The violence in Norway on Friday has shocked the entire country and much of the world. It has shown that violence can strike anywhere, at any time.

Taking a public health perspective may offer a useful frame for Norway to make sense of its tragedies and find a response.  UN Dispatch spoke to Laurie Garrett, director of the Council on Foreign Relations program on Global Health about her new book. Titled “I Heard the Sirens Scream,” the book looks at the events of 9/11 and the anthrax mailings that followed them. Garrett was living in New York City at the time of the attacks, and saw the planes hit the World Trade Center. The book brings her personal witness, journalistic experience and public health approach to bear on the complicated topic of 9/11.

This interview, and Ms. Garrett’s insights, seem especially important in light of the terror attack in Norway.

UND: What made you write the book? It’s a big departure from your work on health.

It’s really not a departure at all. From the first instant, 9/11 was a public health event. It mobilized local, regional, and national public health authorities immediately. There are public health events throughout the book. What was in the plume, and why is it still killing people now? Who in the White House ordered a cover-up about the dangers of the plume? Why did the EPA issue a statement saying that the plume was safe even before any research had been done on it – before there was any evidence.

After the 9/11 attacks, Giuliani and the White House were worried about a biological event – there was a massive search of all hospitals for people showing effects of biological weapons. I also argue that most of the US and international felt a major psychological impact from the attacks. There is still massive PTSD in New York City today. It was not a just a singular event but a continuum through the anthrax fiasco.

The book deals with all the outcomes and the impact on US policy. In response to 9/11, the Centers for Disease Control and Prevention were restructured, there is a huge public health focus on smallpox, and there was a huge FBI investigation that may have picked up the wrong guy.

The biggest mantra after 2001 was on the need for preparedness and being mobilized to respond to anything. After hurricane Katrina, the pressure on law enforcement, health delivery, and basic science was huge. We went from four high security research labs in the US to more than I can keep count of. This has actually increased the number of people exposed to dangerous microbes. Public health departments are being bankrupted by the requirement to focus on bioterrorism, at the expense of traditional and important public health department work.

The style of the book is a departure for me. It’s high risk. I was in New York City for 9/11; I experienced it. And I send out daily emails to a few hundred people I knew – it was a ritual for me. It was a status report on the city from my personal diary. The first two thirds of the book is made up of those daily reports; each chapter is a day. It’s a blow-by-blow account for 123 days, until January 2002. The final third of the book is analysis of what happened. Why I think that Al-Qaeda was behind the anthrax attacks, why the FBI blew the investigation, and why to this day it has not been recognized as a public health disaster. Who lied and said that the anthrax was weaponized, and how that led to invading Iraq.

UND: What made you decide to release this book now?

The tenth anniversary of 9/11 is almost upon us. I have been working on this book for eight years. It’s essential for someone to tell the truth without a political agenda. People who are 21 today were 11 when it happened. The story of the events has been manipulated for political agendas. I was concerned that the tenth anniversary would be used for political purposes and I wanted the truth told directly.

UND: What are the lessons we should be learning from 9/11?

The lesson we need to take away is the importance of resilience. It will never be possible to prepare for every scenario. We can’t look at every dark aspect of human behavior and be able to stop it. It would be like trying to develop a vaccine for every possible microbe. But we can have communities with resilience. On every level – village, city, planet.

We have misdirected our response to a notion of preparedness. Katrina proved that it doesn’t work. What really matters is a community that can respond for the benefit of all, for the strongest members to protect the weakest.

After 9/11, the people of NYC didn’t response like any disaster simulation had predicted. They didn’t loot or attack each other. Instead, strangers helped strangers. People showed compassion and a need to be of use. There were more volunteers at Ground Zero than anyone knew what to do with.

There was a critical moment – I describe it in the book – when George Bush was just out of ideas to respond to anthrax threats. And people just wanted to do something. It was a time when he could have said to America, “The average age of a Red Cross volunteer is 74. They need young people. Step up to the plate and volunteer in your community.” Instead, he asked for volunteers for the Homeland Security Department, what had no idea what to do with volunteers. It was a waste of energy, a mechanistic, militaristic response. A wasted moment.

You know, probably one of the biggest impacts in lifting the spirits of New Yorkers was the Yankees going to the World Series. Academic literature doesn’t talk about collective moments like sports victories, but these are the kinds of things that bring people together to triumph over fear. Resilience is about building strong communities to cope with destructive events.

UND: What is the difference between preparedness and resilience as you see it?

Preparedness assumes a sort of reliance on government to solve every crisis, coupled with some mystical recipe book for home supplies and training to rely upon for everything from floods and fires to terrorist use of nuclear weapons. Resilience assumes a very different posture based on personal and community character, and the abilities of people to respond together to threats and catastrophes, working with compassion and a sort of community spirit to pull through, building on individual and collective strengths.

Preparedness ultimately assumes the public will follow orders, and await instructions. Resilience promotes community cohesiveness, initiative and collaboration with government.

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