Bio-terrorism and Health Risk Communication (2005)Barbera, Joseph, Anthony Macintyre, Larry Gostin, Tom Inglesby, Tara O'Toole, Craig DeAtley, Kevin Tonat, and Marci Layton Abstract: Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action.
Freimuth, Vicki, Huan W. Linnan, and Polyxeni Potter Abstract: The researchers are based in Atlanta , Georgia at the CDC. Their topic of interest is health communication, which is both a combination of crisis and risk communication. Their definition is, “the study and use of methods to inform and influence individual and community decisions that enhance health” (338). The communication process is outlined for each separate entity involved (audience, message, source, etc.). Audience segmentation is listed as an effective way to target certain groups depending on the risk. Numerous theories are cited as possible guides for effective communication.
Health and Human Services , U.S. Department of Abstract: Through development work and literature reviews, the Subcommittee found that, with the possible exception of the National Cancer Institute (NCI) of the National Institutes of Health (NIH), most PHS agencies do not systematically apply agency-specific principles and standards in practicing effective health risk communications. NCI, in 1989, made a significant contribution to the study and practice of health communications by developing a six-stage approach to health communication, commonly referred to as the "health communication wheel." The major steps in the NCI wheel are designed to integrate assessments of target audience needs and perceptions at critical points in program development and implementation. A slightly modified version of the NCI wheel (Appendix 2) has been incorporated into the Subcommittee's recommendation for recognizing proven methods in health risk communications .
Inglesby, Thomas V., Rita Grossman, and Tara O'Toole Abstract : The United States Congress directed the Department of Justice to conduct an exercise engaging key personnel in the management of mock chemical, biological, or cyber terrorist attacks. The resulting exercise was called “TOPOFF,” named for its engagement of top officials of the United States government. This article offers a number of medical and public health observations and lessons discovered during the bioterrorism component of the exercise. The TOPOFF exercise illuminated problematic issues of leadership and decision-making; the difficulties of prioritization and distribution of scarce resources; the crisis that contagious epidemics would cause in health care facilities; and the critical need to formulate sound principles of disease containment. These lessons should provoke consideration of future directions for bioterrorism planning and preparedness at all levels of government and among the many communities and practitioners with responsibilities for national security and public health.
Kellman, Barry and Suzanne Spaulding Abstract: The threat of a bioterrorist attack opens up many difficult legal questions; the nature of the issue, itself, is set in a unique legal environment. Bioterrorism cross-permeates into the realms of public health, criminal law, national security, the environment and the rules of war, among others. And since it cannot be pigeon-holed neatly into any single category, there is a need, at the domestic level, for the effective coordination of resources, personnel, training and equipment among all relevant authorities at the federal, state, and local levels.
O'Toole, Tara, Michael Mair, and Thomas V. Inglesby Abstract: On 22–23 June 2001, the Johns Hopkins Center for Civilian Biodefense Strategies, in collaboration with the Center for Strategic and International Studies, the Analytic Services Institute for Homeland Security, and the Oklahoma National Memorial Institute for the Prevention of Terrorism, held a senior-level exercise entitled “Dark Winter” that simulated a covert smallpox attack on the United States . The first such exercise of its kind, Dark Winter was constructed to examine the challenges that senior-level policy makers would face if confronted with a bioterrorist attack that initiated outbreaks of highly contagious disease. The exercise was intended to increase awareness of the scope and character of the threat posed by biological weapons among senior national security experts and to bring about actions that would improve prevention and response strategies.
RAND Health Abstract: Over the past three years, state and local health departments throughout the United States have undertaken a variety of activities and initiatives to improve their level of preparedness for bioterrorism and other public health emergencies. Under a contract with the Department of Health and Human Services (DHHS), RAND was asked to develop a repository of practices for public health emergency and bioterrorism preparedness at the state and local levels that can serve as exemplars of preparedness for responding to bioterrorism and other public health emergencies. The selection of exemplary practices is one of several tasks in RAND 's work for DHHS. This report describes RAND 's approach and methods for identifying and evaluating practices and describes the individual practices nominated as exemplary.
Sandman, Peter M. Abstract: Over-reassurance is a virtually universal problem in risk communication; those in charge tend to dwell too little on what might go wrong. Vaccination has traditionally been a perfect case in point. Public health communicators try to be conscientious about telling prospective vaccines what might go wrong perhaps even what some critics allege might go wrong. But their heart isn't in it. They believe in the vaccine and the vaccination process, and it shows in their tendency to over-reassure (or under-warn) about vaccine side effects.
Schoch-Spana, Monica Abstract: The 1918 |
1919 influenza pandemic (Spanish flu) had catastrophic effects upon urban populations in the United States . Large numbers of frightened, critically ill people overwhelmed health care providers. Mortuaries and cemeteries were severely strained by rapid accumulation of corpses of flu victims. Understanding of the outbreak's extent and effectiveness of containment measures was obscured by the swiftness of the disease and an inadequate health reporting system. Epidemic controls such as closing public gathering places elicited both community support and resistance, and fear of contagion incited social and ethnic tensions. Review of this infamous outbreak is intended to advance discussions among health professionals and policymakers about an effective medical and public health response to bioterrorism, an infectious disease crisis of increasing likelihood. Elements of an adequate response include building capacity to care for mass casualties, providing emergency burials that respect social mores, properly characterizing the outbreak, earning public confidence in epidemic containment measures, protecting against social discrimination, and fairly allocating health resources.