An ounce of prevention is worth a pound of cure: Improving communication to reduce mortality during bioterrorism responses

Authors

  • Margaret L. Brandeau, PhD
  • Gregory S. Zaric, PhD
  • Johannes Freiesleben, PhD
  • Frances L. Edwards, PhD
  • Dena M. Bravata, MD, MS

DOI:

https://doi.org/10.5055/ajdm.2008.0010

Keywords:

anthrax, risk communication, bioterrorism, preparedness planning

Abstract

Objective: To identify communication needs and evaluate the effectiveness of alternative communication strategies for bioterrorism responses.
Methods: We provide a framework for evaluating communication needs during a bioterrorism response. Then, using a simulation model of a hypothetical response to anthrax bioterrorism in a large metropolitan area, we evaluate the costs and benefits of alternative strategies for communication during a response.
Results: Expected mortality increases significantly with increases in the time for attack detection and announcement; decreases in the rate at which exposed individuals seek and receive prophylaxis; increases in the number of unexposed people seeking prophylaxis; and increases in workload imbalances at dispensing centers. Thus, the timeliness, accuracy, and precision of communications about the mechanisms of exposure and instructions for obtaining prophylaxis and treatment are critical. Investment in strategies that improve adherence to prophylaxis is likely to be highly cost effective, even if the improvement in adherence is modest, and even if such strategies reduce the prophylaxis dispensing rate.
Conclusions: Communication during the response to a bioterror attack must involve the right information delivered at the appropriate time in an effective manner from trusted sources. Because the response system for bioterror communication is only fully operationalized once an attack has occurred, tabletop planning and simulation exercises, and other up-front investments in the design of an effective communication strategy, are critical for effective response planning.

Author Biographies

Margaret L. Brandeau, PhD

Department of Management Science and Engineering, Stanford University, Stanford, California.

Gregory S. Zaric, PhD

Ivey School of Business, University of Western Ontario, London, Ontario, Canada.

Johannes Freiesleben, PhD

Credit Suisse AG, Zurich, Switzerland.

Frances L. Edwards, PhD

Department of Political Science, San Jose State University, San Jose, California.

Dena M. Bravata, MD, MS

Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California.

References

American Public Health Association: National Preparedness Public Opinion Survey, 2007. Available at www.nphw.org/2007/pg_tools_poll.htm. Accessed November 20, 2007.

Burton PW, Silver BD: The credibility of disaster evacuation warnings: The effects of issue framing and trust in government. Annual Meeting of the American Political Science Association. Philadelphia, PA, 2006.

Cooper C, Block R: Disaster! Hurricane Katrina and the Failure of Homeland Security. New York: Times Books, 2006.

Edwards F: Commissioner, California Seismic Safety Commission, 1991-1995, Site visits January 21-26, 1995; 2007.

Ding AW: A theoretical model of public response to the Homeland Security Advisory System. J Disast Med Serv. 2006; 3: 45-55.

Edwards F: Director, Office of Emergency Services, City of San Jose 1991-2006, 2007.

American Red Cross. Talking About Disasters: Guide for Standard Messages.Washington, DC: American Red Cross, 2006.

Lopes R: Eleven C’s of Community Disaster Education. Washington, DC: American Red Cross, 2002.

American Red Cross: Terrorism; 2007. Available at www. redcross.org/images/pdfs/code/terrorism.pdf. Accessed November 20, 2007.

Centers for Disease Control and Prevention (CDC): Communicating in the First Hours: Initial Communication With the Public During a Potential Terrorism Event, 2007. Available at www.bt.cdc.gov/firsthours/. Accessed November 20, 2007.

Santa Clara County California Public Health Department: Bioterrorism Information for Physicians: Zebra Pack, 1999. Available at www.sccgov.org. Accessed November 20, 2007.

Santa Clara County California Public Health Department: Pandemic Influenza Preparedness and Response Plan; 2007. Available at www.sccgov.org/sccsearch/ui.jsp. Accessed November 20, 2007.

Manning FJ, Goldfrank L (eds.): Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program. Washington, DC: National Academy of Sciences, 2002.

Reuland M, Davies HJ: Protecting Your Community From Terrorism: Strategies for Local Law Enforcement.Washington, DC: Police Executive Research Forum, 2004.

Governor’s Office of Emergency Services: San Francisco Bay Area Regional Emergency Coordination Plan, Appendix K, Bay Area Emergency Public Information Network Guide, 2007. Available at http://www.oes.ca.gov/Operational/OESHome.nsf/PDF/Bay%20Area %20Regional%20Coordination%20Plan/$file/BARECPlan.pdf. Accessed March 9, 2008.

Booth S, Hills-Evans K: Influenza pandemic preparation and response: A citizen’s guide, Mid-Peninsula Citizens Preparedness Committee, 2007. Available at http://www.newfluwiki2.com/ upload/Citizen’s%20Guide%20-%20Version%201.2.pdf. Accessed March 9, 2008.

Edwards-Winslow F: Telling it like it is: The role of the media in terrorism response and recovery. In Kayyam J, Pangi R, (eds.): First to Arrive: State and Local Response to Terrorism. Cambridge, MA: MIT Press, 2003: 59-75.

Clarke C, Chess C, Holmes R, O’Neill KM: Speaking with one voice: Risk communication lessons from the US anthrax attacks. J Conting Crisis Manag. 2006; 14: 160-169.

Covello VT, Peters RG,Wojtecki JG, et al.: Risk communication, the West Nile virus epidemic, and bioterrorism: Responding to the communication challenges posed by the intentional or unintentional release of a pathogen in an urban setting. J Urban Health. 2001; 78: 382-391.

Sandman P. Beyond panic prevention: Addressing emotion in emergency communication. Atlanta, GA: Centers for Disease Control and Prevention, 2001. Emergency Risk Communication CDCynergy.

Bravata DM, Zaric GS, Holty J-EC, et al.: Reducing mortality from anthrax bioterrorism: Costs and benefits of alternative strategies for stockpiling and dispensing medical and pharmaceutical supplies. Biosecur Bioterror. 2006; 4(3): 244-262.

Zaric G, Brandeau M, Bravata D, Holty J-E, McDonald K, Owens D: Modeling the logistics of response to anthrax bioterrorism. Med Decis Making 2008.

Holty JE, Bravata DM, Liu H, Olshen RA, McDonald K, Owens DK: Systematic review: a century of inhalational anthrax cases from 1900 to 2005. Ann Intern Med. 2006; 144: 270-280.

U.S. Bureau of the Census: Statistical Abstract of the United States.Washington, DC:U.S. Department of Commerce, 2006.

Shepard CW, Soriano-Gabarro M, Zell ER, et al.: Antimicrobial postexposure prophylaxis for anthrax: Adverse events and adherence. Emerg Infect Dis. 2002; 8: 1124-1132.

Hupert N, Mushlin AI, Callahan MA. Modeling the public health response to bioterrorism: using discrete event simulation to design antibiotic distribution centers. Med Decis Making. 2002; 22 (5 suppl): S17-S25.

Centers for Disease Control and Prevention (CDC): Strategic National Stockpile. Available at http://www.bt.cdc.gov/stockpile/ index.asp. Accessed June 7, 2007.

Centers for Disease Control and Prevention (CDC): National Pharmaceutical Stockpile. Available at www.bt.cdc.gov/Documents App/NationalStockpile/national_pharmaceutical_stockpile.pdf. Accessed August 17, 2003.

Bravata DM, McDonald K, Owens DK, et al.: Regionalization of Bioterrorism Preparedness and Response (Evidence Report/ Technology Assessment). Rockville, MD: Agency for Healthcare Research and Quality, 2003.

Centers for Disease Control and Prevention (CDC). Receiving, Distributing, and Dispensing the National Pharmaceutical Stockpile: A Guide for Planners. Version 9 – Draft. Atlanta, GA, April 2002.

Higgins J, Cooper M, Schroeder-Tucker L, et al.: A field investigation of Bacillus anthracis contamination of U.S. Department of Agriculture and other Washington, D.C., buildings during the anthrax attack of October 2001. Appl Environ Microbiol. 2003; 69: 593-599.

Burnier M: Medication adherence and persistence as the cornerstone of effective antihypertensive therapy. Am J Hypertens. 2006; 19: 1190-1196.

Rueda S, Park-Wyllie LY, Bayoumi AM, et al.: Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database of Systematic Reviews 2006: 3.

Sorenson J. Risk communication and terrorism. Biosecur Bioterror: Biodefense Strategy, Practice, Science. 2004; 2: 229-231.

Santa Clara County California Public Health Department: Your Guide to Preparing for Pandemic Flu. San Jose, CA: Santa Clara County Public Health Department, 2006.

Downloads

Published

03/01/2008

How to Cite

Brandeau, PhD, M. L., G. S. Zaric, PhD, J. Freiesleben, PhD, F. L. Edwards, PhD, and D. M. Bravata, MD, MS. “An Ounce of Prevention Is Worth a Pound of Cure: Improving Communication to Reduce Mortality During Bioterrorism Responses”. American Journal of Disaster Medicine, vol. 3, no. 2, Mar. 2008, pp. 65-78, doi:10.5055/ajdm.2008.0010.

Issue

Section

Articles