Molly J. Hall, Ann E. Norwood, Robert J. Ursano, Carol S. Fullerton


Biosecur Bioterror. 2003;1(2) 

In This Article

Risk Communication and Bioterrorism

Distress, changes in behavior, psychiatric conditions, and medically unexplained physical symptoms reflect the psychological burden of terrorism. Interventions range from public health education and information campaigns to clinical care of individual patients. Response to a biological attack or other terrorism event requires effective risk communication from government and medical leadership to manage rumor and scapegoating as well as other fear-based behaviors. This in turn rests on an incident management system with effective information processing, a response not well developed in the public health and medical arena in contrast to fire response and military systems.[26] Information management is an active planning process that allows proactive development of response objectives, strategies, and priorities. Communication or conveying information is one component of information management. Risk communication is a scientifically based method for communicating effectively under high-threat conditions. Many of the difficulties in the anthrax event could have been avoided with a clear information management system -- notably conflicting recommendations from different jurisdictions in the national capital area on prophylaxis and vaccination. Consistent, accurate information that does not mix reassurance with facts is critical to authorities' credibility and the public's confidence.

Well developed, well thought out risk communication and public education can lessen many of the psychological responses that might hamper disease containment or undermine the nation's ability to respond to bioterrorism. A bioterrorism event presents unique challenges for risk communication efforts to sustain personal and community confidence in a time of great uncertainty and unpredictability.[27] Although prosocial behavior is the norm in natural and manmade disasters,[28] a bioterrorism attack employing a contagious, disfiguring, lethal organism like smallpox would increase the likelihood of fear-based behaviors and even panic. Bioterrorism poses a threat that encompasses elements of our highest risk perceptions and the accompanying fear and anxiety are intense. Strong emotions influence how individuals receive and understand information, and high levels of stress may lead to decision-making that is more urgent, less willing to consider options or alternatives, and driven to premature closure.[27]

Identification of an outbreak that may be a terrorist attack, when there are more questions than answers, is a time of heightened vulnerability for inaccurate information, speculation, worst-case scenarios, and hype. Simple restraint and acknowledging that one "does not yet know but the following steps are being taken to find out" is much safer and more helpful than having to reverse misstatements later. The medical and scientific community must actively reach out to the media and keep the press engaged as well as direct attention to stories that will inform and help the public respond. It would have been very helpful, for instance, had the role of nasal swabbing for spores been made clear during the anthrax attacks. The presence of spores in the nasal passages was not a measure of infection and did not translate to spores in the lung. Nasal swabs were collected from Capitol Hill workers and not Brentwood postal employees because in the former group, the timing and spread of spores could be tracked back to a known time of release -- when the letter was opened.

Coordinated information sharing is vital. Credible scientific authority, a clear news media message, and timely, accurate information from government leaders providing the rationale behind difficult decisions is critical.

Health care providers and the health care system are first responders in bioterrorist events. In the 1994 outbreak of pneumonic plague in Surat, India, 80% of the private physicians fled the city.[29] Absenteeism can result from the conflicted loyalties of the hospital staff, divided between caring for their own families and taking care of patients. Developing plans to ensure that employees' families are cared for in the wake of a bioterrorist attack may diminish this absenteeism. Demoralization is also a concern if there are high mortality rates and an inability to provide adequate care for advanced illness. It is important to be aware of these issues and incorporate them into planning and exercise scenarios.


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