World Trade Center Health Program

Smoke plume coming from the WTC site, seen on NEXRAD weather radar

On September 11, 2001, 19 terrorists associated with the Islamist militant group al-Qaeda hijacked four passenger jets in a series of suicide attacks on the United States, killing 2,996 people and injuring more than 6,000 others. Hijackers flew planes into two main towers of the World Trade Center, resulting in the collapse of three buildings of the World Trade Center complex, and the Pentagon, resulting in the partial destruction of the western side in the building. The resulting dust cloud due to the collapse of the World Trade Center covered Manhattan for days and contained thousands of tons of toxic debris, including asbestos and other known carcinogens.[4][5][6] Another hijacked plane crashed into a field in Shanksville, Pennsylvania, following an attempt by the passengers to retake control of the plane. No one in the airliners survived.

Survivors were covered in dust after the collapse of the towers

As of 2011, approximately 18,000 people have received medical treatment for illnesses related to toxic dust from the World Trade Center site.[7] A study of rescue workers released in April 2010 found that all those studied had impaired lung functions, and that 30–40% were reporting little or no improvement in persistent symptoms that started within the first year of the attack.[8] In 2011 a major research study showed significant long term medical and psychological effects among first responders to the World Trade Center site. These effects include elevated levels of asthma, sinusitis, Gastroesophageal reflux disease and posttraumatic stress disorder.[9]

Residents, students, and office workers of Lower Manhattan and nearby Chinatown have also reported negative health effects.[10] Several deaths have been linked to the toxic dust, and the victims' names have been included in the World Trade Center memorial.[11]

As of 2008, the New York State Department of Health had documented at least 204 deaths of rescue and recovery workers since September 11, 2001. Seventy-seven of these individuals died of illnesses, including 55 from lung and various other cancers. Kitty Gelberg, New York state Bureau of Occupational Health's chief epidemiologist said, "We're not saying they are all World Trade Center related; we're just saying this is what people are dying from." Many of the 55 responders who died from cancer had cancer before September 11, 2001, but most of the cancer patients developed the disease afterward.[12]

A solitary firefighter stands amid the rubble and smoke in New York City

In 2002, following the 9/11 terrorist attacks, both the National Institute for Occupational Safety and Health and the American Red Cross provided grants to launch the World Trade Center Medical Monitoring and Treatment Program (MMTP) in response to individuals developing health issues related to the disaster. The United States Congress passed appropriations to provide limited health screening and treatment services to World Trade Center responders. The MMTP has received approximately $475 million from the federal government. Over 57,000 people met the program's initial eligibility requirements. On July 1, 2011, MMTP became a part of the World Trade Center Health Program.[13]

The World Trade Center Environmental Health Center (EHC) was also established after the 9/11 terrorist attacks to treat WTC-related illnesses. This program consisted of three locations in and around New York City. On September 30, 2008, the Centers for Disease Control and Prevention (CDC) awarded the New York City Health and Hospitals Corporation (HHC) a grant to be administered by the National Institute for Occupational Safety and Health (NIOSH), to provide health services to non-responder populations in New York City affected by the World Trade Center terrorist attacks.[14] Under the grant, HHC provided medical examinations, diagnostic testing, referral and treatment for residents, students, and others in the community that were directly affected by the dust and debris from the collapse of the World Trade Center buildings on September 11, 2001.[15][16] Following the passage of the James Zadroga Act, the WTC EHC became part of the WTC Health Program.

In 2002 the Agency for Toxic Substances and Disease Registry and the New York City Health Department launched the World Trade Center Health Registry in collaboration with the National Institute for Occupational Safety and Health. By tracking and investigating illnesses, the WTC Health Registry strives to monitor the health of people exposed to the September 11, 2001 terrorist attacks.[17] The WTC Health Registry continues to release annual reports on new findings regarding the health effects resulting from the terrorist attacks.[18]

On August 14, 2006, then-Governor of New York George Pataki signed legislation to expand death benefits to Ground Zero workers who die from cancer or respiratory diseases, presumably from exposures to hazardous materials and toxins during recovery efforts. At the bill-signing ceremony, held at the World Trade Center site, Pataki mentioned James Zadroga, a New York Police Department officer and 9/11 responder who had fallen ill following the terrorist attacks and died of lung disease in 2006.[19] James Zadroga would become the namesake of the federal bill that created the WTC Health Program in 2011.

President Obama signing the James L. Zadroga 9/11 Health and Compensation Act of 2010 into law, January 2, 2011 at Plantation Estate in Hawaii.

Originally introduced in 2006 and eventually made law in 2011, the James L. Zadroga 9/11 Health and Compensation Act of 2010 funds and establishes a health program to provide medical treatment for responders and survivors who experienced or may experience health complications related to the 9/11 terrorist attacks. Senator Bob Menendez and Congresswoman Carolyn Maloney initially co-sponsored the bill, which failed to pass in 2006.[20][21]

The U.S. House passed a new version of the act[22] in September 2010. In a Senate vote held on December 9, 2010, Democrats were unable to break a Republican filibuster against the bill.[23] With only 57 votes to end the Senate filibuster and an incoming influx of Republicans in the wake of the 2010 Congressional Elections, the bill's future looked increasingly doubtful towards the end of 2010.[24]

On December 16, 2010 comedian Jon Stewart dedicated an entire episode of The Daily Show to the political battle over the Zadroga Act.[25][26][27] Stewart's coverage of the Republican filibuster raised media awareness of and public support for the bill, drawing praise from politicians and media outlets.[27][28]

On December 19, 2010, New York Senators Chuck Schumer and Kirsten Gillibrand introduced a $6.2 billion version of the bill paid for in part by closing a corporate tax loophole and in part by a 2% excise tax on foreign goods that did not include countries with international procurement agreements with the U.S.[29][24] On December 22, 2010, Congress approved the final bill, which allocated $4.2 billion towards the program,[30] and President Barack Obama signed the Zadroga Act into law on January 2, 2011. This act created the World Trade Center Health Program, which replaced earlier programs (Medical Monitoring and Treatment Program and the WTC Environmental Health Center program).[31]

The Zadroga Act established a process whereby the Administrator of the WTC Health Program may consider petitions by interested parties to add new conditions to the list of those covered by the WTC Health Program.[39] In June 2012, Administrator Dr. John Howard proposed adding certain types of cancer as recommended by the WTC Health Program Scientific/Technical Advisory Committee, in a Notice of Proposed Rulemaking.[40] Many types of cancer were officially added to the coverage list in 2012–2014.[41]