Top-down bio plans err on public cooperation

People will be full of fear and distrust 

Skeptical about government instructions and concerned about loved ones, many Americans would not follow established plans in the event of a real bioterrorism attack, according to a new study 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 found that only two-fifths of 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," says lead investigator Roz Lasker, MD, 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."

Reducing the risk

Though current plans will put many people unnecessarily at risk, immediate actions can be taken to dramatically increase their effectiveness, said Lasker. "Our study shows that if planners listened to and learned from the public, they could protect many more people," he says.

Redefining Readiness: Terrorism Planning Through the Eyes of the Public was based on interviews with government and private-sector planners, group discussions with diverse community residents around the country, and a telephone survey of 2,545 randomly selected adults in the continental United States. Many people fear the smallpox vaccine more than the disease, possibly undermining vaccination efforts, the research found. The study also shows that two-thirds of respondents would try to avoid being with strangers in a smallpox outbreak, suggesting they would be reluctant to report to vaccination sites. Concern for their loved ones was the primary reason cited by people who said they would not fully cooperate with instructions to stay inside the building after a dirty bomb. The report includes model plans to bring the public in and prevent such problems.

For example, the study’s proposed smallpox plans include specific strategies that protect both the people who are at risk of contracting smallpox and the 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.