Planners and policy-makers have long discounted the public's ability to participate in a response to bioterrorism because of a belief that an attack would create mass panic and social disorder. However, researchers at the Bloomberg School of Public Health who reviewed the public's response to the terrorist attacks of Sept. 11, the recent anthrax mailings and other disasters concluded that the public reacts with effective and adaptive action and can be a valuable response force, which should be considered in biodefense planning. The study will appear in the Jan. 15, 2002, edition of Clinical Infectious Diseases.
In addition, the researchers recommend to biodefense planners five guidelines for limiting panic and effectively managing the public during an attack:
First, understand that public panic is rare and preventable. "It is a myth that a community's first response to a crisis is panic. Yet bioterrorism contingency planners have too frequently incorporated the images of a hysterical or lawless mob in their discussions and response exercises. They have made no efforts to capitalize upon the constructive reactions that tend to dominate community responses to crisis, as borne out by history," says Monica Schoch-Spana, the study's co-author and a senior fellow at the Johns Hopkins Center for Civilian Biodefense Strategies. "Although we do not know how people would respond in an unprecedented biological attack, we have found that people usually adapt to a situation based on the best information available, and they often try to assist one another through a crisis."
Leaders must provide timely, accurate information and instructions during an attack so that the public can make decisions on how to protect themselves, according to Schoch-Spana and her co-author, Thomas Glass, an assistant professor of epidemiology at the Bloomberg School of Public Health. Biodefense planners also must create for the public a constructive role, which should be closely based on existing social structures and routines.
"People tend to stick to the standards of civil behavior and their normal social roles even under the most challenging circumstances," Glass says. "Following the anthrax attacks, sales of Ciproflaxacin and gas masks increased dramatically. This was not a panic reaction. Based on the circumstances, many people reasonably thought this was the best way to protect themselves, their families and their children."
Biodefense planners should recognize the public as an active participant in responding to an attack. Volunteers and organizations rushed to ground zero to help survivors of the World Trade Center attacks, despite the dangers, the researchers point out. Schoch-Spana led a rapid response research team to New York following the attacks, documenting the creative and resourceful ways people have organized themselves to offer assistance over the short and long term. Similarly, in the bioterrorism context, civic organizations such as churches, charities and associations could be used to distribute information and medications, and to monitor for disease outbreaks.
Biodefense planners must not rely solely on the hospital system to care for the sick during a bioterrorism disaster. "Hospitals today operate on a 'just-in-time' principle to deliver care. They do not have enough doctors, nurses, beds or equipment to care for a massive surge of patients. We will need to rely on volunteers and nonprofessionals to deliver some care and use community groups as we once did during the flu pandemic of 1918 or as the Israeli government did during the Persian Gulf War," Glass explains.
The researchers stress that information and communication with the community must be an important component of biodefense. Inaccurate or contradictory information could lead to mistrust of authorities, confusion, panic and increased fear. "Leaders must treat information as importantly as they treat medicine. Good communication and practical prevention tips will be vitally important in successfully dealing with a bioterrorism attack," Schoch-Spana says.
In addition, there is an urgent need to create an "information stockpile." Multilingual public service announcements, leaflets and other materials should be developed to provide concrete information on vaccines, antibiotics and exposure risks during a biological attack.
To develop trust with the community, the researchers recommend leaders continually educate the public on preparedness and response plans and encourage the public's input on important biodefense planning measures. Leaders also should develop a collaborative relationship with the news media to ensure an open flow of information during an emergency.
"For a long time, biodefense planners have viewed the public as bystanders during a potential crisis, but the people will play a critical role during a bioterrorism attack," Glass says. "As we spend another $500 million buying enough smallpox vaccine to fill several warehouses, we must at the same time understand that teaching people concrete and practical steps they can take to avoid becoming infected or infecting others will remain the first and most important line of defense in the aftermath of a bioterrorist attack."