Exercise developed and produced by:

Johns Hopkins Center for Civilian Biodefense Studies

National Memorial Institute for the Prevention of Terrorism

Office of Justice Programs, National Institutes of Justice, U.S. Department of Justice

The Alfred P. Sloan Foundation

Moderated Roundtable Discussion

How to Lead During Times of Trouble

[Listen to this talk] [Panelist Biographies]

Transcript

DR. O'TOOLE: So what we're going to do today is ask our panel members, as I said all of whom have been leaders in different contexts and in different crises, to share with us their recollections, their insights, and their lessons from their own experiences, and from observations of other leaders through the course of challenging crisis.

The way we're going to do this is as follows. I'm going to introduce each of the panelists very briefly so that you get an idea of who they are and where they come from. And I'm going to start by asking some questions, but mostly I want this to be a conversation. The panelists are free to query each other, or to comment on questions that I ask, even if I don't direct it to that particular individual. And at the end, as usual, we will stop for comments from the audience.

So first of all, let me thank all of you for being willing to share your experiences in a forum like this. It takes some courage to do this, which is even more testimony that you are, indeed, leaders. I'd like to introduce first of all to my left. Dr. Georges Benjamin. Dr. Benjamin has a long career. He was trained as an emergency medicine physician. He has been Commissioner of Health for the District of Columbia. He was also Commissioner of Health for the State of Maryland from 1995 through December of 2002, and he is now the Executive Director of the American Public Health Association. Georges, welcome.

Next in line is Ed Clarke. Mr. Clarke has a distinguished career in law enforcement, which included extensive experience in community policing. He is credited with saving at least one life during a hostage crisis, and he has a very impressive conviction record, though he never once fired his weapon in the line of duty. He is here today because he is also the Director of School Safety and Security for the Montgomery County Public Schools, and was of course in the midst of managing the sniper attacks of this fall.

To his left is Tom Day. Tom is the Vice President of Engineering for the United States Postal Service, which employs over 750,000 people, second in size as an employer only to Walmart I just learned. During the fall of 2001, of course, Tom and his staff were in the midst of managing the response within the postal system to the Anthrax attacks.

Next to him is Dr. Margaret Hamburg. Peggy is currently the Vice President for the Nuclear Threat Initiative Program in biological weapons and bioterrorism. Before that, she served as Assistant Secretary for Health and Human Services under the Clinton administration. In which capacity she set up the CDC's bioterrorism program in an age when public health was not very keen on accepting such a mission. She's also been Commissioner of Health in New York City, and was in that position during the first World Trade Center bombing in 1993.

Next to her is Mayor Ron Norick, who is a three-term mayor of Oklahoma City. He was mayor of that city during the 1995 bombing of the Murrah Federal Building, and among other things, convened a 350 person committee. I can't even bear to think about a 350 person committee, to create the Oklahoma City National Memorial. He's now a prominent social and business leader in Oklahoma City.

Next to the mayor is Sally Quinn. Sally Quinn is a well-known figure in Washington, D.C. She is an author and reporter for the Washington Post. She is here, in part, because during the Anthrax crisis, Ms. Quinn wrote a very provocative article about the need for officials to provide the public with better information about how they should protect themselves from the Anthrax threat. Thank you for being here, Ms. Quinn.

Next to Sally is Dr. Ivan Walks. Dr. Walks is a physician. He is a former Chief Health Officer for the District of Columbia, and he led the Public Health response in D.C. during the Anthrax attacks of 2001. He is now CEO of Ivan Walks and Associates, which is a consulting firm dedicated to proactive health security, with a focus on the specific opportunities and challenges facing urban communities.

And on the end we have Peter Sandman, who is one of the world's preeminent risk communicators. He has helped public officials and others negotiate a wide range of controversial crises in the course of his career. He is now advising the New York Department of Health on bioterrorism preparedness and communication. He is also the founder of one of the earliest University departments dedicated to risk communication, and he is still a Professor of Environmental and Community Medicine at Rutger's University. Peter, thank you for being here.

So I'm sorry, I think I am making all of these hisses and bumps. I will try to sit still, which is usually not easy for me, but we'll see. Dr. Walks, I want to ask you as someone who is in the very confusing firestorm of the immediate aftermath of the Anthrax attacks, how you managed to maintain your credibility in the course of ever-shifting information? At one point, for example, we believed that postal workers who hadn't been exposed to open envelopes were safe from Anthrax, and found that that was wrong only in the tragic aftermath of two postal workers from Brentwood dying. How do you go with the flow with facts changing as quickly as they were during the Anthrax, and still be a leader?

DR. WALKS: Well, you start by remembering who you are, and where you come from. My mother always told me, if you honestly tell people what you don't know, they'll believe you when you come back to tell them what you do know. And that one pearl stayed with me throughout all of the shifting facts.

The other thing that again goes back to my own community and my own neighborhood, is that it's very difficult to come to someone and say trust me. Trust is something that is garnered through experience with consistent behavior, so if you behave the same way, people begin to trust that that is how you will behave. And you can build credibility that way.

I think that with respect to what happened during the Anthrax attacks, people were very concerned, felt they were being treated unfairly, felt that some groups had certain kinds of things going on, and people were just flat out lying. And I find that during a time like that, if you can use examples, like Dr. Walks, how do you know that the post office people didn't know that there was -- well, the Post Master General had a press conference in the back Brentwood work area. Do you think that if he knew it was dangerous, he would have gone back there? And that kind of actual anecdote that people can go oh yeah, helps to break through -- because no matter how technical you try to talk to people, people want to know about real life experiences. They want a real story, and then they want someone who will come and stand in front of them when they know everything, and when they don't know everything, but always be honest.

DR. O'TOOLE: Ed Clarke, you were also in the midst of a very complicated and scary set of events with the sniper attacks of last fall. And you had to balance a lot of different stakeholder groups, and maintain their trust, including the parents of all of Montgomery's school kids, many of whom were anxious about the decision to reopen the schools two days after the first attack. What do you have to say about maintaining trust in stakeholder communities?

MR. CLARKE: Well, I think like Dr. Walks had mentioned, it's about getting out accurate timely and factual information. And not being afraid to stand up and say we don't have all the facts at this time, but we're working very, very hard to get you the most accurate information, to provide the senior level decision-makers, the superintendent of the schools for Montgomery County Public School, Dr. Weiss, with good recommendations. What should we do? Should we open on time? Should we delay our openings? What information do we share? How do we coordinate that information with really the lead agency who's charged with investigating these homicides in Montgomery County and outside Montgomery County was the Chief of Police, Chief Moose. So it's important to have those relationships and be able to get information back and forth so the senior decision-makers can give good information to a variety of stakeholders.

DR. O'TOOLE: Did the fact that you had been a cop play an important role in your ability to be a player in that decision?

MR. CLARKE: Absolutely. I think that was a critical role for me to play, having come from the County Police Department that was leading the investigation, just removed two years from retirement. In my role, we were now a consumer of public safety services, so it's important to have those relationships.

I was dispatched to the police command post. Ironically, the day of the first shooting in Montgomery County, the very first homicide, the police department was also burying one of their own officers who had died unexpectedly. I was at the service and the chief called me directly on the cell phone, and there was a rumor circulating that the superintendent may be considering school early dismissal. And the chief said, "Ed, here's what I need you to do. Please get with the superintendent, inform him that everything is okay, and we'll share information", so that relationship and the confidence that the chief had in me to go directly to the superintendent as sort of a broker, the information was so valuable and important.

DR. O'TOOLE: Tom Day, you also were in a very difficult position during the Anthrax attacks. You had many different stakeholders that you had to answer to. Your bosses in the postal service, CDC, and Dr. Watts' department were also giving you information. You had to deal with the union leadership, as well as the rank and file. What was that like?

MR. DAY: The leadership really came right from the top. Post Master General Jack Potter, importantly came up through the ranks of the postal service. He's a career employee, and understood that, and spent much of his career working to improve labor relations. And from the very onset of the problem, we had daily meetings with our unions and management associations so that they had the latest information. But obviously, a daunting task. We have 750,000 employees to communicate with. Getting a clear, consistent message out to them, and they're spread out amongst 38,000 locations, so that's not an easy logistics task in and of itself. And then we service the entire U.S. population, so 280 million plus consumers who see us six days a week, so it's not an easy thing to do. But clearly, communicating to them, getting them accurate information was essential.

DR. O'TOOLE: So I'm hearing communication, communication,communication here.

MR. DAY: I think the key, it's not just talking, but you've heard it also, it's letting people know what you know, but also being honest with what you don't know. I think defining moment for Jack Potter was a meeting I was involved in. As it progressed from the original event on October 15th, and then Mr. Kersey and Mr. Moore died on the weekend of the 20th and the 21st, obviously, the whole situation progressed rapidly. The question arose is the mail safe? And we discussed that in a meeting, and there were those pushing to say we ought to say it's safe because there's huge financial problems there. The postal service, in general, represents, and that's the whole mailing industry, represents 8 percent of the gross domestic product. It's a huge industry and employs nine million people. But the reality was we couldn't really say the mail was safe. In a defining moment, he very publicly admitted that no, we cannot say that at this time, so you've got to be honest with them.

DR. O'TOOLE: Georges, you and Ivan have an interesting story about the difficulty leaders sometimes have getting good information during a crisis. Can you tell us about your late night tryst with Dr. Walks, beginning with the Anthrax event?

DR. BENJAMIN: Well, you know, it was a very interesting dynamic in that the world was centered around Washington, D.C., and Maryland and Virginia were pretty much considered outliers, which what basically meant was we were not in the information flow initially at all. So I don't know, it was about 11:00 one night, Ivan, I think it was, I decided to insert myself into the information flow and met him on the corner outside his house. We sat in his kitchen all night, and we talked about communication and ways in which we could improve communications. And ultimately, one of the things that happened was we went to -- basically came down, met with the CDC, got liaisons in place between Virginia and Maryland, did lots of things.

A lot of communication was going on at the lower levels between staff, but not a lot of communication at the upper levels. And when you have a governor, or mayor or the White House on the phone wanting to get answers from you, they understood we were part of the process, but the infrastructure did not, and so we had to really create that on the fly.

DR. O'TOOLE: So what's the sound byte there to leaders in the midst of a crisis where it's murky what's going on?

DR. BENJAMIN: I think is don't just sit there and accept it. You know, go find the information that you need, and create the opportunities to solve your problems. You know, work the problem.

DR. O'TOOLE: Dr. Hamburg, you've had many interesting crisis experiences in your life, one of which was mentioned earlier today. It involved the outbreak of plague in Surat, India. And you got a call at one point, as I understand it, when you were New York City Commissioner of Health, that there was an airliner about to land at Kennedy Airport that might have had a plague infested passenger or two, or three on board. Could you tell us a little bit about what went through your mind, and what you did, and how you dealt with all of the uncertainties and the implications of decisions in that kind of crisis?

DR. HAMBURG: Well, I think actually the true story was a little bit different, and I think, you know, perhaps represents a different aspect of leadership.

DR. O'TOOLE: Okay.

DR. HAMBURG: WE didn't get the call that there was a plane that might have individuals with plague on it, but we did get a call about the seriousness of this plague outbreak in India, and the fact that we needed to be aware that there was going to be a lot of travel potentially between the Indian community, which is quite large in New York City and India because there was a major Indian festival going on in New York City, and that when we looked into it, there were 36 I think it was flights a day that either came directly into Kennedy Airport, or had a brief stopover. So we began thinking about how you would deal with imported cases of plague, and proactively actually set up a program to try to address how we would screen patients, screen potential --

DR. O'TOOLE: How much warning did you get? I mean, what kind of preparatory time was involved to set up the programs?

DR. HAMBURG: There was not -- this wasn't an acute crisis. There was an outbreak going on in India. It was actually poorly defined, but seemed quite worse. I mean, this clearly causing major disruptions. And the most striking part of that, actually, for me was when I, you know, realized that this was something we didn't really seriously think about, and that we didn't necessarily have the capacity to deal with proper isolation and management of a lot of cases of importing plague, I thought it might be good to brief the mayor. This was Mayor Giuliani at this point, about the preparations that we're putting in place. We identified triage hospitals and worked with CDC to develop a screening approach at Kennedy Airport for individuals coming off of airplanes that might be symptomatic, and put out bulletins to all front line health care providers about what to look for, and who to call if you saw a certain set of symptoms.

Initially, I got a very brusk response that the mayor really didn't need to be briefed about plague in India. He could read it in the New York Times. He didn't say the Washington Post, but then I called back and left a message, was he aware that there were 36 flights per day that came directly into New York City, or with a brief stopover. And then he personally got on the phone and said, "Should we close Kennedy Airport?"

DR. O'TOOLE: Well, you know, how to get colleagues' and bosses attention is definitely one of the key skills of leadership. And I noticed that in the conversations earlier today, and even now there's the sense that information kind of flows well, quickly, naturally. That's not usually the case in my experience. Does anybody have a really good worse nightmare story of having to deal with a boss who didn't get it, or a colleague who was fighting turf battles when the ship was going down, and what you do in that situation?

DR. WALKS: I can tell one. The person who didn't get it was me, and the person who -- it happens. And the person who actually came up and told me I didn't get it was Bob Nelson. Because, you know, when you're in the government, you --

DR. O'TOOLE: He's the head of the, we should say D.C. Hospital Association.

DR. WALKS: They all know him. Bob Nelson is the head of the D.c. Hospital Association, and also a very good friend, though not as good a friend of mine as he is of her's, but that's okay. And when you're in the government you think what you're doing is very important, and you've got your colleagues, and you're moving right ahead. And Bob called and said, "Ivan, I don't know what the hell you're doing because I don't know", and there's no communication set up with the outside community. And it was one of the critical junctures of what happened that helped all of us during the Anthrax attacks, was that with Bob's leadership, we set up a routine every day 10 a.m. conference call that got all of the folks from Maryland, Virginia, the military health system, the hospitals here in town, primary care folks, the Health Department all on one call to share information, so I think that it was one of those times when, you know, those are the stories that didn't make it to the Post, that I was the one who didn't get it, but that I had good friends who were able to call and say you're not getting it. You need to do this this way.

DR. O'TOOLE: Georges, you were in a position at one point in the Anthrax response, there was a moment when the District of Columbia, and Virginia and Maryland were about to issue contradictory prophylactic guidelines, prophylaxis - excuse me - guidelines. And it was nipped in the bud, as it were, and things were coordinated. But can you say a little bit about how that happened, and how it got fixed, and what you did afterwards?

DR. BENJAMIN: Yeah. I think the fundamental issue was when do you stop antibiotics? And we had different recommendations between the federal government and the local jurisdictions. And it all revolved around the debate around whether or not you could -- what trace Anthrax was. And as some of you know, the testing was qualitative and not quantitative, and so nobody knew what trace meant.

DR. O'TOOLE: I still don't know what it means, actually.

MR. BENJAMIN: Well, we were very uncomfortable. I think Ivan and I were very much uncomfortable taking people off on antibiotics whom we had already put on antibiotics until that facility had been cleared. And there was a federal recommendation, there was a discussion of doing so, taking people off the antibiotics. And ultimately we came to some near agreement, because there was still a disagreement. I mean, we still had varying recommendations out there, but they were much more narrow when we were all done. And I think actually our recommendation was very much similar to what New Jersey ultimately did on that, but it was on this recommendation that - and this belief that you still couldn't get sick unless you had 8,000 spores. And we all know ultimately that turned out not to be true.

I think that the take-home message was, and we still haven't really resolved this, that it is okay to disagree as long as -- because what we ultimately decided on was that we would disagree on the narrow clinical question, but that we would explain it away so that we all understood the rationale for doing it differently. And that was a very, very tricky communications message. It sure was, and people still talk about the difference in recommendations. I happen to believe that we were right in the end, and we saw that certainly in Connecticut and other places where people apparently got sick from very, very low doses of Anthrax.

DR. O'TOOLE: Sally Quinn. Peter, go right ahead. Peter, go right ahead.

DR. SANDMAN: I just wanted to reinforce that, because it's a point that hasn't come all day, and I think it's an enormously important point, that disagreeing, you know, when mommy and daddy disagree the kids really can take it. And what the kids can't take is if mommy and daddy hate each other. That's another story, but two authorities like CDC and the Health Department that are respectful of each other's opinions, each of which is capable of explaining their own opinion and the other's opinion, and why they reached a somewhat different conclusion does not leave the public in the lurch. It leaves the public understanding that there is a dilemma here. That the answer isn't obvious, and that honorable people who are working well together reached somewhat different conclusions. And I know my clients are terrified that if they don't speak with one voice, the kids will go crazy. And I think it's a false fear, and the kids can take it.

DR. HAMBURG: Well, can I just comment on that? I basically agree with you that open discussions are -- but I think it puts an additional burden on leaders to really speak to the public and explain the issues so that they don't come away with only the sense of confusion that even the experts can't tell me what to do. And I think that in the Anthrax incident, there was an unfortunate episode in my view around the use of the vaccine that I think didn't reflect well ultimately on Public Health leadership, in terms of the data was inadequate, and it was confusing about whether or not vaccine should be used in the context of people who had been exposed, and/or potentially exposed and had gone on antibiotics. There were several standing recommendations that said yes, they should be, but it hadn't really been broached until the very end of the treatment period, the 60 days of antibiotic therapy. And then there was a lot of discussion about the pros and the cons, and the inadequacy of the data, and the problems with the monkey models that had been used, et cetera.

And finally, the recommendation that sort of formally came out was the data is too confusing, so discuss it with your personal physician, and make your own decision. And, you know, I think was very unhelpful. And actually, I had been struck by it at the time, and I was on a panel a few weeks ago with Leroy Richmond, the postal worker who had inhalation Anthrax and did pull through. And he said, you know, I was really looking for leadership, and I really felt let down. You know, the data may be confusing, but don't tell me to talk about it with someone who knows even less.

DR. SANDMAN: Well, I mean, people do feel let down when they're not told precisely what the answer is. But leadership means letting them down gently, if you don't know precisely what the answer is.

DR. HAMBURG: But giving them as many tools as you can, is my point.

DR. SANDMAN: I agree with that.

DR. HAMBURG: In order to make a good decision, and I think it's right that if there isn't an answer that's clear, you don't give it. But I think you have to realize then you have an additional burden of responsibility to really take the time to educate the public, and explain the information, and make sure that there are resources in their community that are as well educated about it, as well, that they can turn to.

DR. SANDMAN: I agree. And they should -- they understand that you're not saying we hate each other. We can't agree. You know, what you're saying is, we agree it's a difficult decision, and one of us came down on one side of that difficult decision, and another of us came down on the other side.

There's a spectacular example right now with Smallpox vaccination, you know, where lots of people think ACIP was right, and many fewer people should be vaccinated than the president decided, and lots of people think that Vice President Cheney was right, and we should vaccinate humongously more people. And that difference of opinion depends mostly not on what you think are the side effects of the vaccine, but on what you think of the probability of a Smallpox attack. And the task now as we reach out to healthcare workers and give them pretty much exactly the same situation, you can get the vaccine if you want it. You don't have to take it if you don't want it. It's voluntary. It's up to you. The task is, I think, to explain to them why some people think it's a good idea, and some people think it's a bad idea.

DR. WALKS: Let me just say this. I don't like that, and I don't like that because what typically winds up happening is that you have people making individual decisions that fall out along resource lines. We saw this with Anthrax. We see it with health literacy differences, primarily folks who understand what you're talking about when you're trying to explain it. And we saw things move out along racial lines, and it's very, very dangerous during a public health crisis to have behavior fall out along racial, religious, ethnic or age lines. Public health is really very simple during a time of crisis. Let me demonstrate.

Everyone get up and move this way. That's public health during a time of crisis. It's shelter in place, it's line up for the vaccine. It can't be you decide what you want to do. With Anthrax maybe, okay. If you don't take it, you die. But with something contagious, you don't take it, many others may die. So I think that leadership is going through all of those gyrations about who's right. But then there needs to be a clear leadership recommendation, not an order, but a clear recommendation that fits everybody in this risk group. That's one person's opinion.

DR. O'TOOLE: Sally Quinn, you wrote a very widely noted article in the midst of the Anthrax response, saying in effect that you weren't hearing coherent advice from public officials, and you called many of them personally to ask what you should do to protect yourself and your family. What do you think about this exchange?

MS. QUINN: Well, actually there are two pieces. One of them was for the opp-ed page which was extremely provocative. I had watched Tommy Thompson on 60 Minutes where he had said, "We're prepared", and it just drove me crazy because I knew that we were not prepared. And we weren't getting any kind of advice from the government at all, what to do. I mean, should people has gas masks? There were all these stories going around. Should people have Cipro? You know, should you go out -- I called my doctor. The gas mask stores were sold out, that kind of -- so I did a piece about that. And then I did a follow-up piece for Outlook on whether the government actually was prepared, and I called everybody, Homeland Security, and the White House, and the Pentagon, and FEMA, and Bob Nelson is the only one gave me any decent information. He actually had figured out how to at least create some sort of communication in the city among the health care facilities, and the police and all of that. And that's unusual.

He in Children's Hospital, he and I were both on the board of Children's Hospital, so I was very proud to see that. We were the only ones who I felt had any coherent answer, any coherent plan at all. But I think the thing that's important for all of us to realize today is that what we're all talking about here on this panel are things that happened that we were not expecting. And now one of the reasons that we're all here today is that we are expecting the unthinkable. That it's not unthinkable any more. It's possible, it might even be probable, particularly if we go to war in Iraq.

And now I think, I feel even more strongly that the government should inform us, just give people the basic idea of how to protect themselves. And there is this view, and it was reiterated over, and over and over on the panel today, information, information, information. We can take it, and the whole idea that people are less likely to panic, the more information they have. And what I found was that nobody wanted to give out information because they were afraid if they said well, you should have a mask, an N-95. I carry it with me at all times, it cost a dollar, or if you want to put bottle water in your house, or have extra money, or flashlights or batteries, it seems to me that that's basic.

I mean, even in California when they have hurricanes, I mean, earthquakes, or in the midwest when they have hurricanes, they give you that basic information. And people sort of say oh well, it's on the website, you can look it up. But I think we need to have somebody, particularly in places which are target cities like Washington, D.C., there should be guidelines. There should be neighborhood organizations. I mean, the government should come out and say look, you know, this is unlikely but we're going to be in a war. I mean, we had air raid shelters during World War II. We need to be prepared. The citizens need to be prepared.

After I did my last piece, Senator Bill Frist called me up and said, you know, I was so horrified to see what you had written. All these people in the government not having any answers at all, and I might even write a book about it. He did, and one of the things he did was just put a list that everybody should have in their house. And it was a radio with batteries and extra water and cash, medicine and that kind of thing. I just don't see why, particularly now, we can't be given guidelines by the government as to what to do in case there's some sort of attack.

DR. O'TOOLE: Mayor Norick, you actually lived through the unthinkable, in a city that was not a target city. And most of the commentaries on -- in fact, all of the commentaries I read on the Murah Federal Building bombing noted with great admiration how forthcoming spokespersons were in the immediate aftermath of the bombing about what was going on, and what to do, and so on and so forth.

What in your mind was valuable in terms of preparedness for that catastrophe? Or what would you do differently now if you were told, God forbid, that such a thing were about to happen in a city? What would you advise other mayors about preparedness?

MAYOR NORICK: Well, it wasn't in my operations manual to begin with, so as I don't think anybody obviously expected it. We probably in the, what I'm going to call the Heartland, which includes probably everybody that doesn't live on the coast, figure anything that's going to happen, is probably going to happen on the coast and it's not going to happen to us. So I think that is probably what, if I can use the word shook the nation up more than anything, was that it happened right flat in the middle of the country. And our city was very fortunate in that the bombing was April 19th, `95. In the summer of `94, our city staff came to Washington, part of FEMA, EMI Institute, Emergency Management Institute, to really learn about how to deal with disasters. And, of course, at the time that our people were in the Washington area, they're thinking of disasters like tornadoes or maybe even an airplane crash at the airport or something like that. But mainly, you know, acts of Mother Nature really is what it amounted to. And then when the actual Murrah Building bombing occurred, the police officers and the fire department that was on the scene really knew very, very quickly that it was a bombing, and not a natural disaster, like a natural gas line or something else just by the crater and what was going on.

But I've heard today over and over about communication, which is absolutely true. And I heard what everybody said, and I think Kathleen was the first one that said it, was if you don't know, tell them you don't know. I mean, that -- you just can't believe how well that sits with the public.

I had probably some advantage in that I'd been in office for eight years, and I'd been through three elections, and without sounding braggadocios was very popular, and was very well respected by not only the people of Oklahoma City, but by the press. I had always shot very straight with the press, and very straight with the people, so they felt like whatever I told them at this particular incident was no different than I'd be telling them for eight years previous.

Governor Keating, who a lot of people I think probably know, he'd been in office three months so, you know, he was at quite a bit of a disadvantage compared to me at that time. And so we worked very well together, but I'll have to admit, he was -- he looked a little bit like, you know, the deer in the headlights. I mean, the eyes were pretty big like a lot of us were at the time, but it all got down to really communication. And we didn't know really, you know, who was the cause or what was the cause. We knew really what it was pretty quickly, and we relayed that that day. It came out that day. We didn't hide it. I came out though in a very organized fashion, and we had set up press -- we had done a number of things that day that, I mean, I could stand up here and talk probably for an hour exactly what we did that day. But really, I'd have to go back and say we were fortunate that we had had planning on disasters a year before that obviously had to have a great impact on the way our community reacted.

DR. O'TOOLE: You know, there's been lot of mention today, and again here amongst yourselves about the public being very different than an undifferentiated mass. Ivan talked about different levels of health literacy in the population. We've also heard a lot about children being a special population. And Ed, you had to deal with a lot of very anxious parents in the course of the sniper shootings. Is there anything you or others would like to say about what leaders should consider when particularly vulnerable populations, particularly children are imperiled?

MR. CLARKE: I think it's critical in a couple of areas. You cannot wait to the day of an emergency or crisis to develop relationships and partnerships, nor can you wait to the day of to be trained up. That has to be done in advance. And I think you have to have an established relationship as a building principal, or a teacher. You need to know your parent groups, and you need to know that in the event of an emergency or crisis, they're coming to your schools.

As we saw certainly on September 11th, and in even some of the sniper days, parents were coming to retrieve their school children, their loved ones, and that was a natural reaction. But I think it's how we plan for that event, how we communicate it, and the superintendent needed to reassure parents that children were safe during that horrific ordeal, 22 plus days.

Also, to have good preparedness drills and training employees. In Montgomery County Public Schools we have what we call a Code Blue Status, which is an enhanced level of safety and security. We may, depending on the situation, secure the exterior doors. Well, when we developed that concept, we never envisioned that we would be in a prolonged state of Code Blue for 22 days, so it's getting that information out, being supportive of parents, and also the teachers that are in that building, because they are parents too. So it's how you reach out to the parents, and how they have confidence in that you have a safe facility for children. And attendance was up very high, very high, except for the last shooting when they came back around, the snipers came back around when tragically the Ride On bus driver was the victim of a homicide. It could't have happened at a worse time. It was right during the start of school. And we saw a little dip, especially in the impact area, but people could not get to the school building. But we saw tremendous signs of leadership by teachers that were able to get to their building, and building services worker that filled the void of the administrator. And they did what they needed to do.

DR. O'TOOLE: Let's talk about the end and the aftermath of crises for a minute here. Tom, you recently were on television because of scares that there were trace Anthrax contamination found in the, I can't remember, was it the Federal Reserve Building? Would you make a few comments about you handled that, and what it means to have these kinds of scares following in the wake of a real crisis, such as we had last fall?

MR. DAY: In the case of Anthrax, and really any biological threat that might come through the mail, the reality is we faced the attack in September/October of 2001, but we've had incidents throughout, and some very public ones like the one at the Federal Reserve. It's just as important that you communicate that even as this one ultimately turned out to be negative. It was not an Anthrax event, but the level of anxiety quickly rises. Our employees are very concerned, and quite honestly, we learned a great deal from the attack of 2001, so based upon that knowledge, it just prompts you to respond that much more quickly. We did some precautionary testing to assure ourselves that we didn't have a risk.

It was interesting to watch the media. It was a slow news day, and we got a lot of coverage over about a 24 to 36 hour period. And the media kind of went both ways on me. I had to handle all the interviews, and there were some as it ultimately turned out to be negative to say well, why did you essentially put us through this? And on the other hand, the other question on the other extreme was, why were you so slow to react? So you kind of get questions from both ends.

But we understood there was a reason to be concerned, and we wanted to get the information out there quickly. Again, it's the common theme here, and we went the extra step of personally briefing our employees at the facility that potentially was at risk, but ultimately was not.

As we found, it's not something that goes away. There's still a very heightened sense of awareness, particularly in our workforce, and just to give you the statistics, and this is probably a little bit dated, but in the year that followed the Anthrax attack, the actual attack, we had 17,000 incidents that closed facilities for four hours or longer, so there is a real heightened sense of awareness. And that was, the overwhelming majority of that was in the first three to four months after the initial attack. But you've to treat it like it's real. You've got to deal with it. You've got people getting anxious just from the fact that they went through what ultimately turns out to be a negative event. It wasn't real.

DR. O'TOOLE: Ron, you're stealing with the aftermath of the `95 bombing. Is that right?

MAYOR NORICK: Yes, I was telling somebody at one of the breaks that we are still having cases of mental health problems, and it's been eight years. There are still police officers, there are still firemen, rescue workers, individuals, you know, the human mind is a funny thing. It doesn't know exactly when it's going to break, but it'll break. And one of the speakers this morning talked about New York, that they had had more problems in mental health the year after. Well, I'm here to tell you it'll be a lot longer than just the year after, it'll be years after.

We are still rebuilding the area, and even though the cameras focused on the Murrah Building, we had 300 buildings damaged in Oklahoma City, and we had over 100 buildings that were completely torn down. They were not the size of the World Trade Center, obviously, but they were buildings nevertheless. And we're in the process now of -- and I guess maybe the final part, at least as far as the rebuilding is the federal campus that's now being built about two blocks north of the Murrah Building, which will rehouse a number of those agencies, are going to come back into the downtown area, and that's been eight years, so it is still probably another year off from finishing.

DR. O'TOOLE: Sally.

MS. QUINN: When he was talking about the mental health reaction, I just think that the sort of anticipation -- I think people are not talking as much about the kind of -- well, we were talking about it earlier during the break, of the kind of anxiety that people have every day, particularly in Washington and New York about the possibility of an attack. And there was an article written by Bart Gellman in the Washington Post right before Christmas where he was talking about the possibility of attack, and basically saying, you know, the terrorists are going to finish off what they didn't accomplish the first time, and the plane that crashed in Pennsylvania was headed toward the White House, and they're going to kill the White House next time. And this said, who was a terrorism expert, who works right next to the White House said I'm scared to go to work everyday. I don't want to be on that street.

It shows itself in every way. It's like it's one level below the conversation. I had a friend the other -- these are high power journalists, and they woke up one morning. There was this horrible explosion and they were terrified. They grabbed the baby. They went down to the basement. They were just absolutely panicked, and they thought that there had been a terrorist attack. It was thunder.

You know, I have friends who carry Iodine with them every day, friends who carry Atropine with them every day to give themselves a shot in case there's some kind of attack. People who have gotten motorbikes so that they can get out of town quickly, and they don't talk about it, particularly the women. Women will talk about it but the men won't. The men sort of seem to be in denial but the women will talk about it. But it's there all the time.

I was talking on the phone with a friend the other day, and I live in Georgetown and my house shook, and she said, "Oh, my God, what was that?" She'd heard it too, and her house had shaken. And my first response was to look out the window to see if the Washington Monument was still there, and it was. But this is the kind of thing that we're dealing with. I mean, everybody has stockpiled Cipro, and Doxycycline. And it just seems to me that instead of having this kind of underlying sense of anxiety and terror, that people would feel a lot safer if there were some guidelines, any guidelines so that there wouldn't be this sort of psychological atmosphere.

DR. O'TOOLE: On that note, and given that everyone in this room is faced with trying to lead during very powerless and uncertain times, let me offer the panel parting shots or pearls of wisdom that you might want to offer before we ask for questions from the audience. Does anybody have any? Let me just open it up.

MAYOR NORICK: To somewhat agree and disagree, what my colleague said to my left, if we as a country are going to crawl under a rock, then in essence the terrorists have won. And I know that we need to protect ourselves and we need to do everything that we can. And I told the people in my community eight years ago, we didn't know who had done it, why or anything else. And like Mayor Giuliani, I wasn't in a bomb shelter somewhere. I was out there on the street. That's where I needed to be. If I was in harm's way, so be it, you know. That was just the way it was going to have to be and, you know, I understand what you're saying, but I think we can get to the point that we can overreact. We do need some guidance. I won't disagree with that at all, but to go around and put fear either into our hearts or the fear of the hearts of our children, I just think means that we've, you know, waved the white flag and given up, and I'm just not ready to do that.

DR. O'TOOLE: Peter.

DR. SANDMAN: Somebody commented in an earlier panel that fear is appropriate. Terror isn't, apathy isn't, denial, which is not the same as apathy isn't, but fear is. And in terms of our task, which is to think about leadership, it seems to me one of the things leaders need to do is model being fearful and bearing it. A fearless leader is no help at all, because I'm fearful, and if the leader is fearless, I can't follow there. I can't go there, but a leader who is fearful and bears it, and makes decisions nonetheless, and is not freaking out, and there's sort of routinization of that fear, that's where we need to go as a society, and that's where our leaders have to take us.

MS. QUINN: Well, that's exactly what I'm talking about, is that we should -- I just think it's important to be realistic, and to be realistic you have to be truthful, and you have to be prepared. And that makes people feel less panicked and less fearful.

DR. WALKS: I think one of the other things that helps people to feel less panicked and less afraid is routine. It's like Tom was talking about, you know, 17,000 things you respond to, and you close the building each time. There's something about routine that helps you to build trust, and helps people to feel a little bit more secure, particularly - and I don't know how much this was covered earlier today, but we live in a very, very diverse America, and we keep hearing these messages like if all of America looks the same way, has the same education level, and most importantly, has the same history of dealing with leaders. We've had in many communities some very bad experiences about the person that shows up and says hi, I'm from the government and I'm here to help.

And if you don't keep that in mind, and you don't treat every scare like if you're going to do the same thing, the same suits come on, same folks show up, close the building for hours, do the whole thing, then the trust that you need during a crisis when people will trust you to tell them what the real risk is, that will be lost.

I think we've had some recent examples of that not happening, and we've seen the fallout break out across communities, across neighborhoods, across racial lines. And my biggest concern is that during a time of crisis, we'll see that again. And we'll have an unnecessary loss of life, because when we're there giving that real good advice, using all the great risk communication skills, the history of the people we're talking to will prevent them from doing what they should do, and we'll have an unneeded loss of life. That's the thing that I spend my time concerned about.

DR. O'TOOLE: Anybody else? Tom.

MR. DAY: Just a little bit, and I'll go to my engineering side. Some of it is technology, and there are moves afoot to do things, because if our warning system remains when the person shows up in the emergency room with the advanced symptoms, be it Anthrax or any other biopathogen, we're well into the crisis, and the mask isn't going to help then. It's already happened. So the investment in technology that gives us some warning that an event has taken place is critical, because then we can spend a lot of time warning the public about if there's an Anthrax attack you can wear this mask, or gloves, or anything else. But the reality is, we're not going to know it until people start getting sick and die. And again, at that point, the mask and the gloves, and all the rest of it are just a placebo. They're not going to do a thing for you.
So there is a technology side to this that we need to advance, that if we really have this threat that is going to be with us for the foreseeable future, we need to have systems that let us know as early as possible.

DR. O'TOOLE: Thank you. All right. Well, it remains to thank our panelists for your generosity with your time and your insights. I know everyone is extremely busy. We very much appreciate all that you did to be here today. Thanks to all of our speakers for that matter. I think it was an extraordinary conference. It gives us a lot to think about in the days ahead.

I'd also like to thank the amazing Andrea Lapp. Where is she? She is never in the room when we thank her for all her choreography, and of course, Monica Schoch-Spana, who was the heart and engine of this. It is as always, Monica, an honor to be your colleague. And thanks to all of you. This has been an amazing audience. Thank you for your attention and your courtesy, and all that we will do together starting now. May you have a safe journey home. Goodbye. Thank you.

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