Postal workers lost trust in fed response to anthrax

Lesson in risk communications from 2001 attacks

With some citing the infamous Tuskegee incident, African-American postal workers exposed in the 2001 anthrax attacks were highly critical of the public health response, according to a recently published study.1 Researchers recommend that future communications on public health emergencies closely involve people from exposed population groups.

Conducted by investigators at the Rand Corp. in Washington, DC, the study recommended that well-known members of the exposed groups be enlisted to help authorities spread information about the health emergency. The message should be consistent and forthright, even about existing uncertainties. "If those directly affected by a public health emergency don’t have confidence in authorities, then it may be hard to get the public to take proper preventive steps," said Janice C. Blanchard, a RAND researcher and report lead author. "Our findings underscore the need to develop better ways to deliver direct, consistent, and accurate information to different groups during a health care emergency."

On Oct. 15, 2001, a letter containing anthrax was opened by a worker in the office of then-Senate Majority Leader Tom Daschle, triggering a public health emergency. About a month later, 22 cases of anthrax had been identified in the United States and a wide array of people had been exposed in the Washington, DC, area.

While the first concern about exposure occurred in the Hart Senate Office Building, no cases were reported there. Four cases of inhalation anthrax originated at the U.S. Postal Service facility on Brentwood Road in Washington that handled the contaminated letter four days before it was opened. Two of those four people died. Health officials did not focus their attention on the postal center until nine days after the tainted letter was discovered. In total, public health officials advised 2,743 people from the postal facility and 600 from the Hart building to take 60 days of preventive antibiotics.

Blanchard and colleagues evaluated perceptions of workers at the U.S. Postal Service Brentwood Processing and Distribution Center and U.S. Senate employees regarding public health responses to the anthrax mailings of October 2001. Transcripts from focus groups conducted with Brentwood and U.S. Senate employees were examined, and qualitative analysis identified common factors.

The Brentwood focus groups consisted of 36 participants (97% African American). U.S. Senate focus groups consisted of seven participants (71% White). African American workers at the U.S. Postal Service center in Washington where the tainted letter was processed were the most vocal in their criticism of information provided by authorities, according to the study.

The workers felt they were not treated with respect because they received attention days later than Senate staff.

They also said their view of the effort was influenced by the legacy of the Tuskegee syphilis experiment on black men, according to the study. In the 40-year-long Tuskegee experiment, 399 African American men with syphilis were denied treatment so researchers could document the natural progression of the disease. By the time the study ended in 1972, 128 men had died from syphilis or related complications.

The postal group also included several hearing-impaired workers, who reported that they felt cut off from information because no effort was made to account for their special communication needs. Many people reported that they turned to their personal physicians or local hospitals for counsel during the anthrax crisis, but found the doctors and hospitals had not been given any information. Workers from the U.S. Senate also said they lost confidence in public health officials during the crisis, but reported that their trust was eroded by inconsistent and disorganized messages that were delivered by a variety of health officials.

"We should not wait until a crisis hits before we try to build relationships with different groups," Blanchard said. "We’ve done this on health issues such as childhood immunizations and breast cancer screenings. We need to do it for bioterrorism, too."

People from both groups said officials from both the Centers for Disease Control and Prevention (CDC) and the District of Columbia Department of Health provided little useful information during the anthrax crisis. In addition, postal workers said information provided by postal managers was incomplete or inadequate. Senate workers reported that they received consistent and helpful information from the Capitol Physician’s Office, which is a regular provider of health care to the group. The postal workers reported that their primary source of information about the anthrax emergency was the news media, which they felt provided accurate information.

The CDC has admitted that many of its assumptions about anthrax were proven wrong in the attacks. One assumption that turned into a fatal error was that postal workers who processed the mail were at risk for cutaneous disease but not inhalational anthrax. (See Hospital Infection Control, May 2002, under archives at www.HIConline.com.)

Reference

1. Blanchard JC, Haywood Y, Stein BD, et al. In their own words: Lessons learned from those exposed to anthrax. Am J Public Health 2005; 95(3):489-495.