February 24, 2010
Leadership during Epidemics
Laura Kahn
Program in Science and Global Security,
Woodrow Wilson School, Princeton
Minutes of the 21st Meeting of the 68th Year
President George Hansen called the meeting to order at 10:15 AM.
It was the 21st meeting of the 68th year of the Old Guard. Don Edwards led the Invocation. Carolyn Livingston introduced her guest Rosemary Walmsley.
Joan Fleming read the minutes of the previous meeting. She emphasized the remarkable career of fellow member John Frederick as well as his recently completed novel of American and British fighters in the American Revolution.
The speaker, introduced by Ruth Miller, was Dr. Laura Kahn. Dr. Kahn is a Research Scholar in the Program on Science and Global Security at the Woodrow Wilson School. She received her B.A. in Nursing at UCLA, her M.D. from Mt. Sinai Medical School, her M.A. in Public Health from Columbia, and her M.A. in Public Policy from the Woodrow Wilson School. Her many accomplishments include working at the FDA and at the New Jersey Dept. of Health and Senior Services, and as a member of the Princeton Regional Health Commission. She chaired a two year study of public health infrastructure in four eastern states. She teaches in a graduate seminar on Defending against Bioterrorism.
Dr. Kahn’s talk was focused on her new book entitled “Who’s in Charge: Leadership During Epidemics, Bioterrorism Attacks, and other Public Health Crises.” Based on her experience in various organizations and on her research on several recent epidemics, Dr. Kahn has developed a thesis on the subject of leadership.
Dr. Kahn made a special study of the anthrax “epidemic”-- better described as an incident or scare-- in 2001. She interviewed the mayor of Hamilton Township who described his own role in dealing with that situation, in which there was confusion and disagreement about who was at risk and what should be done. Initially no one seemed to be in charge, but the mayor assumed a leadership role. He had to deal with conflicting opinions about whether the anthrax bacillus was aerosolized or not, about whether facilities should be closed down, and about who should be treated and by whom. And there were changing recommendations from the State Health Department and the CDC.
Other epidemics were briefly discussed in her talk. For example, Cryptosporidium in Milwaukee, in which 400,000 people were affected, and a hundred died. Also, SARS in Canada, and various flu epidemics in the United States. Also, two epidemics affecting animals in the United Kingdom: Mad Cow Disease, which threatened humans, and Foot & Mouth Disease, which affected cattle only but caused major economic hardship.
Dr. Kahn said that leadership can make or break an enterprise. A good leader is someone who can make something happen that would not happen otherwise. She emphasized and dilated on the tension between politicians and bureaucrats. She noted that ultimately it is the political leaders, the mayors, the governors, and the president, who have the responsibility, although they must rely on others, the “bureaucrats,” for essential information and advice.
Dr. Kahn described two models of effective interaction between political and bureaucratic personnel; the Guiliani model, in which the elected official was front and center, but informed by his bureaucratic adviser, the scientist or the doctor; and the Glendening model (the governor of Maryland),in which he stayed in the background but gave full support to the bureaucrat. Both models can work, if there is good rapport and communication. A good example of this was the smallpox scare in New York City in 1948. Mayor William O’Dwyer gave full support to the recommendations (which were for a massive vaccination program) made by his medical advisor, Dr. Weinstein.
From her personal experience on the Princeton Regional Health Commission, Dr. Kahn described effective and appropriate management of the recent swine flu epidemic. The vaccine was in short supply, but the local personnel were able to arrange for priority vaccination of the people at the highest risk, namely children and pregnant women.
There was a lively question period. One issue raised was the role of the media in epidemics, including not only newspapers and television but now also the internet and other electronic media. The media are essential for the dissemination of information, but they can contribute to misinformation and hysteria. In this regard, Dr, Kahn deplored the absence of a prime statewide newspaper in New Jersey.
With regard to air travel, it was noted that jet air travel can certainly contribute to that rapid dissemination of infectious agents around the world. In addition, the enclosed space in airplanes with suboptimal air changes can increase the risk of contagion.
In concluding remarks, Dr. Kahn noted that bioterrorism, while a public issue which has to be dealt with by state and local agencies, is also a national security issue which requires an effective role for the federal government. She also noted the large number of municipalities and Boards of Health in New Jersey-- “local control run amuck”-- and expressed her opinion that consolidation of various entities would avoid turf battles and make for a better and more efficient system.
Respectfully submitted,
Harvey Rothberg
It was the 21st meeting of the 68th year of the Old Guard. Don Edwards led the Invocation. Carolyn Livingston introduced her guest Rosemary Walmsley.
Joan Fleming read the minutes of the previous meeting. She emphasized the remarkable career of fellow member John Frederick as well as his recently completed novel of American and British fighters in the American Revolution.
The speaker, introduced by Ruth Miller, was Dr. Laura Kahn. Dr. Kahn is a Research Scholar in the Program on Science and Global Security at the Woodrow Wilson School. She received her B.A. in Nursing at UCLA, her M.D. from Mt. Sinai Medical School, her M.A. in Public Health from Columbia, and her M.A. in Public Policy from the Woodrow Wilson School. Her many accomplishments include working at the FDA and at the New Jersey Dept. of Health and Senior Services, and as a member of the Princeton Regional Health Commission. She chaired a two year study of public health infrastructure in four eastern states. She teaches in a graduate seminar on Defending against Bioterrorism.
Dr. Kahn’s talk was focused on her new book entitled “Who’s in Charge: Leadership During Epidemics, Bioterrorism Attacks, and other Public Health Crises.” Based on her experience in various organizations and on her research on several recent epidemics, Dr. Kahn has developed a thesis on the subject of leadership.
Dr. Kahn made a special study of the anthrax “epidemic”-- better described as an incident or scare-- in 2001. She interviewed the mayor of Hamilton Township who described his own role in dealing with that situation, in which there was confusion and disagreement about who was at risk and what should be done. Initially no one seemed to be in charge, but the mayor assumed a leadership role. He had to deal with conflicting opinions about whether the anthrax bacillus was aerosolized or not, about whether facilities should be closed down, and about who should be treated and by whom. And there were changing recommendations from the State Health Department and the CDC.
Other epidemics were briefly discussed in her talk. For example, Cryptosporidium in Milwaukee, in which 400,000 people were affected, and a hundred died. Also, SARS in Canada, and various flu epidemics in the United States. Also, two epidemics affecting animals in the United Kingdom: Mad Cow Disease, which threatened humans, and Foot & Mouth Disease, which affected cattle only but caused major economic hardship.
Dr. Kahn said that leadership can make or break an enterprise. A good leader is someone who can make something happen that would not happen otherwise. She emphasized and dilated on the tension between politicians and bureaucrats. She noted that ultimately it is the political leaders, the mayors, the governors, and the president, who have the responsibility, although they must rely on others, the “bureaucrats,” for essential information and advice.
Dr. Kahn described two models of effective interaction between political and bureaucratic personnel; the Guiliani model, in which the elected official was front and center, but informed by his bureaucratic adviser, the scientist or the doctor; and the Glendening model (the governor of Maryland),in which he stayed in the background but gave full support to the bureaucrat. Both models can work, if there is good rapport and communication. A good example of this was the smallpox scare in New York City in 1948. Mayor William O’Dwyer gave full support to the recommendations (which were for a massive vaccination program) made by his medical advisor, Dr. Weinstein.
From her personal experience on the Princeton Regional Health Commission, Dr. Kahn described effective and appropriate management of the recent swine flu epidemic. The vaccine was in short supply, but the local personnel were able to arrange for priority vaccination of the people at the highest risk, namely children and pregnant women.
There was a lively question period. One issue raised was the role of the media in epidemics, including not only newspapers and television but now also the internet and other electronic media. The media are essential for the dissemination of information, but they can contribute to misinformation and hysteria. In this regard, Dr, Kahn deplored the absence of a prime statewide newspaper in New Jersey.
With regard to air travel, it was noted that jet air travel can certainly contribute to that rapid dissemination of infectious agents around the world. In addition, the enclosed space in airplanes with suboptimal air changes can increase the risk of contagion.
In concluding remarks, Dr. Kahn noted that bioterrorism, while a public issue which has to be dealt with by state and local agencies, is also a national security issue which requires an effective role for the federal government. She also noted the large number of municipalities and Boards of Health in New Jersey-- “local control run amuck”-- and expressed her opinion that consolidation of various entities would avoid turf battles and make for a better and more efficient system.
Respectfully submitted,
Harvey Rothberg