In May 2007, Mr. Andrew Speaker, an attorney from Atlanta, Georgia, caused a major
health scare in the United States and abroad when he flew to and from Europe while knowingly
infected with a drug resistant form of tuberculosis (TB).
Though initially diagnosed with multi-
drug resistant tuberculosis (MDR-TB),
Mr. Speaker was subsequently confirmed to be infected
with extensively drug resistant tuberculosis (XDR-TB).
When public health officials realized
he left the U.S. to travel in Europe, they began working with other Federal and state authorities,
as well as international bodies, to limit the spread of the disease.
Disregarding a directive from the Centers for Disease Control and Prevention (CDC) to
seek medical treatment in Italy, Mr. Speaker returned to the U.S. by altering his flight itinerary,
flying to Canada, and then driving across the border.
Although Mr. Speaker’s name appeared on
a list of individuals who should be denied entry into the country, Federal agents failed to detain
him at the border crossing.
Shortly thereafter, Mr. Speaker notified the CDC of his entry into the
U.S., and the CDC placed him under involuntary isolation – first in New York City, then Atlanta,
and finally Denver.
In July 2007, he was released from a hospital in Colorado, whereupon he
returned to his home state of Georgia for outpatient treatment.
A number of homeland security and public health processes were utilized to manage this
incident, many of which failed at different points.
In addition to providing a comprehensive
timeline of events from January to June 2007, this report (1) explores the interactions between
the Department of Homeland Security and the CDC regarding public health security issues; (2)
identifies weaknesses in homeland security processes designed to prevent entry into the U.S.;
and (3) makes recommendations for agency improvements in these areas.
Although there were certain circumstances in which U.S. federal departments and
agencies worked well together, the 2007 XDR-TB incident was handled ineffectively and
As is always the case with events for which we are poorly prepared, the situation
cast a harsh light on the gaps in communication, coordination, response, patient management,
implementation of quarantine and isolation laws, public messaging, information management,
training, awareness, and professionalism.
Though it is clear that all parties involved in this
situation are aware of these shortfalls, it is not as clear to the Committee that they are being
addressed with the urgency and attention necessary to prevent a similar series of events from
occurring again today.
The twin specters of diseases that are increasingly resistant or completely
without current treatments and antimicrobials, and the ability of diseases to spread more quickly
than ever before due to rapid transit and other enablers, place public health concerns squarely on
the homeland, national, and transnational security agendas.
How we address these gaps now will