On February 3-4, 2003, the Johns Hopkins Center for Civilian Biodefense Strategies [now the Center for Biosecurity of UPMC] convened a summit on engaging "the public" in bioterrorism planning and response. The purpose of this event was to synthesize for government and public health authorities the essential principles of leadership, based on frontline experiences with recent terrorism events and other relevant crises, that encourage the public's constructive collaboration in confronting a bioterrorist attack.
More than 160 people attended representing senior operational decision-makers in public health and safety-including the bioterrorism coordinators from 35 state and local health agencies-as well as thought leaders and policy makers in medicine, public health, nursing, hospital administration, disaster relief, and national security.
Key issues included the following:
Suggested reading list:
Barbera J, Macintyre A, Gostin L, et al. Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences. JAMA. Dec 5, 2001; 286(21): Critically examines the feasibility, efficacy and social acceptability of large-scale quarantine as a measure to control the spread of contagious disease.
Covello VT, Peters RG, Wojtecki JG et al. Risk communication, the West Nile virus epidemic and bioterrorism. Journal of Urban Health. June, 2001; 78(2). Reviews risk communication perspectives and models in light of the case of the New York City outbreak of West Nile virus and an hypothesized biological attack.
Glass T & Schoch-Spana M. Bioterrorism and the people: how to vaccinate a city against panic. Clinical Infectious Diseases. Jan 15, 2002; 34(2): Outlines guidelines for integrating the public into bioterrorism response planning.
Hall MJ, Norwood AE, Ursano RJ et al. Psychological and behavioral impacts of bioterrorism. PTSD Research Quarterly. Fall, 2002;13(4): Review article on psychological consequences of bioterrorism that provides selected abstracts from relevant literature.
Inglesby TV, Grossman R & O'Toole T. A plague on your city: observations from TOPOFF. Clinical Infectious Diseases. Feb 1, 2001; (32): Conveys lessons learned from exercise with top government officials to test nation's ability to react to multiple terrorist attacks. Problems related to bioterrorism response included distribution of scare resources, contagious disease within health care facilities, and need for sound disease containment principles.
O'Toole T, Mair M, & Inglesby TV. Shining light on Dark Winter. Clinical Infectious Diseases. Apr 1, 2002; 34(7): Offers lessons learned from Dark Winter, a tabletop exercise in which former senior-level government officials simulated National Security Council meetings in reaction to a mock smallpox attack.
Schoch-Spana M. Implications of pandemic influenza for bioterrorism response. Clinical Infectious Diseases. Dec 2000; 31(6). Draws upon the 1918 influenza pandemic case to inform public health planning for bioterrorism response; discusses issues of public confidence in epidemic containment measures, fair allocation of resources, and protection against discrimination.
This conference was supported under award #2000-DT-CX-K002 from the Memorial Institute for the Prevention of Terrorism (MIPT) and the Office of Justice Programs, National Institute of Justice, U.S. Department of Justice, and award number 2000-10-7 from The Alfred P. Sloan Foundation. Points of view expressed during the course of this meeting are those of the individual speakers and do not necessarily represent the official position of MIPT, the US Department of Justice, or The Alfred P. Sloan Foundation.
Titles link to transcripts
Welcome: Monica Schoch-Spana, PhD
Leadership's role in helping New Yorkers prevail after 9/11: Neal L. Cohen, MD
Rethinking Preconceptions about Mass Response to Crisis: Is a panicked public, assumed in most bioterrorism planning situations, a myth or reality? Are epidemics like other disasters, or are they different? What do we know about the continuum of psychological and social reactions in the context of trauma and crisis, ranging from mental anguish and social demoralization to more salutary phenomena? How can leaders' decisions and actions exacerbate social tensions, making the public more or less of an asset in crisis?
Introduction and Chair: Robert J. Ursano, MD
Anticipated psychological impact of bioterrorism: Ann E. Norwood, MD, COL, MC, USA
The problem of panic in disaster response: Lee Clarke, PhD
Public resistance or cooperation? Historical experiences with smallpox: Judith W. Leavitt, PhD
The Health and Safety of Actual People, Not a Theoretical Public: How should leaders plan for the public health and safety requirements of special populations? How can leaders mobilize a collective, coordinated response to an epidemic when interacting with a socio-economically and ethnically diverse population?
Introduction and Chair: Monica Schoch-Spana, PhD
The frail and the hardy seniors of 9/11: The needs and contributions of older Americans: Myrna I. Lewis, PhD
The value of culture and social capital in national defense and bioterrorism preparedness: Kathleen Rand Reed, MAA
The role of schools in meeting communities' needs during bioterrorism: Bradley D. Stein, MD, PhD
The people talk back: Anthrax 2001 public communication lessons: Monica Schoch-Spana, PhD (Chair)
How leaders can confidently step up to a reporter's mic? John J. Burke, JD
Civil Society as an Asset during a Public Health Emergency: How can leaders make the best use of pre-existing volunteer networks and turn individual volunteers into an asset? How should leaders manage volunteer impulses in the bioterrorism context; is bioterrorism different from other humanitarian situations? How can workplaces, schools, and other everyday institutions be equipped to help populations cope with a crisis?
Introduction: Kathleen J. Tierney, PhD (Chair)
Community organizations acting during crisis: 9/11 and neighborhood associations: Diane S. Lapson
Mobilizing a community around the desire to protect children: Ernie Allen
They will be there: Managing and protecting volunteers: John Clizbe, PhD
How to Lead a Community during Times of Trouble: What challenges do leaders face when interacting with the public in the context of grave peril? What communication pitfalls should leaders avoid during a public health emergency? How can an environment of trust and credibility be cultivated so that the public is inclined to act on public health guidance? When and how should leaders seek input from public stakeholders on tough decisions that could arise (e.g., prioritized distribution of scarce medical resources)? How can government decision-makers reach out to civic leaders prior to a crisis and establish alliances for communicating critical information? What challenges do leaders face during the crisis recovery period?
Roundtable discussion among the following panelists: [transcript]
Ernie Allen, President and CEO, National Center for Missing and Exploited
John Burke, JD, President, Strategic Communications, Inc.
Lee Clarke, PhD, Professor of Sociology, Rutgers University
John Clizbe, PhD, Interim Executive Director, Triangle Area Chapter, American Red Cross, Raleigh, NC; former Vice President of Disaster Services, American Red Cross
Neal Cohen, MD, Executive Director, AMDeC Center on Biodefense; former New York City Commissioner of Health
Diane S. Lapson, Vice President, Independence Plaza North Tenent Association, New York City
Judith W. Leavitt, PhD, Professor, History of Medicine, University of Wisconsin Medical School
Myrna I. Lewis, Assistant Clinical Professor, Department of Community and Preventive Medicine, Mt. Sinai School of Medicine
Ann E. Norwood, MD, Col. MC, USA, Associate Professor and Associate Chairman, Department of Psychiatry, Uniformed Services University
Kathleen Rand Reed, MAA, Applied Biocultural Anthropologist and Ethnomarketer, The Rand Reed Group
Monica Schoch-Spana, PhD, Senior Fellow, Johns Hopkins Center for Civilian Biodefense Strategies
Bradley D. Stein, MD, PhD, Health Services Researcher, RAND; Assistant Professor of Child Psychiatry, University of Southern California
Kathleen J. Tierney, PhD, Professor, Department of Sociology and Criminal Justice; Director, Disaster Research Center, University of Delaware
Robert J. Ursano, MD, Professor of Psychiatry and Neuroscience and Chairman, Department of Psychiatry, Uniformed Services University School of Medicine
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