexplained, particularly the case of Kathy Nguyen, the woman in New York who was killed. And there didn't appear to be an immediate smoking gun about why she was killed.

A leading supposition, even then as it appears to be the case now, was that there was cross-contamination of mail. That basically a letter that had a lot of spores in it bumped up in the postal processing process against other mail and somehow spores ended up on other mail and people like Kathy Nguyen opened that mail and got contaminated.

When you asked government officials about that scenario early on, they said it is unlikely that that happened. There are two ways to say that phrase. One is to say it is "UNLIKELY" that that happened. And the other way to say that is it's unlikely but we don't know. (Laughter) The second one was what was true. But we all wrote that it was "UNLIKELY" that that happened.

That led to a crazy ream of stories. Another major newspaper wrote in November that federal investigators said that one possibility was that Kathy Nguyen had crossed paths with the perpetrators of the bioterrorism. Well, that's true, and it was also possible that she was Osama bin Laden's lover. (Laughter) We had about as much evidence of that as we had of the fact that she had crossed paths with the perpetrators. But federal investigators were kind of I guess musing on what was the realm of the possible. So it goes to a reporter who writes it and puts it on the front page of a prominent newspaper, and all of a sudden that becomes the story, that she crossed paths with the perpetrators. So you've got this crazy cycle of uncertainty.

MR. KEANE: ...just the government that was musing. The media was musing about that too, and asking the questions.

MS. DENTZER: We plead totally guilty.

MR. KEANE: And why would you not look at that possibility, especially if you're the FBI and trying to crack the case.

MS. DENTZER: But here's what I guess I would hold us accountable for. Sure, that was a possibility. But there's a difference between saying it's a possibility for which we have zero evidence, and nothing that would lead us to think that this is true versus other things are true, and I'm just tossing it out. That's one way to report it.

Another way is to say that and then put it on the front page of a major newspaper, which most people believe is the record of truth, and then it becomes...

Think about the psychological implications for New Yorkers, all of whom are already traumatized. And now they're being told that maybe the guy who's doing this is riding the subway. We have to come up with a better way of communicating this, I think. We in the press.

MR. KALB: Journalists operate on the basis of a lot of things. You can get a handout, you can get an inflection, or you can pursue your gut. There's something that leads in good investigative reporting and all of that.

We don't know where this anthrax has come from. There have been a couple of stories that it could have been developed inside different labs. It's a loner. Do you have enough time as someone who covers the story on a daily basis, to be allowed to peel off and go on a political kind of detective hunt for evidence as to who did this?

The government may not tell us anything until they actually have the person in hand.

MS. CONNOLLY: Right, and you're getting at one of the extra complications in this as a story, which is that it's both a medical and science story as well as law enforcement investigating piece of it.

MR. KALB: Right.

MS. CONNOLLY: So you're also having... Just as we talked about law enforcement and that medical officials not always coordinating so well, you have a dynamic in the newsroom where you've got certain reporters that are talking to FBI sources, certain reporters are talking to say Jeff Koplan, the head of the CDC; and hearing very different things.

So we in our newsroom are day in and day out right on deadline saying wait, my expert is telling me X, your expert is telling you Y, how do we make sense of this? Usually what we do is kind of put both views into the story.

I guess at the Post we're fortunate enough to have enough staff that, for instance, some of our investigative reporters have been able to, as you put it, peel off and sort of pursue more of that story line of which labs have this, etc.

But I would agree with Susan, that we in the media were probably slow to ask some of these tough questions about well who in the United States has had this stuff, and where is it, and that sort of thing.

I was at a session with science writers awhile back and Brian Kelly, a Managing Editor at US News who I have great respect for, sort of chastised the crowd of science reporters and said you folks are reporters first and scientists and medical people second and you've got to put on your investigative reporter hat now and get to the bottom of this, not sort of sit around and think deep lofty thoughts about studies conducted over years.

MR. HESS: But doesn't that get into the question Jonathan that you're talking different languages and as Susan says, the emphasis is "not likely" and so forth. Talk as a policy scientists, if you will.

It strikes me, where do you come together? A lot of this misinformation just floats out because you're crossing each other with the languages you use. You mull over things that are speculation that seem perfectly fine talking to your colleagues in the laboratory but look awfully frightening, or are misinterpreted entirely, as you said in another publication. Tell us a little about that.

MR. TUCKER: I think this is both a medical mystery and a law enforcement whodunit. There are huge uncertainties, evidence pointing in different directions towards some kind of international involvement, toward a domestic perpetrator, and I think people are just speculating, which is a natural activity in the absence of hard data.

I'm hoping, for example, that the forensic analysis of the Leahy letter which was intact and contained a relatively large amount of material will yield some hard evidence that will point in one direction or another, but until that information is available there is a kind of vacuum, and the news media abhor a vacuum and they have to fill it with something and it's usually with speculation.

MR. KALB: But Jonathan...

MR. TUCKER: I think it's true that it's important not to put too much weight on any different hypothesis. To say Kathy Nguyen was exposed by direct contact with the perpetrator, that was just one hypothesis and it should be just mentioned is one of many competing theories and not too much weight put on it. But I think it's understandable that everyone is speculating, including the media, and until we have hard evident it's a natural...

MR. KALB: What you're saying is that even as a scientist you can't provide helpful hints to Susan and Ceci to look for where they ought to go to look for ways of advancing the solution of this anthrax mystery.

MR. TUCKER: I think as more is known about, for example, where the strain is available, what laboratories have the capability to process anthrax in the way this material was processed, we can limit the range of hypotheses to those consistent with the facts, but until we have more facts there's still a number of competing hypotheses that are consistent with what we know, and I think it's perfectly natural for experts like myself or the news media to speculate. It's just important not to put too much weight or credence in any one particular hypothesis until we know more.

MR. HESS: What's the responsibility, Kevin, of a government to tamp down speculation in this regard? We have speculation of the most thoughtful nature, but what happens when it gets a 24 hour cable speculation and so forth. It strikes me that there's where we need...

MR. KEANE: But it's tricky for us, too. What if one of those speculative pieces turn out to be right and you say, like Ceci did, it was virtually impossible to have cross-contamination, and you learn more, and maybe you're looking at it then, we still don't know. We still don't know how these two poor women got it. So it's tough.

What we try to do and what we've really tried to do since October 4th, and we learn more every day ourselves, is to stick to the science and what we do know. If you look at the Secretary and some of the scientists who were doing daily teleconferences every day, and now we do them at least once or twice a week. I think if you look through those transcripts, at least my guy, the Secretary, says we don't know a lot. We don't. He wants to have that out there, that we're still investigating a lot of these questions and a lot of these issues and we don't have answers yet.

But conversely, if we know a reporter is really going down the wrong path, really doing something that's unfair or unduly scaring people, we do get pretty aggressive and try to pull them back, especially with the TV folks. And I don't mean to pick on TV folks. I'll be honest with you, my biggest worry as a government communicator, when October 4th happened, wasn't so much Ceci and her colleagues, or even Susan, because I kind of consider them almost newspaper folks anyway. It was...

MS. DENTZER: We'll take that as a compliment.

MR. KEANE: Yeah. I'm a newspaper guy so I have a bias. But I was worried about the cable folks and the sensationalism. And I have to say I think they did a pretty darn good job. And I think one of the reasons they did a good job is the CNN types and the FOX types have medical correspondents now, and they quickly turned it over to those doctors and those doctors I think kept things in perspective. They didn't let it, certain types within those news rooms wanted to get a little more sensational, a little more on the edge. The doctors pulled them back.

I remember days I was watching, I was having a frustrating time getting some points across to some media, and then I saw Sonje Gupte go up on CNN and say exactly the points I was trying to make. I was like Sonje, can you come here? I need your help.

I think that helped. I think that's been a wise move not only for the cable networks to bring these medical experts on their teams, but to turn to them and to give them prominent roles because I think they've helped keep it in perspective.

MR. KALB: The press and the media at large was criticized, very energetically, about a month ago for having pushed the nation way beyond where the facts should have taken them. That there was too much coverage. That it was too sensationalistic, and maybe that's Steve's point about the 24x7, that in that environment there's no way almost of escaping it.

But as you look back upon that now, Ceci, do you think, leveling with us, do you think the press overdid it? And let me in asking that question quickly tell you, I personally don't. I think it was terrific reporting. But there was a lot of criticism. I'm just wondering as you look back upon it.

MS. CONNOLLY: You mean specifically on the subject of bioterrorism?

MR. KALB: Bioterrorism. What we're calling this program, is the coverage informative or needlessly frightening?

MS. CONNOLLY: No, I don't think we've gone overboard, and I certainly know in our newsroom and many others, just in talking to friends in the business, that there are very serious heated conversations in the newsrooms over the past several months about this concern of scaring people needlessly.

Keep in mind, we're hearing from a lot of the "experts", some in government, but frankly many out of government who are more comfortable I think speaking saying look, this is really serious. We've been trying to get people to pay attention to this for years. This is the time to shine the light on this, and I think there's something to that.

On the other hand, you're absolutely right, these stories have to say this is what we know about a possible imminent threat right now, etc. Again, keep in mind we have to take some of our cues from people like Tom Ridge and the FBI. When they stand up and issue another one of their mysterious alerts, what are we supposed to do with those things?

MR. KALB: So you put that alert within the context of a possible bioterrorist threat and therefore you feel justified in moving forward.

MS. CONNOLLY: I think that's one more piece of data that we as journalists are taking in in weighing what sort of stories we want to pursue and where we play them in our newspaper.

MR. KALB: Susan, even on the NewsHour, and looking beyond just the NewsHour to television, but keep cable out of it for a second, do you think you put too much out at the beginning? Or was it just right?

MS. DENTZER: I think on balance it was about right, for the following reasons. This was, this has been the first large-scale systematic bioterrorist attack in history, and certainly in U.S. history.

Tell me what the appropriate upper bound is of the coverage of that topic? I don't know what it is. We didn't know how widespread this is going to be, and it is true, as we've now established, that there were enough spores in one of those letters that went to Daschle to kill a million people. A million people could have been killed by that.

And we now know, or think we know, that only a handful of spores could do the trick, because that appears to be what happened in the case of Kathy Nguyen and Ottilie Lundgren. That they got a couple of spores on a letter. That is the leading speculation.

So this could have been... It's bad enough that five people are dead, five innocent people are dead. But it could have been millions. And in that uncertainty I don't know where you draw the line and say too much coverage.

MR. KALB: Fair enough.

MR. KEANE: I think that's an example of hyperbole, because there's no way a million people could be infected by a few letters through the mail. That's a theoretical dose in terms of numbers of spores, but the key factor is delivery, how they're delivered.

So one would have to take those 500 spores, or whatever, and individually infect a million people. But of course there's no way that would happen by cross-contamination.

MS. DENTZER: But as I say, we didn't even know if that was the end of those letters. Nobody knew.

MR. HESS: The basic question, Jonathan, is how well, two and a half months, looking back, did they get it right? Were they unnecessarily frightening to us?

MR. TUCKER: I have no criticism with the responsible media, the New York Times, the Washington Post, but I do think the cable channels went way overboard. In fact whenever I appeared on a show like the Geraldo Rivera Show or the Larry King Show and I tried to tamp down some of the hysteria I would be cut off because I was not saying what they wanted to hear.

They wanted to hype the story because it was good for their ratings. I think that was very unfortunate and it created a kind of dynamic in which the various cable channels, even with different networks, and that's NBC competing with CNBC, to have a more dramatic story and it did create I think a very negative dynamic.

MR. KALB: Jonathan, was this your impression or did somebody actually say that to you? That you're not responding as we would like you to respond?

MR. TUCKER: I would be on shows in which there would be an alarmist and I would be the one trying to tampen down some of the hysteria and the alarmists would get 90 percent of the attention. So I assumed that it was because he was saying what they wanted to hear.

MR. KALB: Did anyone ever say this to you?

MR. TUCKER: They didn't say explicitly we don't want to talk to you because you're not saying the right thing. But it was clear to me repeatedly on a number of interviews that when I said I think this is an unlikely, when talking about smallpox or largescale attacks I would go into the technical hurdles involved with dissemination of large amounts of anthrax through the air, things like that. I would basically be cut off, and the person talking, for example, experts on the more alarmist side of the spectrum, such as Michael Osterholm or people of that stripe, who tend to, I think, exaggerate the threat, would get more attention.

So there was a certain perverse incentive or dynamic going on, at least on the cable channels.

MR. KALB: Kevin, it's not in your interest to attack the press, but how did they do?

MR. KEANE: I would agree with Susan. I think on balance they did a good job and they're doing a good job. The only thing I would continue to caution them to remember, because it's easy to forget and we have to remind ourselves, is it is new. You always have to remember it's new and that we're learning. You can't get into a situation where it's kind of like you would blame Jonas Salk if he didn't come up with the polio vaccine soon enough and people suffered because he didn't get it soon enough.

The scientists are learning, they're adjusting, they're going to come up with. I have very confidence that our guys are going to come up with a good solid, clear, anthrax treatment some day. It may take them awhile, but they're on that path, they're pursuing it. Clearly there's a need now because there's a public concern for it. And I think they're smart enough to figure it out one day.

MR. KALB: Talk a little bit about smallpox for a minute. As one looks ahead, and there's already been a good bit of talk about it, but as one looks ahead, from a journalist perspective now, what do you think is your obligation, what is the story that you ought to be looking into now?

MS. CONNOLLY: That really is sort of the next subject or sub-theme of the bioterrorism coverage. Again, we take some of our cues from government here. They made the decision very early on to stockpile this vaccine because of their concern about the threat of this.

I think that one of the real challenges and obligations of the press when it comes to the smallpox coverage is explaining to people the pros and cons, for instance, of getting the vaccine. I think that so far there's been a good deal of confusion about oh it's just like getting your measles vaccine when you're a kid, because decades ago that was a standard vaccine. But there are real risks.

So I think that is going to be a real challenge in the coverage to kind of keep that proper tone and balance.

MR. KALB: Susan?

MS. DENTZER: I agree, and I think the one clear lesson I think we all take away from this is that the press has a lot of trouble with scientific uncertainty. We just do. First of all, if you wrote a story like this, very truthfully, you would never get it on the front page because you would say well, there's a lot of gray areas here, there's a lot ambiguity, some people say this, some people say that, we don't know this, we don't know that. Your editor would say what? Why are we writing the story? There's no there there.

That's the problem we have going forward with all of these stories, I think, particularly in a case like smallpox. Even just writing about the possibilities of a smallpox attack, the kinds of caveats you have to built into any kind of description of what the likelihood is of that. The ability to walk the line between telling people what is really true and what is really possible. Ken Alibek used to run the Soviet bio-weapons program, was second in command there. You sit and interview him and you listen to him describe what the Soviets were doing all those years that we thought they were abiding by our bio-weapons treaty in terms of figuring out gee, how many pieces of smallpox virus can we load onto a nuclear weapon so we could not only destroy the United States, but after it's all destroyed then infect everybody with smallpox? It gives new meaning to the word overkill.

You sit and listen to all of that and you know that that Russian bio-weapons effort continued at least to some degree into the recent era. That that virus didn't just go away. And you sort of say okay, now how do I sit here as a journalist and write about all of this in a way that doesn't completely terrify people, but yet gives adequate attention to the realm of the possible? That's very hard for us to do and we're going to be sort of staggering through this process I think for some time, assuming that the interest in bio-terrorism continues, and I think there's every reason to believe that it will.

MR. HESS: Jonathan, you wrote the book. What do we do?

MR. TUCKER: I think it's a real dilemma both for the press and for policymakers to deal with low probability/high consequence threats such as smallpox. Probably unlikely that terrorists would get their hands on it, but if they do the consequences could be very severe.

Policymakers generally have to err on the side of caution. They have to do a worst case analysis, stockpile vaccine as an insurance, just in case, because they are responsible for the security of the United States.

Journalists on the other hand have to, I think, err on the side of caution in terms of not panicking the public. So it's a different kind of calculation that a policymaker makes and a reporter makes.

As you mentioned, uncertainty is not news. On the other hand, you have to point out that there uncertainty, that this is a possible threat but not a likely threat, but the government needs to take certain precautions to reduce our vulnerability. I think it's been very difficult for the media, particularly television, because they have so little time, to provide those qualifications and a depth of explanation to reassure the public.

I also think there is some blame to place on the side of the government because of the confusion, the panoply of voices coming from different government agencies with different messages. Tom Ridge providing one message; Tommy Thompson providing another; CDC providing another. I think at least initially there was a lot of confusion for the media because of this conflicting information coming out of the U.S. government.

Even on factual issues such as the quality of the anthrax, Senator Daschle saying one things, Tom Ridge saying another, and that was confusing for analysts like myself. I couldn't really come to any conclusions until I knew was this in fact weapons grade anthrax, was it garden variety anthrax. And there was really no consensus in terms of the information being provided by the U.S. government.

So it is a dilemma I think for the press to deal with this issue because it is highly complex, it involves scientific uncertainties, and because the calculations made by officials are different from those made by reporters.

MR. HESS: Kevin, how do you coordinate within the government? What's the connection between Thompson and Ridge and the various aspects of HHS in Atlanta and otherwise?

MR. KEANE: I think it's going to help a great deal to have Tom Ridge there, and frankly, I think he took some hits early on that were unfair to him because he was new. The man literally just got there and was expected to the expert on all these issues.

But since he's been there there's been a lot better coordination in terms of getting information and disseminating it, distilling it and then figuring out how you can disseminate it.

You raised a good point on the weapons grade. That was somewhat frustrating out at HHS too, because our scientists didn't have the information either and didn't know, weren't sure how to read it. But again, we've adjusted quickly to this. I think as an Administration we've adjusted very quickly to this.

I know within HHS, and one of our biggest challenges is the fact that CDC is in Atlanta. It's not like the Secretary can walk down the hall and sit down and talk with Jeff Koplan and his array of scientists. They're in Atlanta and you do it by teleconference. That creates more problems than you might think. It's not as easy to communicate and talk. But I think we're doing a much stronger job coordinating and putting out a clear message and disseminating information that we have within HHS. I think the Administration as a whole is doing a lot better and it's only been a couple of months. I think we've adjusted very rapidly.

If you go back and look at some of the other crises we've faced in this country including health crises like AIDS, like Love Canal and those challenges, I think we're doing a heck of a lot better job than...

MR. KALB: How do you do it? How do you actually coordinate? Is there somebody on Ridge's staff who calls you ever morning at 8:00 or 9:00...

MR. KEANE: I did miss my call today because I came here.

MR. KALB: That's good.

MR. KEANE: It's just old fashioned talking to each other. And it's not as easy as it sounds because people are so busy. Jeff Koplan and his scientists early on in the stage, they're trying to figure out what's going on, they're trying to analyze the data. They're getting asked 100 questions by 100 different people. Same with us.

MR. KALB: I'm asking now. You're claiming there's better coordination. How does it actually work?

MR. KEANE: With homeland security, myself, I'm in daily communication with their team. I'm in daily communication with the White House on these issues.

MR. KALB: That's too broad. Who on Ridge's staff? Who at the White House deals with this? Do you have a regular call at a certain time every day? Is there an agreement that these issues I will handle and those you will handle?

MR. KEANE: We sort that on the conference call. Susan Neely who is head of communications in homeland security coordinates with myself and colleagues at the other agencies and we decide what's going on, who should handle it, what's the message out of it.

More importantly at the higher level there's a homeland security meeting that the President chairs and holds twice a week that the Secretary's at, Governor Ridge is at it, the Secretary and Governor Ridge talk several times a week, and if things are up they'll stalk several times daily. The relationship there is great and I think a lot of that goes back to their prior relationship and that they know each other. So from our perspective at HHS we think the system is working very well and much better communication, much better coordination of information, much better sharing of information.

MR. KALB: Ceci, do you share Kevin's view that there is this better coordination, you can turn to one or two people and at least get a good handle on what the data is?

MS. CONNOLLY: I would say that certainly the communications have improved in the last couple of months, in particular the conference calls that are arranged for reporters can be very useful.

There are, I think that it still takes quite a long time to sometimes get answers and responses, and especially in this environment of daily news, 24x7. Hours really do matter.

One of the real troubles with these conference calls, quite frankly, is that they're usually at 4:00 or 5:00 p.m. and you're asking a lot of a news organization on deadline to make sense of in some sort of intelligent way this complicated, uncertain material. Then you're following up with people at 6:00 p.m. with your follow-up calls. So I think there are still a lot of problems.

Susan Neely is new. I've spoken to her a couple of times but she's swamped, quite frankly, and it's still not clear to me who is in charge of the communication effort for the Bush Administration.

MR. HESS: If they had this perfectly coordinated and there was one person who stood up there each day, would that be satisfactory to you? You have all your own sources at the National Institutes, in Atlanta, in the universities, you want to triangulate. Isn't this the nature of your work to look for multiple sources that in fact are telling you somewhat different things?

MS. DENTZER: Yes. And I think, again, unaccustomed as I am to complimenting... Things have gotten a lot better. These daily press briefings, and for those of you who don't know, essentially we went from an environment where you were desperately trying to call the CDC, calling up, getting some receptionist to take your question down, and maybe four or five days later someone would call you back. We've moved from that environment to the environment of these daily press calls. Yes, it would be better if they were earlier in the day, I'll second that vote. But it's much better. And frankly, the quality of the information and the honesty of the information to me has improved considerably because people now are saying we don't know. What you say raises an interesting point because we don't have a clue. That, frankly, to me as a journalist rings a lot truer than the earlier insistence that this was unlikely or whatever.

Now it is true, journalists are going to continue to have frustration with that and there was a classic exchange yesterday in the briefing where the government having said we're going to give people these three options, we're not going to tell you what to do, we don't have enough bases of information to tell you what to do but we're going to present these three options to you. One reporter said, I can't believe you're not making specific recommendations to people. The press is going to continue to have that frustration.

But on balance, the breadth of the information that is now being presented, the honesty of the information is good, and you're right, we don't get let off the hook just because all of our questions don't get answered in one phone call. It is our responsibility to continue to look beyond that.

MR. HESS: Jonathan, you're the expert. You're the one that Geraldo is going to call in tonight based on what they read in the morning paper. Where do you get your information then?

MR. TUCKER: Most of the information I get is actually from the media. (Laughter) So it's a bit of a vicious cycle.

I have a few other sources, but because the government is not telling me things that it isn't telling the New York Times, I am quite dependent on that news cycle as well, so it is a bit of an incestuous process.

MS. CONNOLLY: But keep in mind here, it wasn't just a reporter yesterday who was saying you're not making any recommendations? The DC Health Director, Ivan Walks, and all of the Postal Service and union officials were clamoring us and have been over the last several months, we're not getting guidance, we're not getting information. And people are going to call Ivan Walks, frankly, before they call Tommy Thompson to say oh, my God, how do I make this decision?

So it's not just a bunch of reporters sitting around whining saying can't you give us a nice cut and dried story where you're going to say do X and do Y. It's medical personnel are expressing the frustration.

I can't tell you how many e-mails and phone calls I get from random doctors I've never met or heard of in my life saying please, please, please, I don't know what to tell my patients.

MR. KEANE: But you see where you two just like contradict each other, and it drives my world nuts. (Laughter)

On the one hand you're saying you like the honesty when we say we don't know, we don't have the knowledge base. On the other hand, you're saying how can we not give clear-cut recommendations. Well, we don't have the science and the 100 percent fool-proof evidence to give a clear-cut recommendation. So you've got to go with the best of what you know and what you have and what your scientists are telling you.

MS. CONNOLLY: I think what Ivan Walks would say just to take one example, which is the current issue on the anthrax vaccine, I think what Ivan Walks would say is we need some more parameters with respect to this anthrax vaccine. Are you saying if an individual was in a certain area, within a certain period of time? You can help people, there are 32,000 people in this country that were put on antibiotics at one point. That's a pretty large universe. I do think that the experts in making this kind of announcement could start guiding people a little bit better, and in fact they did on Capitol Hill. They were up on Capitol Hill on Monday telling 75 people that were around the Daschle suite, we are recommending it to you folks. So they have that ability.

MR. KEANE: But that wasn't HHS. That was the military.

Secondly...

MS. DENTZER: That would be the other part of the Administration. (Laughter)

MR. KEANE: But you told half the story there. We have been talking with Ivan Walks as early as last week. We have been talking with the postal union as early as last week. So we have been doing that, too. And we're going to continue to make our experts available so they can make educated choices. So that Ivan Walks can help walk his folks through that and help walk doctors through it, and so doctors can help advise their patients.

MS. DENTZER: And I think this illustrates a broader point which is that reporters are also operating in an environment where the government officials are going... You know. So that's part of what we're experiencing.

MR. KALB: There is the problem...

MS. DENTZER: ...cross-currents between the local...

MR. HESS: You know that's not going to appear on our transcript. (Laughter)

MS. DENTZER: To make it really dull and academic, cross-jurisdictional issues that factor into all of these health issues are spectacular. When you have local governments making decisions, and particularly the D.C. area where you have three. One whole issue in this coverage has been what do people say in D.C. that really should pertain to people in Maryland, but people forgot to tell the people in Maryland that it should also pertain to the people in Maryland. So you get a lot of this going on as well. And when you complicate that where you've got the district government, you've got the state and local governments, you've got public health officials sometimes, you've got the national government, then you've got the multiple agencies of the federal government, things get very confusing.

MR. KALB: I know that Steve wants to widen the circle of our discussion and bring you all into it and get your questions as well, but in my mind just summarizing some of the large points here, you need better coordination but there has been progress so far in that direction. This story touches people. It's not a theoretical exercise, and so a lot of those people will then turn to reporters for help. Even doctors will turn to reporters for help. And that's a very large point because the government is asking an individual who might be involved, might be affected, turn to your doctor and ask what it is that you should do when that doctor may not know what it is he should do, and that we're all in something that is very new and we're all kind of struggling together to come up with some common understanding and guidelines.

MR. HESS: Can we ask them to speculate? Or would that be poor form?

We did mention smallpox, but mostly we've been talking retroactively. Look ahead at what other things should we be planning for? You did touch on it with somewhat the smallpox, but there is a big scary world out there. You have a whole unit at the NewsHour. When you sit down with your unit and you do the stories for the next, think about the stories for the next six months, what are you thinking about?

MS. DENTZER: I think rather than sort of going off onto the list of all the other things that we could be attacked with, we've sort of at this point confined our efforts to smallpox. We haven't moved on to Ebola and sclerema and plague and all the other things that we could do. All those could be done.

Some various obvious areas that don't get sufficient attention that we will be looking into, one is food safety. And in fact the Administration in its request to Congress for assistance made very clear that that's one possible avenue that they take very seriously for potential future attacks. And it would in fact be, because our food supply now is global, because we have a very paltry number of food inspectors. It would be rather easy to create a lot of havoc by contaminating food that was exported to the United States, so I think we'll look at that.

Then more broadly, I think this crisis has had the useful impact of exposing how weak our public health system is overall. Not just to respond to bioterrorism, but to respond to the things that really kill Americans consistently in large numbers, like heart disease in particular. And what a world it would be if not only we had a public health system that was geared up to respond very quickly to the rare instances of bioterrorism, but also was far better equipped to deal with the things that are killing us in large numbers routinely and costing lots of money. I think we'll focus on that, too.

MS. CONNOLLY: I absolutely agree with that. I think sort of along those same lines we've been having discussions in our newsroom about if this threat quiets down to some extent as we hope and think it may be, we've been talking about more coverage in terms of the preparedness issues. Looking at on the ground how ready are hospitals to respond if in fact there would be some larger crisis, the public health system. Very serious stories to go and look at... I mean the one and only story I've sort of gotten to do off the news was going to New York and writing about their health surveillance system, and it's phenomenal. It's so impressive, but it's also

If you go to other places in the United States, health departments have been decimated over the years. They don't have e-mail, they don't have internet access. They have one and two staffers doing all sorts of things.

So I think that's the direction that we'd like the coverage to go if in fact things quiet down.

MR. HESS: Jonathan, what would you propose or suggest additionally that they should be looking at as we go forward?

MR. TUCKER: I would agree on the importance of stressing a public health system, not only for the hostility of bioterrorism, but also emerging infectious diseases. Because as the world grows smaller and people travel readily across borders, they can bring with them exotic infections that we normally haven't had to deal with in this country.

I think there's been an unfortunate tendency to respond either with panic or complacency. There's been a kind of sine wave vacillation between being very concerned about these issues or being I think excessively unconcerned. Part of that is because of the nature of news coverage. It tends to be a spotlight that focuses on an issue for awhile and then it goes away. Whereas this, I believe bioterrorism is a long term emerging threat, as more and more countries acquire biological weapons, as biotechnology spreads around the world, more and more people have access to the materials and the know-how to use these infectious disease for nefarious purposes, that we're going to have to deal with this threat in the future perhaps on a much larger scale.

So now is the time, we've had this wakeup call, fortunately small scale incident. Now is the time to strengthen our public health system, to become more prepared, less vulnerable. But that effort has to be sustained, systematic, strategic over a period of years. And because of the nature of news coverage, I think... My concern is that the public, if there isn't another incident in the next six months or a year, the public will become complacent again and it will be difficult to sustain support for congressional action to actually spend real money on strengthening the state and local health departments as Ceci mentioned.

So maybe the next thing that the news media could think about or sort of more analytical pieces, about this emerging threat and the forms it's likely to take not only terrorist use but also perhaps state use as an asymmetric weapon against either our troops or our population. Then how should we respond as a nation in a reasoned, systematic way.

MR. HESS: Both Ceci and Susan, from their knowledge of the news industry, and Marvin of course, too. Given the point that there is tremendous pressure closing down. I mean we've seen some things in Washington even in the last week in terms of slimming down organizations in this period. Is there any sense that news organizations are building units, are looking for reorganizing their resources to move forward in this area? They now see the threat, but of course they've sent their excess people to Kabul. What are they going to do about sending them to the CDC or the National Institutes?

Do you have any sense that the news organizations have awakened to this threat?

MS. DENTZER: No. Not as much as probably should be the case.

I think it would be interesting to hear what Ceci has to say about this, but I still think that generally speaking a lot of the press and news media, we're still fighting the Cold War, frankly, and a lot of the orientation still is toward subjects of ten years ago. And that it's taken a lot of people a lot of time to think in terms of health stories as being the critical stories for our time.

And you can see this even now. The war has pulled lots of attention away to it because there are bombs and there are people dying and frankly in television terms it's much better coverage than public health epidemiology.

So we're not quite there yet. And particularly when you're talking about things like... I could put a lot of people at the NewsHour to sleep if I said you really have to do a piece about emerging infectious disease trends. I could knock them out real fast. Because until somebody, people are actually dying from it, it's not real. And that's the dynamic that we're going to continue to have to fight.

MR. KEANE: Maybe if you framed it as the Ebola outbreak in Gabon and what if someone from Gabon traveled to the United States. During the incubation period of the disease, they could spread it here.

MS. DENTZER: And they said that's really interesting, maybe...

MR. KALB: When it gets here...

MS. DENTZER: ...six or seven months down the road we'll be able to get to a really good story on that.

Keep in mind, we're still having trouble getting... Look at how many people are dying of AIDS/HIV. How much press coverage is devoted on a day in/day out basis to that? Even the World AIDS Day comes and goes, UNH puts out a totally scarifying report about the degree of infection, the rate at which infections are going up in new areas around the world, and it's a blip

MS. CONNOLLY: I agree with Susan that this has been a cultural sort of change in newsrooms in that when this started, there would be a national security meeting in the newsroom and none of the health reporters would be included. So it's even taken a little while to just kind of say hey guys, we need to change the way that we have been thinking about the issues and the way that we're going to cover them and sort of the different kind of reporting partnerships that we're going to start forming of reporters that maybe didn't speak a common language in the past or have much need to.

I do think that newsrooms have shifted their attention and their focus to a number of these issues. Certainly mine has and I think many others.

My great concern is that, Steve, as you pointed out, most of these newsrooms are having shrinking budgets and shrinking staff, so that for instance at our place we now have two people full time on the homeland security beat—a beat that didn't exist three months ago. But one of those folks was pulled from court coverage, and one of them was pulled from environmental coverage.

Again, the answer from editors is always well you can do that too in your spare time. You can keep up with the EPA and you try as best as you can. But other things will get short shrift.

I know as a health reporter I feel terrible the days that I can't be writing about the uninsured, AIDS, what's going on in the pharmaceutical industry, Medicare coverage. But there are only so many hours in a day, there are only so many inches in the paper.

MR. HESS: Marvin, do you want to open it up to any questions?

MR. KALB: Yes, please.

Q: My name is Ira Allen. I used to be a reporter and I'm now Public Affairs Director for the Center for the Advancement of Health which looks at translating research on behavior into public policy.

I think what Jonathan said is the most important thing, because we've been kicking it around too. If the public health system is in a shambles and if the government can't be trusted, and if there's ambiguity in the science, then presto, the media becomes truly the mediator so that if bad information gets out at 7:00 o'clock, at 9:00 o'clock another network or possibly the same one has another better story, and personally I'm fascinated by this, and I wonder if you all could talk about that a little more.

Given the public health system infrastructures, the failure, that the media has an opportunity to do something they've never done before.

MS. DENTZER: And in fact we were. We heard over and over again from physicians in the early days of the anthrax crisis that they were getting all their information from us. None from government authorities, none from the CDC.

The CDC, here's the understandable mindset. The CDC for years is publishing this morbidity and mortality weekly report and if you look at most of the things that are in the MMWR they are about things that happened a year ago or two years ago, and finally the epidemiological investigation is complete and then they publish it.

It was basically a month before the CDC published a report on the first death of inhalational anthrax, and for them that was record speed. Record speed.

So there's this disconnect now, and we've filled the vacuum. We supplied the information, such as it was. As we had it available, and whether we rendered it correctly or not, we were it.

I think that it forces a lot of us to think through what is going to be our role next time. If there's another serious, systematic attack like this, what will we do differently, what is our obligation to walk the line between making the coverage informative but not needlessly frightening. We have a very important responsibility.

MS. CONNOLLY: I would absolutely agree. One of the challenges, though, is to always keep that kind of coverage relevant and interesting. You can't just sort of lecture the readers about you know, we need a better public health system. That's not really what journalism's all about.

Q: Rick Henry from Brookings.

You touched on this, you've kind of danced around it, but I wanted to get you to comment on, and when Marvin mentioned the coverage of his bioterrorism coverage, getting people into a fright and things like that. And I see it as two different issues, which is the bioterrorism coverage and the anthrax coverage. I see bioterrorism as the reporting has been good, talking about the scenarios, getting the public information out there, very important. What is out there, what's coming.

Some of the anthrax reporting I have to say, it's happened, there's been five deaths and people, but I've seen stories talking about people that are scared to send out their mail, and people aren't sending mail out for Christmas cards, and this is how you... It seems to me there has been some of this gloom and doom scenario in terms of the anthrax coverage, and I just wanted to have you comment on that.

MR. KEANE: From our perspective we try to get the information out. I think the media is trying to get it out too. But there's a certain point where you've got to trust people and I've always been, I learned in my days as a reporter that you've got to trust people that they're intelligent, they can make their own decisions, and in the end they're going to be rational about things. I think the best, or one of the greatest things that's happened out of this whole anthrax scare is how rationally the public has addressed it. We didn't have panic. We didn't have people... There were certainly some, but as a whole, we didn't have hysteria in this country. We had concern, we had people wanting to know facts. We had people getting things, disseminating it, making decisions for themselves and making rational decisions. I think that's the way we are as Americans. I think you've got to trust people that if you give them information, and you give them the best you have, and it's based on what you know now, that they can make educated decisions.

And we're kind of doing that today with the anthrax shot. We're giving them what we know, our best knowledge, our best information, but ultimately it's going to be a choice they're going to have to make.

MS. CONNOLLY: There is some underlying tension though here, elements of this. On the anthrax and mail and people being afraid about sending out mail.

One of the things that we've written a little bit about, and its difficult to report, is that there's been real tension between the Postal Service and some of the CDC/HHS medical experts because the Postal Service is facing a real economic crisis here. If there is panic about the mail system, if you think about how much money the Postal Service has already lost and it's trying to spend on this whole procedure. They're very fearful.

I remember when CDC was going to come out with that MMWR a couple of weeks ago on extra guidelines for handling your mail. There was a real internal struggle within the Bush Administration over how far they should go, and whether or not the Postal Service should actually send out some sort of notice to everyone who received mail that for instance came through Brentwood or the Trenton Station, that had had the tainted letter. The Postal Service obviously did not want to do that. They were afraid it was alarmist.

So there are other dynamics often at work here. Dare I say often politics.

MR. KEANE: We're working on it.

Q: I'm Eunice Moscuso. I'm a reporter with the Cox Newspapers. I've been covering some of the anthrax lately.

I wanted to ask Kevin if Congress has been a problem for HHS. I remember Dennis Hastert talking about people in Daschle's office being infected, which was not correct. And a lot of misinformation coming out of Congress. I was wondering if you all ever sort of said will you just stop talking? (Laughter)

MR. KEANE: You know I have to be confirmed by the Senate. My budget's in their control... (Laughter)

There's been some frustration, especially for us. And I think with [law enforcement] there's been some frustration there. Because we didn't have control of the Daschle level story. We never really did, at least from HHS. It happened on capital grounds. The capital police handled it. They packaged the evidence. They sent it to [the FBI] which has strong ties to the Congress. A lot of it was handled by Congress.

Yes, you had Senator Daschle, you had Speaker Hastert, you had other congressmen, other senators, out making very bold statements about the information which we frankly didn't have the data to contradict or not contradict.

So we were in a tough spot, in a bit of a spot. And Congress had a lot of control over that situation that the Administration did not.

There was actually, you had a split and you saw a bit of how the splits and separations of branches, it did have a little affect on this crisis.

Q: Mary Mullen. I work with the Bosnia/Kosovo Support Committee, but I was wanting to ask a question about anthrax.

When it was reported after September 11th, I guess I don't understand, it seems to me that not only are we reading the papers but al Qaeda and their people are reading the papers and watching TV, and maybe some sick people that might have done this anthrax thing. And right after September 11th, through the media, they were projecting well, it could be anthrax next, it could be smallpox next.

I'm not saying that it's wrong to do that, I'm just wondering do you think, why do you do that? Can it be harmful?

MS. CONNOLLY: The reason I think... I remember a week after September 11th sitting down and having a story conference session where we were debating should we move on to the potential of coverage of bioterrorism, and there were conflicting opinions on both sides of that question. We said what if we had come in on August 11th and said let's do a story about people who hijack planes and drive them into the World Trade Center and kill thousands of people.

Of course we would say that's crazy. Please, it's time for a mental health break.

You had to be in that mindset the week after September 11th. What's possible? Anything was possible, and we had extremely credible people telling us, look at the state efforts that are underway that we know are underway in bio weapons. And frankly, among the people we now consider our allies, like the Russians. You notice that the United States government is very careful not to say, not to include Russia among the list of people that we think has an active bio weapons capability. Why? Because it's politically indelicate to say that right now. But we do believe that they have an ongoing bio weapons capability.

So the notion that if state-sponsored terrorism was a fact as of September 11th, as clearly it was, it was a very small leap to say why couldn't it be bio weapons? Why couldn't it be chemical weapons? Why couldn't it be nuclear? It was the responsibility, I think, of news organizations, to begin to put that out there as a potential.

Again, subject to all the caveats we've said about, as Jonathan said, low probability/high risk. Yes. But we could not be relieved from the obligation to say that this was a possibility.

MR. TUCKER: I did have concern about some of the coverage because of the level of technical detail that was provided that might potentially be of help to terrorists. There's a very fine line that I think the press has to walk between informing the public and not providing so much information as to assist terrorists, and some of the reporting in the New York Times in particular was so detailed and went into such scientific depth in terms of electrostatic charges and pumping of anthrax spores and the chemical additives that would have to be added to the spores to make them more readily airborne, sort of identifying all the steps that terrorists would have to overcome to actually achieve a super weapon, that this I thought was counter-productive.

MS. DENTZER: But Jonathan, you could read all that on the internet.

MR. TUCKER: Too much information.

MS. CONNOLLY: Right.

MR. TUCKER: But...

MS. CONNOLLY: ...conversation in the newsroom. We had it early on, we continue to have those conversations. But let's face it. If even the best reporter at the New York Times can make sense of the clumping and the chemical treating, you don't think that these terrorists are able to get that information? And not only that, but it's one thing to be able to read a document that lays information out.

When we're talking about something like an anthrax attack, you're also talking about a certain amount of skill in the laboratory, a certain amount of expertise. So we had very serious thoughtful conversations weighing do we want to aid and abet, do we want to steer people, do we want to give them a recipe and a map, and we certainly don't want to do any of those things.

On the other hand, I think we have to be realistic about the information available on the internet, in books, in government documents currently, and again, give people a little credit and treat them like adults. This information is out there and it's available.

MR. TUCKER: But most of the information on the internet, or it's interspersed with misinformation or disinformation. When it appears in the New York Times as all of the dimensions of weaponization it gives it a certain credibility and there is a kind of road map that is laid out.

So I'm not saying there shouldn't be detailed reporting on this issue, but there should be some kind of informed judgment about how much is too much. I do think the New York Times in particular went over the line in that area.

These things were well known to experts, but we felt very uncomfortable for public discussion of some of those detailed technical parameters.

MR. HESS: Let me say that Marvin and I have often commented after these sessions that we almost forget our hosting responsibilities because we get so involved and fascinated by our panelists. This was certainly one of those times. This was a wonderful, wonderful panel.

We will have the next in our series on January 9th. It will commemorate the first quarter of the war in Afghanistan so it will be in a sense a quarterly report. Our guests, as of today, are Torie Clarke, the Assistant Secretary of Defense for Public Affairs; Michael Getler, the Ombudsman of the Washington Post, a former Editor of the International Herald Tribune; Jack McWethy, the National Security Correspondent for ABC Television; and Sandy Unger, now the President of Goucher College but formerly the Director of The Voice of America.

Then we are going into a second phase of this crisis of government and journalism, and feel that we should add to our agenda the questions of propaganda and public diplomacy. So we will by January 16th formally become, change our name from the Brookings/Harvard Forum on the role of the press in the present crisis to the Brookings/Harvard Forum on the role of information in the present crisis. And on January 16th we'll have a session on public diplomacy where so far we have commitments from Joe Duffy, the former Director of the US Information Agency and Tom Dime, the Director of Radio free Europe and there will be others of course.

So we wish you all the happiest holiday season. We will see you again back here on January 9th—same time same place.

Thank you.