Panel urges leaders to be forthright and open

Don’t withhold info out of fear of public panic

Given the well-chronicled vulnerabilities of human society to large-scale disease outbreaks, the prospect of "deliberate epidemics" is a daunting one for both political and medical leadership.

In that regard, a working group has published a bioterrorism leadership guide to assist such decision makers, including governors, mayors, and health officials.1

The panel concluded that governing successfully during large, fast-moving, lethal epidemics requires dynamic collaboration among members of a community and the community’s leaders.

"Particularly in the context of bioterrorism, when fear and uncertainty may be significant forces, leaders’ abilities to enlist communities in a collaborative effort to care for the sick and prevent the spread of disease could prove pivotal, not only in terms of implementing an adequate response to the health crisis, but in limiting social and economic losses and in preserving fundamental democratic values and processes," the authors concluded. They outline five strategic goals:

1. Limit death and suffering through proper preventive, curative, and supportive care; tend to the greater vulnerability of children, the frail elderly, and the physically compromised.

2. Defend civil liberties by using the least restrictive interventions to contain an infectious agent that causes communicable disease.

3. Preserve economic stability, managing the financial blow to victims as well as the near- and long-term losses of hard-hit industries, cities, and neighborhoods.

4. Discourage scapegoating, hate crimes, and the stigmatization of specific people or places as "contaminated" or unhealthy.

5. Bolster the ability of individuals and the larger community to rebound from unpredictable and traumatic events; provide mental health support to those who need it.

The report urges transparency in government actions, noting attempts to hide or hinder reports of disease historically have backfired. Breaches of social trust are a common predicament for leaders during outbreaks and are likely to arise during a bioattack. Social and economic fault lines as well as preconceived notions about "the government," "the public," and "the media" can alienate leaders and the public and community members from one another. The authors urged leaders to:

  • Share what you know. Do not withhold information because you think people will panic. Creative coping is the norm; panic is the exception.
  • Hold press briefings early and often to reach the public. Answering questions is not a distraction from managing the crisis; it is managing the crisis.
  • Confirm that local health agencies and medical facilities are prepared to handle an onslaught of questions from concerned individuals, in person and by phone.
  • Convey basic health facts clearly and quickly so people have peace of mind that they are safe or so that they seek out care, if needed. Similarly, brief health care and emergency workers so they have a realistic understanding about job safety.
  • View rumors as a normal sign of people’s need to make sense of vague or disturbing events. Refine your outreach efforts; the current ones may not be working.


1. The Working Group on "Governance Dilemmas" in Bioterrorism Response. Leading during bioattacks and epidemics with the public’s trust and help. Biosecurity and Bioterrorism 2004; 2. Web: