Jerome M. Hauer - Director, NYC Office of Emergency Management

• In office : February, 1996 – February, 2000

• Appointed by : Rudolph Giuliani

• Succeeded by : Richard J. Sheirer

Jerome M. Hauer Commissioner, NYS Division of Homeland Security and Emergency Services

• In office : October, 2011 – December 2014

• Appointed by : Andrew M. Cuomo

• Succeeded by : John Melville^[1]

Jerome M. Hauer is the chief executive officer of a consulting firm, The Hauer Group LLC. He has also held several governmental positions related to emergency management in the states of New York and Indiana. He has also worked as a member of the Hollis-Eden Pharmaceuticals board of directors.

Hauer served as Commissioner of Homeland Security and Emergency Services for the government of New York State from October, 2011 until December 2014.^[2][3]

Commissioner Hauer with NYS Gov. Andrew M. Cuomo and MTA Chairman Joseph J. Lhota discussing the response to Hurricane Sandy

Hauer was the acting assistant secretary for the Office of Public Health Emergency Preparedness (OPHP) within the US Department of Health and Human Services (DHHS). He was appointed by HHS Secretary Tommy G. Thompson on May 5, 2002 and served until replaced on April 28, 2004. In this role, Hauer was responsible for coordinating the country’s medical and public health preparedness and response to emergencies, including acts of biological, chemical and nuclear terrorism.

He was formerly the director of New York City's Office of Emergency Management under mayor Rudy Giuliani from 1996 to 2000. Additionally, he was previously an employee of Kroll Inc. which studied biological terrorism attacks.

Hauer was the director of the Indiana Department of Emergency Management from 1989 to 1993 during the gubernatorial administration of Evan Bayh. Hauer joined IBM in 1993 to manage programs for Hazardous Materials Response and Crisis Management and Fire Safety. For his production of related training videos he received the International Film and TV Critics of New York Bronze award in 1996. In the early 1990s he received a master's degree in emergency medical services from the Johns Hopkins University School of Hygiene and Public Health (now known as the Johns Hopkins School of Public Health) and later became a member of the Johns Hopkins Working Group on Civilian Bio Defense. He wrote several articles on possible bio terrorist attacks. On April 10, 1998 Hauer attended a "roundtable on genetic engineering and biological weapons" under President Bill Clinton. Hauer holds a Ph.D. from the Defence Academy of the United Kingdom, Cranfield University.^{[citation needed]}

Hauer was known for his pioneering work on autotransfusion in cardiac surgery and trauma. In 1978 Hauer developed the first unit to reinfuse blood lost following cardiac surgery, reducing the risk of hepatitis. That work reduced before morbitiy and mortality in these patients. He was issued a patent for his device. Before he became a Giuliani commissioner he had previously run emergency management programs for the State of Indiana and IBM.

On September 11, 2001, Jerome Hauer was a national security advisor with the Department of Health and Human Services, a managing director with Kroll Associates, and a guest on national television, because of his background in counter-terror and his specialized knowledge of biological warfare.^{[citation needed]}

New York City Office of Emergency Management

Jerome M. Hauer was the first director of Mayor Giuliani's Office of Emergency Management. He directed the agency since 1996, when Giuliani shifted responsibility for the city's emergency preparedness from the police department to the new agency – headed by Hauer.

Giuliani and Hauer began their relationship in January 1996 when Hauer was hired to lead the new Office of Emergency Management, created to coordinate the city’s response to crises.

Jerome Hauer is best known for being the director of the New York City Office of Emergency Management (NYC OEM) when he made the decision to build a $13 million crisis center on the 23rd floor at 7 World Trade Center.^[4] This crisis center was unveiled in June 1999, and became the subject of tension between the agency and the police department, whose own command center at 1 Police Plaza had until then been the focus of emergency preparedness operations.

As the first director of the new crisis center, "one of Hauer’s first tasks was to find a home for an emergency command center to replace the inadequate facilities at police headquarters," according to the Times. The site selected, was immediately controversial because it was part of the World Trade Center complex (although not in one of the Twin Towers), which had already been the location of a truck bomb attack in 1993. City officials, though, including Hauer, have long defended their decision, even after the command center had to be evacuated during the 2001 terror attack. The Emergency Operation Center was widely hailed as the finest such facility in the nation, receiving visitors from around the world and serving as a model for others. A memo revealed by Chris Wallace on Fox news showed that Hauer wanted to put the command center in Brooklyn but was forced by Guilliani to put the facility within walking distance of City Hall.

The center was destroyed when the 47-story tower collapsed at about 5:25 p.m. on 9-11.

References

• ^ "Governor Cuomo Announces Administration Appointments". Governor Andrew M. Cuomo. 13 January 2015. Retrieved 15 October 2017.
• ^ "Biography Of Jerome M. Hauer". ny.gov. Retrieved 7 January 2014.
• ^ "Governor Cuomo Announces Appointments to the New York Division of Homeland Security and Emergency Services". Governor Andrew M. Cuomo. 28 September 2014. Retrieved 15 October 2017.
• ^ "With Crisis in Mind, Center Opens", NYTimes June 8, 1999.

On May 22, President Clinton unveiled an ambitious plan to stockpile vaccines at strategic sites around the country so communities could better fight germ attacks. ''We must do more to protect our civilian population,'' Mr. Clinton told graduating midshipmen at the United States Naval Academy in Annapolis, Md. ''We must do more to protect our people.''

While such major initiatives usually result from many months and sometimes years of fierce debate, this one, Federal and private experts said in interviews, was developed in record time, rushed through amid worries of rising threats from Iraq and germ terrorists. But today the multimillion-dollar plan is in jeopardy, a victim in part of the haste in which the decision was reached.

Some Government officials are calling for a different approach that initially plays down vaccines in favor of antibiotics. Others defend vaccines, but concede that getting them quickly is nearly impossible, given industry's production limits and the need to insure vaccine safety and effectiveness. Still others fault vaccines as offering little or no protection against such deadly threats as smallpox and anthrax, seen as likely weapons in germ attacks.

A review of events leading to the Clinton vaccine decision reveals that the proposal was pushed by a small group of scientists, businessmen and policy makers who largely shared the same views as they struggled to do something, anything about a threat whose dimensions were potentially terrifying but frustratingly unclear. Working in Washington's frenetic, often insular world, they tended to overwhelm or sidestep doubters, and failed to see warning signs.

*The apparent consensus on acquiring vaccines masked deep divisions among scientists and military officials.

[Dr. William Capers Patrick III (born 1926)], who made germ weapons for the United States before President Richard M. Nixon outlawed them nearly three decades ago, warned that vaccinations against particular germs could be easily countered by foes, making such safeguards potentially useless.

''It's a hell of a problem,'' Mr. Patrick said. ''Defensive measures are much more difficult than offensive ones. There's no easy way around it. You immunize against anthrax and then an enemy just tries something else.''

Even the Administration's top public health officials have begun to warn that stockpiling is no quick fix.

''My view is that the stockpile isn't sufficient,'' said a senior Administration official, who spoke on condition of anonymity. ''We need an entire care system in place'' to avoid creating a false sense of security.

And Congress, which has strongly supported the Administration's anti-terrorism efforts, is questioning the rationale and structure of the civilian stockpile. A Senate hearing is being considered for the fall.

''The plan,'' said Senator Lauch Faircloth, Republican of North Carolina, ''needs to be more carefully thought out and discussed more publicly.''

The Pentagon - In Early Debate, Focus on Troops

For decades, scientists and military officials debated the merits of vaccines as a defense against germ warfare. Worries grew after the 1991 Persian Gulf war, when United Nations inspectors found that President Saddam Hussein of Iraq had studied dozens of microbial agents and had placed at least 180 biological bombs and warheads around his country ready to spray lethal germs on enemy troops.

As the Pentagon discussed an ambitious program to make a variety of vaccines, its officials weighed the possibility that enemies would simply choose new deadly germs or modify old ones to outwit American defenses.

''People asked if we were just making it possible for Saddam to pick another agent,'' recalled Stephen C. Joseph, a doctor who at the time was Assistant Secretary of Defense for health affairs.

Dr. Joseph added that he and his Pentagon colleagues nonetheless recommended in the mid-1990's that the military embark on a vaccine effort. They were motivated in part, Pentagon officials said, by intelligence reports of rising dangers outside Iraq of germs being used against American troops.

In 1996, the Pentagon began looking for a company to develop and obtain licenses for 18 vaccines other than the standard one for anthrax. The initial ones were to guard against smallpox, which causes fever, boils and can be fatal; tularemia, which causes chills, aches, fatigue and typhoid-like symptoms, and Q-fever, which causes headaches, weakness and coughing.

In November 1997, the Pentagon awarded a $322 million, 10-year contract for the 18 vaccines to [DynPort Vaccine Company, LLC], a British-American venture. The plan sidestepped the knotty issue of immunizing troops, focusing instead on making and stockpiling vaccines for military personnel.

Exactly how the Pentagon would use its stored vaccines would depend on future events and threats.

Late last year, worry in the Pentagon about biological attacks turned to alarm as United States troops prepared to strike Iraq after President Hussein expelled Americans from international teams investigating his germ arsenal. On Dec. 15, Defense Secretary William S. Cohen announced that all 2.4 million American troops would get anthrax shots. Pentagon officials said the effort would take six years and cost $130 million.

Just at that moment, the theory of enemy countermeasures became real publicly for the first time. In December, Russian scientists stunned the biological world by disclosing that they had used genetic engineering to make a new anthrax microbe. It attacked blood cells and made Russia's vaccine useless.

Whether the organism was a laboratory curiosity or a battlefield weapon was unclear. The Russian scientists gave out no samples, so detailed analysis was impossible. But Western military officials were shaken and wondered whether the American anthrax vaccine was now obsolete, and whether the same was true of other vaccines in development.

''It's not just an academic debate anymore,'' said Jack Melling, director of the Salk Institute in Swiftwater, Pa., a vaccine center that does research for the Defense Department.

The news got worse in February. Ken Alibek, a top Russian defector, went public to assert that Moscow was working on a range of exotic germ weapons, including hybrids of the smallpox virus that cause profuse bleeding. If real, such germs could sow plagues that kill most victims.

The President - Pushing a Plan To Save Civilians

Around that time, President Clinton became fixated on the emerging germ threat and ways to counter it among civilians, aides said.

Influences are said to have included the Iraqi crisis, the Russian claims, the intelligence reports and a novel, ''The Cobra Event'' (Random House, 1997), about a terrorist attack on New York City with a genetically engineered mix of the smallpox and cold viruses. Mr. Clinton was so alarmed by the book, his aides said, that he instructed his intelligence experts to assess its credibility and urged Speaker Newt Gingrich, Republican of Georgia, to read it.

Aides said the President and his National Security Council increasingly wrestled with the danger of biological attacks not only on troops abroad but also on American cities, states or even the entire country.

In January, in his State of the Union address, Mr. Clinton vowed to confront the hazard of germ weapons obtained ''by outlaw states, terrorists and organized criminals.''

In March, the White House held a secret exercise to play out what would happen if terrorists struck with one of the theoretical smallpox hybrids. The results of the war game were grim and fueled a Federal drive to find better ways to cope with such an attack.

In April, the President explored ways in which modern biology might help. He and his top officials met at the White House on April 10 with seven private scientists in the Truman Room, where Cabinet meetings are held. For an hour, participants say, the scientists discussed the germ topic and pushed for a vaccine stockpile.

Mr. Clinton's attending officials included the Secretary of Defense, the Attorney General, the Secretary of Health and Human Services, the Director of Central Intelligence and the national security adviser.

The scientists present were Dr. Frank E. Young, a former head of the Food and Drug Administration, who moderated the panel; [Dr. Joshua Lederberg (born 1925)], president emeritus of Rockefeller University; Dr. Lucille Shapiro, a biologist at Stanford University; [Dr. Jerome Maurice Hauer (born 1951)], head of emergency management for New York City; and [Dr. Barbara Hatch Rosenberg (born 1930)], a biological arms-control expert at the Federation of American Scientists, a private group.

The scientific panel also had two industry experts, both with financial ties to vaccine work.

One was a pioneer of genetic engineering who had decoded the smallpox virus and other microbes and used the meeting to push his own scientific agenda, participants said. But that researcher, [Dr. John Craig Venter (born 1946)], president of The Institute for Genomic Research, a nonprofit biotechnology group just outside Washington, said he simply urged the Government to step up support for the genetic mapping of deadly microbes. The insights, Dr. Venter added, would aid vaccine development and new methods of germ detection and treatment.

''The argument is that if we decipher these genomes it could be the ultimate deterrent,'' Dr. Venter said, referring to the ability to have so many avenues of defense that germ attacks would become futile.

Over the years, his institute had received millions of dollars in Federal support and is now gearing up to use more Government money to map the anthrax microbe as an aid to germ defense.

At the White House meeting, participants said, the business interests of another scientist were less well known.

[Dr. Thomas Patrick Monath (born 1940)] was identified in a White House announcement as a vice president of Oravax and a former official of the Centers for Disease Control and the United States Army Medical Research Institute of Infectious Diseases, the Government's top body for defensive germ-warfare studies.

A graduate of Harvard College and the Harvard Medical School, a world authority on yellow fever and other epidemics, Dr. Monath had devoted most of his career to public service.

At the meeting, he was viewed mainly through that lens, participants said, who added that they knew little about his company other than it worked on vaccines.

Based in Cambridge, Mass., Oravax was founded in 1990 to tap an emerging multibillion-dollar market in oral vaccines and antibodies to combat infectious diseases. But the small company kept having problems getting beyond research and bringing products to market.

By 1996 and 1997, its survival at stake, Oravax tried to win part of the Pentagon's expanding germ work as a subcontractor to make smallpox vaccines and others. By early this year, that work had failed to materialize and the company's stock price was down 90 percent from $10 a share in the initial public offering.

Memories of meeting participants varied, but no one could recall [Dr. Thomas Patrick Monath (born 1940)] telling the President of his company's financial interest in vaccine stockpiles -- a step he now insists that he took.

''The way to handle it is to be open, so people understand that I may have a potential bias,'' Dr. Monath said. ''I don't make it a business of taking advantage of situations in which I'm asked to participate to push the Oravax agenda.''

Many participants remember [Dr. Thomas Patrick Monath (born 1940)] arguing forcefully for stockpiling, a subject he had been asked by the panel's moderator to discuss.

[Dr. John Craig Venter (born 1946)] said the views of Dr. Monath, while strong, reflected the panel's consensus.

''Even through he was pushing harder than anyone else,'' Dr. Venter said, ''our recommendations to develop stockpiles of vaccines and medicines would have come out the same.''

A retired Army colonel, [Dr. Thomas Patrick Monath (born 1940)] was most likely the only scientist in the room who had deeply studied such problems for germ defense as enemy countermeasures.

That topic, participants say, was discussed little and in any case was overshadowed by [Dr. John Craig Venter (born 1946)]'s repeated assertions that genetic advances in theory had the power to solve these problems.

The Presidential briefing was such a hit that the experts were asked to take it on the road. In the following weeks, the scientists delivered their views to senior officials involved in vaccine issues at the Pentagon and the Department of Health and Human Services, participants said.

On May 6, the panel delivered a follow-up report to the President that, among other things, called for a stockpile of drugs and vaccines to protect millions of Americans against a variety of germs, up to 40 million against smallpox. The total cost over five years was estimated at $420 million.

Such a stockpile, the report said, could help ''reduce the death and illness 10 to 100 fold.''

A White House official who spoke on the condition of anonymity said the recommendation by the scientific panel simply encouraged the Administration to do what it was already contemplating. The official added that he saw no conflict of interest in [Dr. Thomas Patrick Monath (born 1940)]'s participation because his company had signed no Federal contracts for vaccine production.

Government ethics experts say that such private White House advisers are exempt from Federal conflict-of-interest rules and that Dr. Monath, even if he had an undisclosed interest, broke no law.

The White House official called Dr. Monath ''very knowledgeable,'' adding, ''The point of the meeting was to get a wide range of opinions from leading experts.''

The Pharmaceutical Research and Manufacturers of America, a Washington trade group that represents the nation's top 100 drug companies (Oravax is not among them), said it was never contacted by the White House for advice on the stockpile idea.

The Company - Good News In Stock Market

Oravax at this time was increasingly desperate. In filings to the Securities and Exchange Commission, the company said it had won part of the Pentagon vaccine work.

Its stock price continued to slide. On May 4, the company put out a news release boasting of the contract, and the stock rose that day in heavy trading to $1.31, up from $1.00.

But in fact, Oravax had only a preliminary promise of possible work as a subcontractor to the British-American venture that had won the Pentagon contract, executives from both companies now agree.

Securities lawyers say such misrepresentations in S.E.C. filings are potential violations of Federal securities laws.

Later that month, as rumors and news reports suggested that the President was about to announce a civilian stockpiling effort, Lance K. Gordon, Oravax's president, issued a press release saying the company was prepared to take on the challenge.

''Although there is no guarantee that Oravax will be involved,'' Mr. Gordon said in the May 21 statement, ''the company believes it has the capacity to produce both smallpox and tularemia vaccines for civilian use.''

The next day, a Friday, Mr. Clinton announced the new push to create stockpiles of ''medicines and vaccines to protect our civilian population.'' He also praised gene research as ''very, very important'' to developing new ways of countering germ terror.

The same day, 2,413,100 shares of Oravax changed hands in the Nasdaq market, closing at $1.41, up 28 cents, or 25 percent. It was the stock's heaviest trading day ever. Later, the company issued a statement explaining the sudden activity, which it attributed to the President's action.

For [Dr. Thomas Patrick Monath (born 1940)], who owns or has options on 150,574 shares, the stock's price increase amounted to a profit on paper of $42,160.

The Battle - In Shaping Shield, Emphasis Changes

A quiet war erupted as Federal agencies and experts weighed in heavily for the first time. The Department of Health and Human Services, designated to oversee the stockpile, was ambivalent about the project, officials said. The agency faulted the initiative as simplistic, saying the plan put too little emphasis on the costly, painstaking work of improving the nation's public health network to cope with germ attacks.

Significantly, the agency found that no company was making, or would soon be able to make for civilians, the vaccines scheduled to be stockpiled. It therefore switched the emphasis to antibiotics. Though also potentially vulnerable to enemy countermeasures, these drugs were seen as having the benefit of fighting a variety of noxious germs.

Two weeks after the President's announcement, on June 8, the Government quietly began to back pedal. Even though the White House asked Congress for $51 million in the next fiscal year to develop ''a civilian stockpile of antidotes, antibiotics and vaccines,'' that same day Administration officials disclosed that vaccines had been ruled out for the moment. Why? Cheaper and more effective ones might appear in the next few years, the officials told reporters.

The developing plan has yet to address in detail how and where the medicines would be made, stored or distributed in a crisis.

As for Oravax, its stock is down, closing yesterday at 56 cents. And it still has no Federal stockpile work.

Despite the setbacks, many experts continue to back vaccines as important for germ defense and even hold out the possibility of wide civilian immunizations.

''Preventing an outbreak is always preferable to trying to suppress one after it has started,'' Senator Faircloth said.

As for the worry that an enemy might outwit vaccines with new or modified germs, vaccine supporters say that most of these enhanced germs are theoretical and would probably be less available and attractive to terrorists than known strains of deadly, dependable germs like unmodified anthrax and smallpox. If so, they say, vaccines are a good deterrent and a relatively cheap insurance policy.

Whatever their flaws or merits, vaccines continue to draw the interest of small companies eager to gain a foothold in an expanding area of the Federal budget.

On July 7, the State of Michigan approved the sale of the nation's only licensed maker of anthrax vaccine to a company led by Adm. William J. Crowe Jr., a former Chairman of the Joint Chiefs of Staff who was an important supporter of Mr. Clinton in the 1992 Presidential campaign.

Admiral Crowe's newly formed company has individuals with extensive drug industry experience and now has an inside track on at least $60 million in Pentagon contracts, officials of the Defense Department said. And while aiming at the military market, it wants to expand to civilian customers as well, company officials said, if that becomes possible in the years ahead. Companies drawn to the germ-defense business see the emerging civilian market as potentialy dozens of times larger than the military one and much more profitable.

How Vaccines and Antibiotics Work

Vaccines are made of dead or weakened germs. When they are injected -- or, in some cases, swallowed -- vaccines alert the body's immune system, which forms antibodies to fight a particular disease.

In contrast, antibiotics attack invading germs rather than work pre-emptively. Their chemical assaults weaken the invaders to help the immune system fight the infection. Typically, success requires daily doses. Antibiotics can work against a variety of microbes, making them more flexible than vaccines. But they cannot kill viruses, a crucial shortcoming.

To counter germ attacks, both vaccines and antibiotics can be administered in advance. But that step, while potentially effective, is laden with logistic, legal, cost and medical problems, especially with vaccines that in their current state of development carry some risk of causing accidental illnesses.

In theory, stockpiles of vaccines and antibiotics are useful for biological defense because the medicine can be administered quickly to help stop epidemics in progress, just as quick immunizations can help control natural outbreaks.

With vaccines, the Clinton Administration is pursuing a variety of options. It is vaccinating troops against anthrax, preparing to stockpile other vaccines for the military and embarking on a parallel stockpiling effort for civilians. For now, that step is caught up in debate and delay.

No other large police force in the country had developed such sophisticated antiterrorism strategies. None had done as much training or had received as much expert counsel on how to prepare for a terrorist catastrophe.

In fact, the New York Police Department had spent heavily on equipment, participated in mock disasters to test its readiness, maintained a high-tech command center, and advised on the construction of the mayor's own $7 million emergency bunker in a downtown high rise.

But when two planes hijacked by terrorists crashed into the two towers of the World Trade Center last Tuesday, causing the buildings to collapse, the department's ability to carry out its emergency-management plans was seriously compromised.

The bunker, at 7 World Trade Center, was damaged and soon fell along with the rest of the building. The department's communications system was damaged as well, and the ability of senior officials to stay in touch was curtailed for much of the first day. To make matters worse, at least two dozen officers, including some of the men who had been trained most extensively in search and rescue operations, were lost in the tragedy's first hour.

But in what police officials regard as a striking achievement in improvisation and commitment, the department, often using tools no more complex than pens and paper, has managed to recover quickly and respond, not only to the trade center crisis, but also to the demands of effectively policing the rest of the city.

''It's really a test for the entire department,'' Police Commissioner Bernard Kerik said on Friday. ''It's a test for the managers, it's a test for the administrators and it's a test for the rank-and-file cops and the first-line supervisors. And everybody is acting; they are far surpassing what I would have imagined under the circumstances.''

And circumstances were initially close to overwhelming. After the towers collapsed, every phone went dead at police headquarters downtown, the home of its own command center. Pager and cellular phone service was completely lost for nearly 24 hours. E-mail and other computer communications were also knocked out.

The loss of cellular phones and pagers increased the already heavy flow of radio transmissions as department officials scrambled to deploy more officers. ''We made the best with what we had and we made it work,'' Mr. Kerik said.

Jerome M. Hauer, who until last year ran the city's Office of Emergency Management, said the improvisation was rooted in readiness. ''Our Police Department has been and is better prepared for any type of incident than any department in the country, hands down,'' he said.

Within a few hours of the collapse, the department was calling in all off-duty officers to work, and by day's end, it had switched from 8-hour to 12-hour shifts.

Tuesday afternoon the department, along with the Mayor's Office of Emergency Management, opened a makeshift command center at the police academy, and department technicians began running phone lines into a few essential offices inside headquarters.

As more than 1,000 officers responded to the stricken area south of 14th Street, Mr. Kerik redeployed some 10,000 others -- narcotics and precinct detectives and officers from the Organized Crime Control Bureau, the Street Crime Unit and other special units -- to patrol duties.

With the additional help, Mr. Kerik said, the department has had no problem patrolling the streets. Citywide, he said, crime was down by 30 percent during the first days of the crisis.

He also said that the extraordinary public support the officers had seen had energized the police at the moment when they needed it most.

''Now the entire city is out there cheering and clapping and sending letters and just really showing their signs of support for the cops,'' Mr. Kerik said.

''You know what that's doing for them? It's just boosting and enhancing the morale, it's making it, as bad as it is, as tragic as it is, so much better.''

Minutes after two jets slammed into the World Trade Center, an elite team of 22 soldiers was ordered from its base in Scotia, N.Y., to the scene of the disaster, the world's worst terror attack.

By 8:30 that night, the unit had deployed special gear in New York City and was quietly sampling the air, making sure the terrorists had released no deadly germs or toxic chemicals, which in theory could cause widespread illness and death.

No such dangers were found. But despite the fast start, experts say civil defenses across the nation are a rudimentary patchwork that could prove inadequate for what might lie ahead, especially lethal germs, which are considered some of the most dangerous weapons of mass destruction. Many experts approve of President Bush's decision to appoint a cabinet secretary for Homeland Security, calling it an important step toward protecting civilians against terrorist arms.

The emergency teams ''did very well in dealing with this attack,''[Dr. Tara Jeanne O'Toole (born 1951)], a physician at the Center for Civilian Biodefense Studies at Johns Hopkins University, said in an interview. ''But we've never really had a test of the hospital system where people in large numbers required sophisticated medical care.''

Moreover, there are no measures to routinely check for biological attack. Instead, the authorities rely on reports from doctors that people are seeking medical attention for unusual symptoms. That is why the Centers for Disease Control and Prevention in Atlanta issued a national alert on Sept. 11 calling on public health officials to ''initiate heightened surveillance for any unusual disease occurrence or increased numbers of illnesses that might be associated with today's events.''

The alert is still in effect. ''We haven't heard a thing,'' one federal official, who spoke on condition of anonymity, said of any reports of unusual disease patterns.

But medical experts often fault this approach as inadequate, especially because symptoms of serious illness often appear days and weeks after an infection has begun to spread and when life-saving treatments are no longer effective.

The nation is ''woefully unprepared to deal with bioterrorism,'' Jerome M. Hauer, former head of emergency management for New York City, told Congress two months ago.

How serious is the threat? Today it is considered low. Experts say that biological weapons, with few exceptions, are hard to make and use. In the early 1990's, Aum Shinriko, a Japanese cult, launched germ attacks in and around Tokyo that were meant to kill millions. The strikes produced no known injuries or deaths.

But the chances that some rogue state or terrorist group will successfully deploy germ weapons are seen as rising, as knowledge of how to make deadly weapons spreads, along with the necessary technology.

''There's a greater risk of dying on the highway than from exposure to anthrax,'' said Jonathan B. Tucker, a germ-weapons expert in the Washington, D.C., office of the Monterey Institute of International Studies.

But Dr. Tucker cautioned that the attacks on New York and near Washington were unusual in showing a high degree of care and preparation, suggesting that terrorists ''may be able to overcome the technical hurdles'' to mass destruction, especially if aided by rogue states or scientists.

George J. Tenet, director of central intelligence, warned Congress last year that terrorists were exploring how ''rapidly evolving and spreading technologies might enhance the lethality of their operations.'' A number of groups, he said, are seeking germ, chemical, radiological or nuclear arms.

Mr. Tenet added that operatives of Osama bin Laden, the renegade Saudi millionaire suspected in the Sept. 11 attacks, ''have trained to conduct attacks with toxic chemicals or biological toxins.''

Military experts say germ weapons can be cheaper, stealthier and potentially more devastating than nuclear arms, though hard for terrorists to acquire and use without hurting themselves.

Shock waves from the recent suicide attacks, experts agree, could help forge a consensus to erect better defenses against unconventional weapons, reversing decades of neglect of civil defense. Many government reports and private experts have criticized recent efforts as wasteful, poorly coordinated among some 40 federal agencies and ill suited for dealing with a wide spectrum of possible threats.

The Clinton administration, rocked by terrorist attacks on Americans at home and abroad, embarked on a wide but sporadic campaign to build civil defenses. Among other things, the campaign established a national stockpile of drugs and vaccines and on Sept. 11, [Tommy George Thompson (born 1941)], secretary of the Department of Health and Human Services, authorized the first shipments from it, sending truckloads of emergency drugs, bandages, dressings and other medical supplies to New York City.

Even so, Dr. O'Toole of the Johns Hopkins center said, the nation has vaccines or drugs to combat only about a dozen of the 50 pathogens thought to be the likeliest threats.

As part of the stockpile push, the disease control centers last year awarded a $343 million contract for making 40 million doses of smallpox vaccine, the first of which is due in 2004. The disease is a contagious killer of high fevers and open sores.

Though smallpox was eliminated from human populations in the late 1970's, stocks of the virus still exist and making vaccine has become a priority as worries over bioterrorism have grown.

The United States has on hand roughly 7.5 million vaccine doses, said Dr. Tucker in ''Scourge,'' a new book on smallpox. That amount, he added, is ''inadequate to cope with even a medium-sized outbreak that might result from a bioterrorist attack.''

This year, federal and private officials met to act out how the government would cope with a smallpox outbreak. The exercise, code named Dark Winter, ended in chaos when the spreading disease overwhelmed all attempts at containment.

''Most state and local governments have not begun to address the issues that Dark Winter presented,'' Mr. Hauer told a House Government Reform subcommittee in July. ''An incident using biological agents will likely go unnoticed for days, and the typical response of the first responders will have little impact. It is not a 'lights and sirens' type of incident.''

In the last few years, New York City has quietly undertaken many efforts to counter attacks with deadly chemicals or germs.

One program, the kind that the disease control centers called for nationally on Sept. 11, monitors patterns of emergency hospitalizations. Another trains city police officers and firefighters to handle such emergencies, including the decontamination of materials and people.

Stephen S. Morse, a biologist at Columbia University who directs its Center for Public Health Preparedness, which is part of a new national network of such groups run by the disease control centers, recently helped the city set up a program for training school nurses as well.

''Their main role would be sheltering people and ministering in the shelters,'' Mr. Morse said. ''You hope for the best, and prepare for the worst.''

The Defense Department, meanwhile, is continuing a wide effort, begun in the Clinton administration, to have university scientists and biotech companies come up with innovative ways to combat a variety of disease agents.

Although the F.B.I. was notified on Sept. 25 about a suspicious letter sent to NBC, neither the letter, nor the powder residue inside them were tested until nearly five or six days later, and then only because a private doctor notified city public health officials about a troubling skin condition in the news assistant who had handled the mail, officials acknowledged yesterday.

[Note: Only one letter was reported belatedly to New York City officials. The second letter was not initially known to the F.B.I. ]

In fact, the F.B.I. laboratory neither performed nor sought any tests on the powder or the skin samples taken from the employee, identified as Erin M. O'Connor, a 38-year-old assistant to Tom Brokaw.

"That, unfortunately, did not take place," said Barry W. Mawn, assistant director in charge of the F.B.I.'s New York office.

He also said the agents had intended to interview Ms. O'Connor soon after they learned of the case, but did not, for reasons he did not explain.

F.B.I. officials said investigators picked up the envelopes on Sept. 26, the day after NBC security officials called the agency. New York City officials were not informed of the preliminary inquiry until days later.

Indeed if the Health Department had not been alerted to the case by a private doctor, it might well have hibernated in the F.B.I. files.

Mr. Mawn said yesterday that the agency had to investigate dozens of threats, scares and false alarms, and that is how this case was initially treated. Since Sept. 11, when the two planes slammed into the World Trade Center, city and federal law enforcement officials have received hundreds of reports of menace and foul play ranging from bomb threats to chemical attack scares.

The discovery of a case of apparently deliberate anthrax poisoning in the heart of New York City is just the latest in a string of terrifying events that have challenged the law enforcement and health care infrastructure in the last month. It pushed health care officials to nail down a pathogen that most of them had no experience with.

And it once again tested the fragile relationship that has always existed between the New York City Police Department and the F.B.I., agencies that are forced to work in tandem on unprecedented and constantly evolving crimes.

"Information sharing between the F.B.I. and the N.Y.P.D. has always been poor," said one person who has worked closely with both agencies. "There is often a lack of willingness on the F.B.I.'s part to share information, although it is getting better. As they move forward, clearly the F.B.I. is going to have to be more forthcoming."

In this case, Mr. Mawn said, the gravity of the situation was not fully appreciated by the federal authorities until recently.

Between Sept. 19 and Sept. 25, Ms. O'Connor handled a letter postmarked from St. Petersburg, Fla., filled with white powder, according to law enforcement officials. She also handled a second letter containing a sandy substance. Network officials, immediately suspicious, called the F.B.I. The F.B.I. and the New York police both learned of it on Oct. 12, and on the 13th, it tested positive for anthrax.

Then, the agency began to prepare a cover letter for its own laboratory indicating that the substances needed to be tested, but the letter was never completed and the evidence was never sent from the F.B.I.'s office in New York to its laboratory, said Joseph Valiquette, an F.B.I. spokesman.

He added that some delays happened because investigators were unable to interview Ms. O'Connor to supplement the cover letter. "We wanted to send a complete package to the laboratory," said Mr. Valiquette. So none of it was sent. Mr. Valiquette said he did not know why the F.B.I. could not speak with Ms. O'Connor, who works in Rockefeller Plaza and lives in the metropolitan area.

On Sept. 28, Ms. O'Connor developed a strange sore on her chest. Nervous, she went to see Dr. Richard Fried, a Manhattan infectious disease specialist, said Dr. Annetta Kimball, the doctor covering for Dr. Fried, who could not be reached last night.

Armed with the description of the rash — which she described as central scarring surrounded by a lot of swelling — the doctor likely consulted his textbooks to nail down what was going on. Dr. Kimball said that Dr. Fried suspected that his patient had been exposed to anthrax, and immediately prescribed Cipro.

"There is a good chance he had never seen anthrax before," said Dr. Kimball. "This is New York City, not an agricultural area." He also took cultures from a wound Ms. O'Connor developed, but those swabs were negative for anthrax, she said.

At some point, officials and Dr. Kimball said, the patient visited a dermatologist.

One of those doctors notified the city's Health Department on Oct. 6 of a possible case of anthrax. The city has among the most sophisticated epidemiologists and public health labs in the country.

Mr. Valiquette said that the F.B.I. learned from the city's Health Department that "this was an issue." The substance eventually made its way to the Centers for Disease Control and Prevention in Atlanta, which went to unusual lengths to identify it. There was little powder to work with, and a power failure in the lab halted the work for nearly a day, said Dr. James M. Hughes of the C.D.C.

"None of this ever did go to the F.B.I. lab," he said.

One of the Ms. O'Connor's doctors ordered a skin biopsy, which was sent to the C.D.C. But by the time the tissue was taken, the patient had begun taking an antibiotic to counter possible anthrax. As intended, that drug degraded the cellular structure of the bacteria. On Wednesday, the city was informed of the case under investigation. The C.D.C. was able to identify the spores of anthrax, and officials were informed of the results early yesterday morning.

Mayor Rudolph W. Giuliani announced the first confirmed case of anthrax yesterday morning at NBC.

He was described by a person who was with him early yesterday as being "three feet off the ground" when he learned that the F.B.I. had not brought word of the developments to city officials earlier.

Mr. Mawn acknowledged that investigators revisited the case after learning of the concerns of the health officials. "A second notification came through to the Department of Health, at which time the evidence response people and the F.B.I. also became involved with it. It was initially assigned to two agents that just covered the lead. And upon that, it was immediately submitted for tests. As you know and as the mayor has talked about, those tests were initially negative."

Yesterday, The New York Times received a letter filled with white powder that was addressed to a reporter, Judith Miller. The Times notified the mayor's office, and city and F.B.I. officials responded immediately. Tests for radioactive and chemical substances were negative, and results from a more definitive test for anthrax DNA by state and federal labs were expected over the weekend.

Coordinating the efforts of the various law enforcement and public health officials is proving tricky — there have been dozens of bomb and other threats around the city since Sept. 11, and the city, which investigates each case, cannot inform the public or other agencies about each one. Just yesterday, the city heard of about a half dozen cases of suspicious powder or envelopes that it is investigating, the mayor said.

"If there was a problem, it was in the way they first investigated it," one Police Department official said of the F.B.I.'s performance.

But there was some concern last night among health care experts about the delay in the testing. The inability of the agency to identify the substance was "not very comforting," said one C.D.C. official, who spoke on the condition of anonymity. "That is a little disappointing, to say the least."

Anthrax spores, if kept under appropriate conditions — sealed and unexposed to lots of light — can be preserved for years, said Jerome M. Hauer, the former director of the Office of Emergency Management and currently managing director of Kroll Inc. , an investigation firm. He added: "You don't want them sitting around. In this environment, you hope there is good information sharing, especially when it involves biological agents."

Yesterday, soon after the United States Capitol closed, and the world learned that more than two dozen people on the Senate majority leader's staff had been exposed to a potent form of anthrax, and Gov. George E. Pataki and other state workers began taking Cipro, and environmental testing began at City Hall, Mayor Rudolph W. Giuliani held a news conference with four large puppets.

The puppets were part of an effort to publicize a cultural festival. But the message went beyond tourism.

It was part of Mr. Giuliani's studied effort to appear calm, even relaxed, in the face of scary news and general uncertainty. At the heart of Mr. Giuliani's message, one he is increasingly alone in urging, is a conviction that panic can be as damaging, perhaps even more damaging, than germs, and that things could be worse. ''So far this is all very, very psychological,'' he said yesterday, before making a reference to the London blitz of World War II. ''We're not being bombed every day, like the people of London were bombed every day and still able to go on with their lives. So we can be just as brave as they were. This is easy, a lot easier than what they went through.''

Other officials, including President Bush and Governor Pataki, have urged Americans to live normal lives, to triumph over fear. But Mr. Bush's administration has also issued terrifyingly vague warnings of more terror to come. Mr. Pataki is evacuating state offices and is taking antibiotics after anthrax bacteria were found in his Manhattan office suite. Public health experts now say there is no need to take antibiotics before being tested.

Mr. Giuliani says that against the advice of people close to him he is taking no medicines for anthrax. At news conferences filled with questions about fear, he still talks about the Yankees, encourages people to go to restaurants and peppers the conversation with joking asides. ''A little culture,'' he said yesterday, before he tugged at the snout of the elephant puppet. ''This is the kind of culture I like. Not like anthrax cultures.''

Somebody sneezed. ''Want to get checked?'' the mayor said.

He wasn't serious. ''Only kidding,'' he said. ''We've got to joke about this. It's the only way we're going to all get through it.''

He does not mock those who are fearful. He answers hundreds of questions, doles out information and, after a month of daily funerals and anthrax scares, acknowledges that these are frightening times.

''This is very uncharted territory that everybody is in,'' he said yesterday.

Like officials in Albany and Washington, Mr. Giuliani seeks to balance the appetite for information against the potential for hysteria. But his tone is distinctive. He seems to lean harder than most against panic.

''Obviously there are two competing points of view here,'' said Dr. Richard Fried, a Manhattan specialist in infectious diseases who treated the woman at NBC who contracted anthrax. ''There is the necessity for public officials to keep people free of a panic and to be realistic about what the threat is. And those two paths intersect along the way.''

Here is what he is up against: Every day for almost a week, there has been a new anthrax scare in an office building in New York City and in other places around the nation. A vast majority have been false alarms, but two New Yorkers have been infected. Offices, including his own yesterday, have been tested for contaminants. He must convey a flurry of medical and technical information to people who have already watched two office towers fall and heard of a baby who became ill with anthrax after visiting an office building for a birthday party.

But his demeanor is calm, at times insouciant. He speaks frequently of dining out. He likes it, and wants others to do more of it. When he is questioned beyond what he thinks is reasonable during his daily briefing, he will abruptly turn the topic to sports.

On Sunday, a reporter asked: ''There's a suspicion in Edison, N.J., of a Ford worker that perhaps this individual was exposed to anthrax. Could you update us on the status of that?''

Mr. Giuliani replied: ''Could somebody update me on the Giants score? You have the Giants score, Steve? Giants winning? Good. And we've got a big Yankee game this afternoon. Unbelievable game last night, unbelievable. Almost got a heart attack.''

The reporter tried to continue: ''There was a report this morning that . . .'' The mayor cut the reporter off. ''Can you imagine what Mariano Rivera must be like?'' Mr. Giuliani said. ''He probably has like ice water in his veins.''

He tries to draw lines, at least on the surface, to divide his many messages. Puppets are ushered out when his health commissioner comes into a room for a briefing, and he rarely updates the number of dead at a news conference for lighter matters. He can sometimes seem a bit detached, insisting that most New Yorkers are not afraid when conversations around the city suggest otherwise.

The mayor has also chosen to play down the facts of one case, without altering its essential truth, apparently to keep the lines between threat and fear starkly drawn.

For instance, while he immediately acknowledged that a baby whose mother took him to ABC News had shown symptoms of anthrax exposure, he never revealed that the baby had fallen quite ill and that his kidneys nearly failed. The child was given antibiotics and has recovered.

And while Mr. Giuliani said that everything was being tested at ABC, behind the scenes, ABC executives revealed this week, he was holding the F.B.I.'s feet to the fire, deeply displeased with the speed at which the bureau was working. For security reasons, he and his police commissioner are loath to give out the sort of details that would provide the most comfort, such as what the city is doing to secure the subway system. The mayor's own public schedule is held under tighter wraps than usual.

''I think it is always a very difficult question, how much information you give out,'' said Jerome M. Hauer, the former head of the mayor's Office of Emergency Management. ''It is important that you give information out on a frequent basis, but it has to be accurate. You can't let the desire for information drive it. Because inaccurate information can be very very harmful, as we have seen that over the years with the Internet.

''The balance you have to strike is realizing that we live in an era where there are threats now, and letting people know that you can't succumb to these threats,'' Mr. Hauer added. ''I think the mayor is right on this. We need to be cautious, but we can't crawl into holes. We need to go about living.''

Correction: Oct. 19, 2001

A news analysis article yesterday about Mayor Rudolph W. Giuliani's response to anthrax fears referred imprecisely to the closings of government offices in Washington. While all six House and Senate office buildings were closed for further screening, the Capitol was not closed. The article also referred incorrectly to the consensus of public health experts about treatment in cases like that of Gov. George E. Pataki, who decided to take antibiotics without first being tested to see if he was exposed to anthrax found in his Manhattan office. Many experts advise taking antibiotics immediately. There is no consensus that taking antibiotics should be postponed until after testing.

A number of health officials and experts are warning that steps being taken by the government and members of the public in response to threats of bioterrorism carry health risks that may far exceed their benefits.

These experts are focusing on two developments: the rising interest in powerful antibiotics to counter anthrax and the possibility of renewing mass vaccinations for smallpox.

Antibiotics and vaccines, like all medicines, can have harmful side effects, the experts say. In addition, the soaring sales of Cipro -- a powerful antibiotic widely if erroneously believed to be the only effective drug against anthrax -- raise the prospect that if large numbers of people start taking it, anthrax and other far more common bacteria will become resistant to it.

''Our big problem is not bioterrorism,'' said Dr. Lucy Shapiro, a microbiologist who heads the Arnold and Mabel Beckman Center for Molecular and Genetic Medicine at Stanford University. ''It's our response that's going to lead to a big jump in antibiotic resistance. That's the terror.''

The smallpox question arose last week, when the federal government announced that it planned to stockpile 300 million doses of smallpox vaccine, enough to immunize everyone in the country. ''Sometime in the future there may be a discussion that may lead to voluntary vaccination for the smallpox bug,'' said Tommy G. Thompson, the secretary of health and human services.

But some public health experts question the wisdom of vaccinating Americans in the absence of any cases of smallpox anywhere in the world. As with antibiotics for anthrax, they say, in the event of a smallpox outbreak there should be time to get the vaccine to most people who were exposed.

Dr. Jonathan B. Tucker, a bioterrorism expert at the Washington office of the Monterey Institute of International Studies and the author of ''Scourge: The Once and Future Threat of Smallpox'' (Atlantic Monthly Press, 2001), said the vaccine could prevent the disease from spreading to those who came in contact with an infected person, providing substantial immunity 10 days after vaccination.

''Even within five days, while there is some risk of disease, it probably will not be life-threatening,'' Dr. Tucker said. ''That means there is somewhat less of an imperative to vaccinate prophylactically.''

In the absence of disease, it does not make sense to reinstitute vaccinations, he said.

''Given that this is a live virus vaccine, there is a small but significant risk of serious complications,'' Dr. Tucker said, adding that one in a million who were vaccinated in the 1960's died or had brain damage. The vaccine can cause severe infections in one of 18,000, with the virus spreading throughout the body.

Routine vaccinations against smallpox were discontinued in the United States in 1972, when the disease had been virtually eradicated worldwide. A new vaccine would be made with more modern methods. Nevertheless, experts caution that some side effects are inevitable.

Dr. Tucker noted that a recently vaccinated person can spread the virus to others, possibly making them ill. This was one reason the Pentagon stopped vaccinating troops for smallpox, he said, adding, ''They would have to quarantine those who were vaccinated so they wouldn't spread the virus to their families.''

As for anthrax, some health experts point out that only a handful of people have developed the disease, with one death so far, and a few dozen more have tested positive for exposure to anthrax spores.

''What we're seeing now, in the big picture of a public health impact is relatively minor,'' said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. ''It's high on terror and low on impact.''

Health experts say they know firsthand how terror can make even the most rational person reach for a bottle of Cipro. But they say that makes it all the more important to spread a temperate message.

''I was in the ABC and CBS newsrooms on Wednesday,'' said Dr. Allan Rosenfield, the dean of the Mailman School of Public Health at Columbia University. ''On Thursday night, I came down with a sore throat and a fever.''

Anthrax infections have been found in a CBS News employee and in an ABC producer's baby. Dr. Rosenfield could not help thinking of the disease, and he could not help being tempted to start taking Cipro. But ''I didn't take anything,'' he said. ''I was proud of myself.''

The next day, Dr. Rosenfield said, he had a few qualms. ''I said, 'If I made a mistake, I'm dead.' '' He has now recovered. He does not have anthrax.

Dr. Shapiro, the Stanford microbiologist, acknowledges that she was shaken by the terrorist attacks. ''I'm scared,'' she said, but added that she, too, was not taking antibiotics.

''They don't have to kill us with anthrax,'' Dr. Shapiro said, referring to the prospect that diseases might develop a resistance to antibiotics. ''They can just change the whole flora and fauna of our pathogen world. This is about the worst thing that can happen in our war on bugs.''

Then there is the problem of antibiotic side effects. These can vary from nausea and diarrhea to much more serious medical conditions.

''Antibiotics are justified to treat infections,'' said Dr. Timothy T. Flaherty, who is chairman of the board of trustees of the American Medical Association. ''But without infections, all you're left with are side effects.''

Some public health experts warned against hasty reactions to the terrorist threat.

Jerome M. Hauer, a former director of New York City's Office of Emergency Management who advises Mr. Thompson on bioterrorism, added his own word of caution when it came to smallpox. ''I think you've got to be careful,'' Mr. Hauer said, ''about public pressure pushing you into medical decisions that could at the end of the day be harmful.''