Hopkins study dispels 'panic' myth and suggests ways to involve public in response to a bioterrorist attack

December 04, 2001

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 Johns Hopkins Bloomberg School of Public Health, who reviewed the public's response to the terrorist attacks of September 11th, the recent anthrax mailings, and other disasters concluded that the public does not react with panic but with effective and adaptive action and can be an valuable response force and that should be considered in biodefense planning.

The study will appear in the January 15, 2001 edition of Clinical Infectious Diseases. In addition, the researchers recommend five guidelines for limiting panic and effectively managing the public during a bioterrorism attack.

The first recommendation for biodefense planners is to 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, PhD, 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," explains Dr. Schoch-Spana.

Dr. Schoch-Spana and her co-author, Thomas Glass, PhD, assistant professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, say leaders must provide timely accurate information and instructions during an attack so that the public can make decisions on how to protect themselves. Biodefense planners must also create a constructive role for the public, 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. Following the anthrax attack, 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," explains Dr. Glass.

Next, the researchers recommend that biodefense planners 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 attack, despite the dangers. Dr. Schoch-Spana led a rapid response research team to New York following the World Trade Center 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.

According to the researchers, biodefense planners must not solely rely on the hospital system to care for the sick during a bioterrorism disaster. "Hospitals today operate on a 'just-in-time' principal 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 non-professionals 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," explains Dr. Glass.

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," explains Dr. Schoch-Spana.

In addition, there is an urgent need to create an "information stockpile." Multilingual public services announcements, leaflets, and other materials should be developed to provide concrete information on vaccines, antibiotics, and exposure risks during a biological attack.

Finally, biodefense planners must develop trust with the community. The researchers recommend leaders continually educate the public on preparedness and response plans for bioterrorism and encourage the public's input on important biodefense planning measures. Leaders should also 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. 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," says Dr. Glass.
For more information, visit the Johns Hopkins Bloomberg School of Public Health website at http://www.jhsph.edu and the Johns Hopkins Center for Civilian Biodefense Strategies at http://www.hopkins-biodefense.org.

Johns Hopkins University Bloomberg School of Public Health

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