Michael Osterholm was just settling in as director of the new Center for Infectious Disease Research and Policy at the University of Minnesota when terrorists flew planes into the World Trade Center in New York, the Pentagon outside Washington, D.C., and a field in rural Pennsylvania. Overnight, as the nation’s vulnerability to terrorism became apparent, the former Minnesota state epidemiologist became one of the most sought-after experts in infectious diseases.

For years, Osterholm (M.S. ’78, M.A. ’80, Ph.D. ’80) has been an outspoken critic of the nation’s lack of preparedness in the face of bioterrorist threats. His book, Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe (Delacorte Press, 2000), describes the havoc various types of biological warfare would wreak on an ill-prepared society. Osterholm has been called an alarmist, accused of exaggerating the likelihood of a large-scale bioterrorist attack on the United States. Nonetheless, he has been unwavering in his belief that people need to know the truth about the possibility of a widespread anthrax outbreak, smallpox epidemic, or other bioterrorist disaster. In short, he hopes to scare people into taking action.

And many are listening. Osterholm, 48, has been interviewed by every major media outlet in the United States since September 11. A former adviser on bioterrorism to the late King Hussein of Jordan, a U.S. ally, Osterholm recently testified before Congress about improving the public health system to respond to a bioterrorist attack and was named to a national advisory committee on bioterrorism by Tommy Thompson, the U.S. secretary of health and human services.

Although in his new advisory role he spends as much time in the nation’s capital as in Minnesota, Osterholm’s base will continue to be the University of Minnesota and the Center for Infectious Disease Research and Policy. "I think in some ways my entire career has been spring training for what’s happening right now," Osterholm says, "and the U has been a part of that for 26 years."

Q: Your book is a warning to the United States to prepare for an inevitable bioterrorist catastrophe. Suddenly, since the anthrax outbreaks following September 11, that time appears to be upon us. As a nation, how should we react given our lack of preparedness?
A: The current public health system, while it has been allowed to fray substantially over the past two decades, is still a system that is responding. How long they can respond and to what degree they can respond are important concerns, and we’re obviously going to need some real infusion of resources into that system.

People are confused by what we mean by "responding." They see the police, firefighters, and haz-mat workers responding to these anthrax letters, . . . but what they don’t see are the epidemiologists and the public health personnel who are doing the investigations and all of the lab testing that is so critical. That’s what we’re talking about in terms of responding. So when people ask if we’re unprepared, yes, we are unprepared. Are we totally unprepared? No, we’re really underprepared. And that’s what we need to respond to.

The events of September 11 have obviously been a watershed event. As tragic as it was in terms of loss of human life and this sense now of a newly found fear that we hadn’t had before, I think we as Americans also realize that we are going to have to change the way we look at terrorism, and we have changed the ways in which we have to prepare for it—for example, the discussions on the [federal government’s plan to stockpile] 300 million doses of smallpox vaccine. The public health capability at the federal, state, and local level is now receiving a renewed and fresh look in a way it hasn’t had in decades. And I think that’s very positive.

Q: Biological warfare has been a part of human history for centuries. In your book you cite an instance in 1346 in which the Tatar army attacked Caffa (in modern Ukraine) and catapulted the bodies of dead plague victims over the city wall. What is different about biological warfare today?
A: I have always been of the mind that, yes, you can take the complicated modern aerosol particle technology and transmit disease, but also the "box-cutter efficiency" for transmission is a reality. And think of the situation that occurred at Fort Pitt at the end of the French-Indian War, when the British troops actually gave smallpox blankets to the Delaware Indians and, over the next six months, largely decimated that population. Giving people blankets with the scabs of smallpox in the fibers—that’s not a high-tech weapon. It was a very powerful bullet and a very ineffective gun, but combined they still made a very effective weapon. Today, this anthrax, a material that’s currently available to someone, is a very very powerful bullet but has to date been used in a relatively ineffective gun. But if it gets into a semieffective gun, we’re in big trouble as a society.

We have to understand that that’s the reality today. That’s not fear mongering. You know, in early October I was on the various media outlets being interviewed, and look at how many people were on there saying again I was a fear mongerer, that people couldn’t possibly get their hands on this kind of anthrax, that it just didn’t exist, that it was just too technologically difficult, et cetera, et cetera. Now look where we’re at. And this is not about being right or wrong.

Q: You have a reputation of being a straight talker and have even been accused of perhaps needlessly scaring people, but do people have unfounded fears that you would like to quell?
A: We tend to approach this issue like a wide-swinging pendulum, where at one point, on September 10, bioterrorism just wasn’t an issue on the radar screen. Now the pendulum has swung all the way over to the side where we’re living in fear. Where the truth is . . . not quite in the middle, but a little on the fear side. We as a society have to adjust to this new world. A good example is that many different media outlets and elected officials blamed the Centers for Disease Control for the deaths of the two postal workers. I’ll tell you right now that, having been very outspoken on bioterrorism and having led some of the largest investigations in this country of infectious-disease outbreaks, had I been in the shoes of the CDC people on that given week, I don’t know if I’d have done anything differently either. Because the science just wasn’t there . . . the data weren’t there to suggest the danger.

We have to get off blaming people. . . . We have to understand what has happened to us and that we are now in a world where we’re going to have to adjust to military thinking of anticipated losses. . . . We are now going to have anticipated losses among our civilians, and we have to understand that. If we’re not prepared as a society to understand that, then when things get tougher we are not going to have the resolve to see it through. Failure is not an option here, so we’re going to have to figure out what to do.

And that’s not to scare people, but it’s to say you have a choice. You can either live in fear or live with fear. If we live in fear we will do nothing except be terrorized. If we live with fear, we’ll take all the American ingenuity that we have, we will understand the threat, we will bring the best of our biotechnology, we will bring the best of our public health and medical services systems, the best of our law enforcement, and we will go after it. That’s where academic health centers come in, and universities in general, because they’re going to be part of the solution. They’re going to be part of understanding how to live with fear. They will help us, with the American ingenuity, to respond.

If we do the other, if we allow ourselves to just sit there and blame people every time another person dies because of this, then we will live in fear and we will lose.

Q: In your book, you describe hypothetical bioterrorism events involving anthrax, food-borne disease, and smallpox and the results: thousands of deaths, mob scenes, and cities shutting down. How accurate is that estimation?
A: The food-borne one, that could happen tomorrow. The smallpox one, now we realize what the potential is for these programs. In some ways, where we’re at right now actually speaks very loudly that those scenarios are not far off at all. Look at what we’ve done, with just a couple of letters and a few cases of anthrax we’ve shut down all three branches of government. Think of if this were thousands of cases. Look at the panic and fear that’s been there. Was anything in that book exaggerated when you think about that? And that’s the problem. One of things I talk about is the fear and panic you have seen with just a few cases of illness. More people died of meningitis from natural causes over the same time period that these anthrax cases have occurred. But look at the fear and panic. Did you hear anything about the meningitis cases in the country? Not a thing.

Now imagine—and this is where the fear and panic will be escalated both in terms of what it will do to society but also as a result of many deaths—what if this is put into a much more effective gun and thousands of people die?

Q: What is your greatest concern regarding an outbreak of smallpox or other infectious disease?
A: The fact that panic and fear associated with infectious agents, and specifically bioterrorism agents, are so disproportionate with their actual risk to society of causing disease or death. And that’s one of the reasons they make very good bioweapons but also why we as a society have to prepare to respond. That’s the point I try to make in my book: One of the reasons you prepare and respond to this is not just due to the death and dying, it’s also because of what it does to society.

Q: People want to feel that they’re taking some kind of action, such as stockpiling food or buying gas masks. What do you think Americans should be doing as bioterrorism threats hang over them?
A: That’s one of the problems, that we don’t have anything per se for people to do, and that has left people feeling helpless. That’s why I have said contact your senators and congressmen and tell them what you believe about this issue, that this is really an important thing to you and you want them to respond, you want them to do something effective, you want them to provide leadership. That may seem shallow, but in fact it is truly an action you can take that could have tremendous implications.

You can ask your health plans and your hospitals and your health department, "How prepared are you?" You can go to your state legislators and ask, "What are the capabilities of our state?" What we’re not to do is give people platitudes. We’ve got to stop saying, "We’re OK; we’re fully prepared." I think anyone who in the past month has issued those words has regretted them.

Q: What, if anything, has been wrong with the U.S. response to the bioterrorism events?
A: Well, I think that we’ve got a ways to go. What I’m really pleased with, though, is that we are finally, for the first time, beginning to understand the need for comprehensive and long-term approaches to this, not just spin control and the message that we’re all OK. Messages that say that this is doomsday are not correct and also are not helpful.

Q: Do you have concerns that the U may have unwittingly helped train microbiologists who have since used their knowledge to develop bioweapons?
A: I don’t think we have any evidence of that. But I think it’s important that we understand that the balance between the freedom of the academic center and the potential for providing training to people who might one day use it for nefarious purposes is obviously a real issue, and it obviously needs real, very thoughtful discussion. I believe that the U is prepared to do that.

Q: What are you doing as an adviser to Health and Human Services Secretary Tommy Thompson?
A: All I can say is I appreciate the opportunity to help my country however I can right now, and because of my experience and my expertise I’ve been asked to provide input to the Bush administration. I’m actually on loan from the University, and that was a decision made by the U. . . . You know, the University has provided literally the most supportive environment for both this center and me specifically in terms of helping to respond to the bioterrorism issue. . . . From administrative support to public policy support, this university has been just incredible in how it’s assisted us in doing our job here. People probably don’t see the U as being right on the front lines here; but for the U we wouldn’t be on the front lines.

- Shelly Fling is editor of Minnesota.