10/13/2009 - 06:29

The need for political leadership during a crisis

Laura H. Kahn

Laura H. Kahn

A general internist who began her career in health care as a registered nurse, Kahn works on the research staff of Princeton University's ...

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The concept of "meta leaders"--individuals who make decisions beyond their official lines of authority in order to facilitate collaborations across jurisdictions and agencies--was proposed in an effort to overcome the silo thinking that characterizes how traditional government leaders carry out their roles. Since then, meetings and summits have promoted the concept of "meta leadership" among business, government, and nonprofit sectors.

The challenge with relying on people to become "meta leaders" during crises is that they must be willing to act (and often make decisions) beyond their official job descriptions, potentially risking disciplinary action if their choices are later considered inappropriate. With that in mind, it could be argued that the only individuals with the legal and moral authority to facilitate cross-agency decisions are elected officials. They are, you could say, natural "meta leaders."

When Milwaukee's mayor asked the state epidemiologist during the city's 1993 cryptosporidium outbreak if he would drink the local tap water, the state epidemiologist said no. If the state epidemiologist wouldn't drink the water, the mayor reasoned, then no one should."

Take, for instance, the 1993 cryptosporidium outbreak in Milwaukee--the largest waterborne illness outbreak in U.S. history--which perfectly exemplifies the critical "meta leadership" role of elected officials.

The crisis. Lake Michigan supplies the drinking water for 800,000 Milwaukee residents and the residents of the surrounding municipalities. Around March 11, 1993, chemists at a local water treatment plant, which drew water in from the lake, were struggling with a failing water filtration system and, at the same time, learning how to work with a new chemical. A little more than a week later, local water turbidity--the concentration of particulate matter that makes contaminated water cloudy--reached unprecedented levels. Soon thereafter, city residents began calling Milwaukee Water Works officials to complain about foul-smelling, brownish water. The officials assured residents that the water was safe to drink and made no effort to contact the health department--a bad move.

By the first week of April, the number of people complaining of severe diarrhea, vomiting, and cramps in hospitals was well above normal levels. The Milwaukee Health Department began receiving calls from the public on April 5 and heard reports that hospital emergency rooms were filling up and anti-diarrheal medications were flying off the shelves at local pharmacies. Negative bacterial test results from hospital laboratories led health department officials to suspect a gastrointestinal virus.

The response. In the late afternoon of April 7, Thomas Taft, an infectious disease specialist, solved the mystery of the outbreak's cause when he reported that he had a patient who had tested positive for cryptosporidium, the water-borne parasite that typically lives in the intestines of infected animals or humans. When drinking water is contaminated with feces from an infected host, people can show symptoms of a cryptosporidium infection similar to those mentioned above. As news got out, the public panicked. They sought bottled water, and hospitals were flooded with calls from people asking for guidance.

Health officials charged that the municipal water supply was the source of the illnesses, but Milwaukee Water Works officials disagreed. In order to resolve this dispute and speed up the crisis response efforts, health department officials decided to set up a meeting with the state epidemiologist, Milwaukee Water Works representatives, and the mayor. At the meeting, the mayor asked the state epidemiologist if he would drink the city's tap water--to which the state epidemiologist said no. If the state epidemiologist wouldn't drink the water, the mayor reasoned, then no one should. As a result, the mayor decided to issue a "boil water" advisory to the public until everyone could be assured that the water was safe to drink. He also shut down the offending water treatment plant--the same one that weeks earlier chemists had been working at--and held daily press briefings to keep the public informed about the progress being made. Milwaukee residents gave his leadership high ratings in a newspaper poll soon after the crisis.

In the end, more than 400,000 people got sick, 4,400 were hospitalized, and about 100 people died. However, the situation could have been significantly worse if the mayor hadn't assumed the role of a "meta leader." He was the only one who had the authority to mediate the dispute between the health and water works officials and ensure that cooperation rather than argument characterized the city's response. In fact, by assuming this responsibility, he saved lives and provided a model for future health crisis management.

Editor’s Note: This column is drawn from the author’s recently released book, Who's in Charge? Leadership during Epidemics, Bioterror Attacks, and Other Public Health Crises.