Terrorism Response Plans Will Not Protect Many Americans, New Academy Study Finds

WASHINGTON, D.C., Sept. 14???What would you do if you found out that some people in your community had become sick with smallpox after having been exposed to the virus in a terrorist attack at a major airport? What if terrorists exploded a dirty bomb a mile away, when you were at work and your children were at school?

In these crisis situations, many Americans would not be safeguarded because existing terrorism response plans don???t account for how people would behave, according to a study released today by the Center for the Advancement of Collaborative Strategies in Health at The New York Academy of Medicine. Current plans have been created in a ???top-down??? style, telling people what to do in the event of an attack without considering all of the risks and concerns that drive people???s actions, the investigators found.

The study documents that only two-fifths of the American people would follow instructions to go to a public vaccination site in a smallpox outbreak and only three-fifths would stay inside an undamaged building other than their home after a dirty bomb explosion. ???It???s not that the rest of the people want to be uncooperative,??? said lead investigator Roz Lasker, M.D., Director of the Center and of the Academy???s Division of Public Health. ???The problem is that current plans unwittingly put them in extremely difficult decision-making predicaments. So even if first responders work out all of the challenging logistics, far fewer people would be protected than planners want or the public deserves.???

Existing terrorism response plans don't account for how people would behave

Though current plans will put many people unnecessarily at risk, immediate actions can be taken to dramatically increase their effectiveness, said Lasker, who is releasing the study with co-investigators this morning at a National Press Club briefing. ???Our study shows that if planners listened to and learned from the public, they could protect many more people.???

Called Redefining Readiness: Terrorism Planning Through the Eyes of the Public and funded by the W. K. Kellogg Foundation, this year-long study gave the American people their first opportunity to describe how they would react to two kinds of terrorist attacks: a smallpox outbreak and a dirty bomb explosion. The rigorous study involved in-depth conversations with government and private-sector planners, 14 group discussions with diverse community residents around the country, and a telephone survey of 2,545 randomly selected adults in the continental United States. To view the report online click here

In preparing to respond to a smallpox outbreak, planners have focused almost exclusively on protecting people from catching the potentially fatal disease. But the study shows that this isn???t the only risk the American people face. Three-fifths of the population would be seriously worried about the vaccine ??? that???s twice as many people as would be seriously worried about catching smallpox. Vaccine worries would keep many people away from the vaccination site.

???The public???s concern about the smallpox vaccine is well founded,??? said study co-investigator Alonzo Plough, Ph.D., Director of Public Health in Seattle and King County, Washington. Over 50 million people in this country have conditions like eczema, pregnancy, or immune system problems that put them at risk of developing severe complications from the vaccine, either from being vaccinated themselves or from coming in contact with someone who has recently been vaccinated. ???Concerns about the vaccine???s side effects were a major reason that so few health care workers agreed to be vaccinated in CDC???s recent Smallpox Vaccination Program,??? Plough said.

The study also shows that two-thirds of the American people would try to avoid being with other people they don???t know in a smallpox outbreak. But this puts people in a terrible predicament, because they can???t simultaneously isolate themselves and go to a public vaccination site. Two-fifths of the population would be afraid of catching smallpox from other people at the site, the study found. One-fifth would be afraid of coming in contact with someone who shouldn???t be exposed to recently vaccinated people.

In the event of a dirty bomb explosion, the study shows that people need to be protected from more than dust and radiation. They also need to know that they and their loved ones would be safe and cared for in whatever building they happen to be in at the time of an explosion. Three-quarters of the people who said they would not fully cooperate with instructions to stay inside the building after a dirty bomb explosion would do so if (1) they could communicate with people they care about or (2) if they were sure that they and their loved ones were in places that had prepared in advance to take good care of them in this kind of situation. But three-fifths of Americans know only a little or nothing at all about how people would actually be cared for in these places.

Because current plans to deal with smallpox and dirty bomb attacks create unanticipated problems for the public, a large number of people who should be protected will be unnecessarily harmed if these kinds of attacks occur. Such problems can be avoided by adopting the model plans proposed in the study, said co-investigator Otis Johnson, Mayor of Savannah, Georgia. ???These model plans reduce the conflicting worries and trade-offs that people face, making it possible for many more people to take actions that will protect them and their family.???

The study???s proposed smallpox plans include specific strategies that protect both the people who are at risk of contracting smallpox and the many people who are at risk of developing serious complications from the vaccine. The study???s dirty bomb response calls for the development of safe-haven plans in the broad array of places where people are likely to be when an attack occurs, such as work sites, shops, malls, schools, day care centers, and entertainment facilities. That means preparing to keep the people inside fed and safe during the crisis.

The Redefining Readiness study documents the value of letting the American people speak for themselves rather than relying on planners??? untested assumptions about what the public cares about and how the public will behave. ???Because the study???s findings about smallpox and dirty bomb attacks are generalizable, planners throughout the country can use this information to strengthen their responses to these situations,??? Plough said. ???Some strategies in the model plans are also applicable to certain natural emergencies, like pandemic influenza, SARS, or an electrical blackout.???

Mayor Johnson added that ???to find out what would matter to the public in other kinds of emergencies, planners will need to work directly with the residents of their communities.??? Fortunately, the study documents that over a third of the American people have a strong personal interest in participating in community and organizational planning. As the study found, putting people in specific and realistic crisis scenarios is an effective tool for engaging the public. Through upcoming demonstration projects, the Center will provide planners with the information they need to put this kind of public engagement into practice.

The New York Academy of Medicine is a nonpartisan, nonprofit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education, and advocacy with a particular focus on disadvantaged urban populations.

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Posted on September 14, 2004

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