It has been twenty-five years since the Sept. 11 attacks left the United States still shaken, and the first of two batches of anthrax-laden envelopes was sent from New Jersey. That mailing produced 22 cases of anthrax disease and five deaths. It also cost billions of dollars in response and recovery, and it caused considerable fear across the country.
A person who formerly served with the CDC and took part in the inquiry into those letters is now wondering if the nation is prepared for the next biological danger. His response, he says, is not simple.
The First Envelope Arrives in Florida
The anthrax letters targeted news media outlets and congressional offices. The initial delivery reached American Media Incorporated (AMI) in Florida, where a photo editor for The Sun tabloid fell seriously ill. A perceptive physician recognized anthrax after examining a specimen from a spinal tap.
The Laboratory Response Network notified the CDC the following day. A team was dispatched to the scene, and investigators first concentrated on whether natural exposures might explain the outbreak.
When a second AMI employee tested positive for anthrax, just weeks after the Sept. 11 attacks, bioterrorism became the top worry. The CDC set up an Emergency Operations Center (EOC) in one of its auditoriums, and the official took charge as the lead of the Epidemiology and Surveillance Team there.
Two Mailing Dates, Two Different Forms of Anthrax
Investigators ultimately uncovered significant distinctions between the two mailings. The Sept. 18 mailing was linked to a higher rate of skin disease and media industry workers, a connection that the team informally labeled “crunchy” anthrax due to its clumped appearance.
In contrast to other mailings, the Oct. 9 batch was tied to more breathing problems and sickness among postal workers who handled the mail. Because it broke apart more easily into tiny particles, it became known as “fine powder” anthrax.
The research made clear that a deliberate biological release produced effects that reached well past the people it was meant to harm. The makeup of the agent, how it was prepared, the method used to spread it, and the group of people exposed all shaped the clinical and epidemic picture in significant ways.
The Team’s Work on the Ground
To demonstrate a common origin, the inquiry employed molecular analysis, an approach that was still new back then, and found that the specimens taken from patients, the four powder-filled envelopes, and the environmental samples could not be distinguished from one another.
The clinical presentation was odd: some patients had only limited skin infection, while others suffered from the far more dangerous inhalational form of the disease. At first, the distinction between the two shipments appeared to be a rough experiment, with different versions of anthrax being tried out to gauge their separate results.
The team grew worried that a bigger release was being prepared. None of the subsequent reports describe any additional deliberate anthrax releases, though numerous “white powder” incidents have put pressure on public health and law enforcement resources. A paper was published detailing the cases stemming from contaminated mail.
A Gap Between Prediction and Reality
The official notes that the most significant discovery was that information available before the attacks failed to accurately forecast how exposure would happen. A substantial portion of earlier research indicated that the danger of resuspension or re-aerosolization of deposited anthrax spores was small.
The earlier guidance concentrated mostly on people and places that were directly exposed when an envelope was opened, covering prophylaxis and decontamination. The serious disease and deaths among postal workers pushed the team to reconsider its understanding of infection and its public health response as new evidence came in.
Some 32,000 individuals initiated antimicrobial prophylaxis. None of those at suspected exposure sites who took prophylactic drugs developed further cases.
The wider takeaway from the official’s account is that early signs can mislead, that past experience does not always prepare investigators for what follows, and that those probing these matters must cast their net wide, examining not just the intended targets but everyone who might have been caught up in the spread of the thing under examination.
What Has Changed Since 2001
The equipment now on hand for finding biological dangers works far better than before. The volume of mail has dropped, and it gets checked. Machines that handle letters are built in a different way. Rules put in place after the event make it harder for someone to abuse their power over anthrax.
The official warns that the system meant to answer both natural and deliberate infectious diseases is weak, pointing to cuts to several civilian and military biodefense programs that have left it exposed.
According to a recent Center for Strategic and International Studies report, “Americans face greater risks from biological threats today than at any time this century—and these risks are growing rapidly.” The growing ability of artificial intelligence to aid in the creation of, and perhaps produce, biothreat pathogens contributes to that elevated danger.
The Bipartisan Commission on Biodefense reached the conclusion that “AI fundamentally transforms the biological threat landscape.”, which means the nation’s capacity to respond to biological threats is not ready for the scale of danger it faces.
Three Lessons From the Anthrax Investigation
The official has now offered three lessons from the experience, a full 25 years after the first EOC was put together quickly.
- Detection must lead rapidly to interpretation and action. The pace and scale of the emerging impact were far beyond our usual outbreak response, even for a team accustomed to traditional “shoe-leather” epidemiology.
- The initial cases can be misleading. Assumptions based on previous experience may prove inadequate.
- Investigators need to look beyond the intended targets to everyone potentially exposed along the path of dissemination.
The Path Ahead
Five people died from the anthrax letters, which also cost billions of dollars, and the infrastructure built to respond to them has since become weaker. While the technologies used to detect such threats have improved, the dangers they face are increasing.
The lessons from 2001 are still relevant. A handful of letters produced an enormous impact, and the postal system’s reach and distribution was intentionally used as an anthrax dissemination machine. The clinical picture was unusual: half of the cases were limited skin infection, while the rest were highly fatal inhalational disease. The investigation showed that the consequences of an intentional biological release went far beyond the intended targets.
The country’s readiness for the next letter is a question without an easy answer. The technologies are better, but the infrastructure is weaker. The lessons from 2001 are still relevant.
| Date | Event |
|---|---|
| Sept. 11 | The attacks |
| Sept. 18 | First mailing |
| Oct. 9 | Second mailing |
| 2001 | CDC stands up EOC |
The sequence demonstrates the rapid development of events. The reaction came without delay, yet the systems built to handle it are now stretched beyond their capacity.
Source material: “Opinion: I worked on the CDC investigation of the anthrax letters. 25 years later, are we ready for the next biothreat?,” STAT.
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