The term public health has a certain irony for those working in the field, according to Alfred Sommer. Oftentimes, the less the public knows about what they're doing, the better.

As compared to medical colleagues who are lauded for the discovery of a miracle cure or a life-saving procedure, Sommer says, those in public health are not often front-page news.

"What we do is not very sexy," says Sommer, the dean of the Bloomberg School of Public Health. "When we are successful, nothing happens."

Before Sept. 11, the Bloomberg School's Center for Civilian Biodefense Studies existed in relative obscurity for the nation at large. Yet, in a time when it's difficult to go 10 minutes without hearing the words anthrax and bioterrorism, it's clear the center and its principals' days of anonymity are over.

Its experts are quoted daily in major newspapers and on television, and its Web site, which prior to Sept. 11 received an average of 240 hits per day, skyrocketed to 22,000 hits on Sept. 15, as bioterrorism came more fully into the public consciousness. In the weeks since, the ever-burgeoning site -- http://www.hopkins-biodefense.org -- has become a one-stop portal for bioterrorism-related information, drawing an average of 12,000 hits a day.

Established in September 1998, the Center for Civilian Biodefense Studies was created to increase national and international awareness of the medical and public health threats posed by biological weapons, such as anthrax and smallpox, that terrorists can use to unleash mass destruction on a population. Specifically, the center's experts are concerned with policy development for prevention and response to bioterrorism. Working with government, medical and public health leaders, they seek to diminish the adverse health impact and widespread death that could follow a biological attack.

The center was founded by D.A. Henderson, University Distinguished Service Professor and former longtime dean of the School of Public Health, who was concerned about the nation's lack of preparation in the event of a biological attack. Henderson served as the center's director until last Thursday, when he was appointed by Health and Human Services Secretary Tommy G. Thompson to be director of the federal government's newly created Office of Public Health Preparedness. He continues to head a national advisory council on public health preparedness, a post for which Thompson had tapped him a month earlier. Tara O'Toole, previously the center's deputy director, replaces Henderson as director.

The only academic center of its kind, the Center for Civilian Biodefense Studies brings together top experts from the schools of Public Health and Medicine with former and current government and military officials to help catalyze the development of effective response systems. Since the center's founding, its staff has nearly tripled in size and today has eight professional and eight support staff working in its offices in the Candler Building in the Inner Harbor.

Originally seeded with monies from the schools of Public Health and Medicine, the center now receives its funding from Congress, the Alfred P. Sloan Foundation, the Robert Wood Johnson Foundation and a few private philanthropists.

Monica Schoch-Spana, a senior fellow at the center, says that what the creation of the center did was essentially help fill an information vacuum.

"Before us there clearly was a void of knowledge about bioterrorism response and prevention," Schoch-Spana says. "What we are about is getting knowledge to individuals in authoritative positions so that they can bring about change to achieve an effective medical and public health response to this problem."

Not surprisingly, since Sept. 11 and the subsequent anthrax attacks, the experts at the center have been much in demand. The Bloomberg School of Public Health's Office of Public Affairs has been bombarded with media requests to interview the center's staff, receiving on average 300 calls per day. These calls are in addition to those from individuals on bioterrorism's frontline, including public health officials, hospital administrators and those in local, state and federal governments.

Sommer says both the school and the center are unaccustomed to this type of attention. "Before this recent crisis, if we had a couple of media requests a day, we thought we died and went to heaven," he says.

Referring to the current menace, Sommer says the U.S. public at large has not felt such anxiety since the outbreak of polio in the late 1950s.

Schoch-Spana says the potential threat of bioterrorism was already with us. It just took an event the magnitude of the Sept. 11 terrorist attacks to bring it to the forefront.

Which is not to say the center's officials haven't exhaustively tried to get their message of prevention and preparedness across, however. To alert people to the problem, the center's staff have traveled around the country lecturing to medical and scientific organizations about the threat of biological weapons. It also has convened two national symposia on the medical and public health response to bioterrorism.

On Nov. 6, D.A. Henderson will take part in a daylong conference titled "Globalization and Infectious Diseases: Institutions, Policies and the Threat of Bioterrorism," sponsored by the School of Advanced International Studies in association with the Novartis Corporation. [See below].

Also, a series of lunchtime lectures on biodefense will take place this week at the Bloomberg School. [See box, below.]

Earlier this year, in an effort to illustrate the challenges posed by a bioterrorist attack, the center conducted what it called Dark Winter, a fictional scenario depicting a covert smallpox attack on U.S. citizens. Former senior government officials played the roles of National Security Council members responding to the evolving epidemic, and representatives from the media were among the observers of these mock meetings. Among the chief findings of the exercise, Schoch-spana says, was that the lack of sufficient smallpox vaccine severely limited the management options of the fictional NSC members and hampered their attempts to deal with the outbreak effectively.

Schoch-Spana says that despite such findings, it's been an uphill battle to educate some in the medical and public health communities and government as to the serious threat of bioterrorism. "It has been very hard to convey the message that the potential consequence of a biological weapon is an epidemic, making this weapon of mass destruction and disruption different from all others, Schoch-Spana says.

This attitude might be changing, however. "The sheer weight of recent events, both the anthrax outbreaks and the potential threat of the release of smallpox, has changed some people's positions," she says. "However, not all lights have turned green as to incorporating changes that would improve our public health and medical care system. But I would say that people are more open than before."

Sommer says that what has developed with the recent anthrax attacks has been the worst case of "I told you so."

Yet, Sommer says, wherever he goes these days, people realize that it's those in public health who are the ones likely to, if not fully protect us, minimizing the impact of a biological attack.

"In the middle of all this, I've come to realize that hopefully never again will I have to define to others what public health is," Sommer says.

Schoch-Spana says that although people often don't want to hear what those at the center have to say, they are coming to realize that the message can't be ignored.

"Make no mistake--this is a grim business," Schoch-Spana says. "But what keeps us coming back each day is that the problem is not going to go away in the short term, and we have the opportunity now to build up response capabilities so that we can avert the worst effects of biological weapons. In addition, we have an equal obligation to prevent their very development and use in the first place."

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