Collaboration between public health and law enforcement: new paradigms and partnerships for bioterrorism planning and response - Bioterrorism-Related Anthrax

Emerging Infectious Diseases,  Oct, 2002  by Jay C. Butler,  Mitchell L. Cohen,  Cindy R. Friedman,  Robert M. Scripp,  Craig G. Watz

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Similarities and Differences

Although both public health and law enforcement protect the public, the approach and nature of the work performed in the two disciplines are quite different. The similarities and differences in public health and law enforcement investigations have to be understood and coordinated so that both can be most effective (Table). Public health investigations generally take an inductive approach. Persons are interviewed, data are collected, hypotheses are developed to explain transmission, and epidemiologic and laboratory studies are conducted to test these hypotheses. If the studies confirm the hypothesis, prevention and control strategies are developed, implemented, and evaluated. All this work is held to the standard of scientific peer review, generally through presentation of data at scientific meetings and publication in a scientific journal.

On the other hand, the law enforcement investigation takes a deductive approach and is held to a very different standard. Witnesses and potential suspects are interviewed, leads are developed and pursued, and all available evidence is collected, identified, and tracked. If evidence is adequate, the suspected perpetrator is identified, arrested, and prosecuted. The work of law enforcement is held to legal standards. Thus, while the public health investigator's aim is to collect data that will withstand the scrutiny of subject matter experts and the global scientific community, with the ultimate goal of developing effective control measures, the law enforcement investigator's goal is gathering evidence that will meet constitutional standards and withstand legal challenges to obtain a conviction.

The differing nature of the work and standards to which the work is held can pose difficulties on occasion when public health and law enforcement officials conduct joint investigations. In high-profile investigations, such as the anthrax attacks in 2001, these differences can be exaggerated by public perceptions and media portrayals of public health and law-enforcement investigative methods. The issues become even more complex when events involve multiple geographic areas or organizations that have overlapping responsibilities. These difficulties can be addressed within the public health and law enforcement communities by understanding each other's approaches, by communicating effectively, and by making thoughtful preparations, including testing the system through exercises (10-12). These measures will improve collaboration during crises. The adage that "an emergency is a bad time to begin exchanging business cards" applies. During the investigations of the anthrax attacks in 2001, preexisting relationships between FBI field offices and state and local public health officials improved communications for field investigations and facilitated the public health response (M. Layton, New York City Health Department, pers. comm.).

Preexisting relationships were particularly important for coordinating microbiologic testing of environmental and clinical samples, which were critical to both investigations. Before the 2001 anthrax incidents, the Centers for Disease Control and Prevention (CDC) and FBI began working together to develop notification procedures for possible bioterrorism events and to establish the Laboratory Response Network (LRN) for Bioterrorism, a multilevel network connecting local and state public health laboratories with advanced capacity public health and military laboratories (13). The federal, state, and local collaborative effort of law enforcement and public health that developed the LRN is the result of predicting the need for validated tests that would be consistent with evidentiary requirements. A uniform set of laboratory protocols, based on established procedures and reagents, facilitates the introduction of test results into a court of law, thereby limiting evidentiary challenges that may result from the use of different testing methods or analyses. Because clinical specimens are referred to LRN laboratories for analysis, the LRN also serves as a front-line resource and detection mechanism for identifying a potential covert attack. The 2001 anthrax incidents demonstrated the importance of the LRN in responding to a biological attack and revealed the need to expand its laboratory capacities.