Summer 2002 Issue
A New Era for Public Health Communication is Key in the New Battle Against Bioterrorism
Terrorist attacks typically evoke images of suicide bombers, hijackers and explosions. The public is immediately alerted to the crisis, and the appropriate medical and emergency personnel are called into action.
Enter the new era of bioterrorism. With the potential to cause massive death and greater societal disruption, bioterrorism is far more insidious. A small amount of bacteria or viruses released into the air could silently infect thousands of people with one of a dozen deadly microbes. And victims could pass the disease to thousands of others before doctors even figured out what was happening. The nation’s medical system could be quickly overwhelmed, and the public health laboratories flooded with specimens.
Until recently, our public health system was not adequately prepared to manage these kinds of threats. Although preparing for an outbreak of a naturally occurring infectious disease is not unlike preparing for an event of bioterrorism, the surprise nature of the event, the magnitude of its impact and its criminal intent create new challenges.
James M. Hughes, M.D., director of CDC’s National Center for Infectious Diseases, says effective communication between the public health community and frontline responders, particularly those who work in the health care system, is critical to quickly recognizing an attack, controlling the outbreak, calming the public and ultimately catching the perpetrator. Dr. Hughes should know. He, along with several other CDC leaders, is charged with directing CDC’s bioterrorism efforts, which includes helping reshape the public health system to better prepare for such events.
“Before 9/11 and the anthrax attacks, investments were being made at the state and local levels to improve surveillance, epidemiology and public health laboratory capacity to detect agents of bioterrorism,” says Dr. Hughes. “After the anthrax attacks, it became apparent that all of these efforts need to be coordinated and closely linked to the health care delivery system and health care providers. It is also important to work with other partners including law enforcement and the veterinary community – which is why communications have become an important priority.”
Rapid detection is the first step in controlling an outbreak. For these frontline responders to be most effective, regardless of their medical specialty, they must have enough basic information about the symptoms and signs of infections caused by bioterrorism agents to raise their suspicion. They must know how to diagnose these conditions and when and how to report a suspicious diagnosis to local public health and law enforcement officials. On-going training is essential to improving health care provider education and communication around bioterrorism preparedness, says Dr. Hughes.
Also critical is developing effective methods of communicating with public health professionals, law enforcement agencies, the media and the general public. CDC is discussing joint training efforts with the Federal Bureau of Investigation. In addition, the agency has made significant changes in the way it disseminates information to the media and general public. Should another attack occur, Dr. Hughes and others at CDC are confident that these improvements will help provide more timely and accurate information about the event and potential risks to prevent unnecessary panic and worry among the public.
Another important need that is currently being addressed is that of the real-time exchange of data and information – especially among the public health departments themselves.
Prior to the anthrax attacks, investments had been made in developing the Health Alert Network (HAN) and the Epidemic Information Exchange (Epi-X), which are web-based communications systems linking local, state and federal public health authorities (see bottom right). Recognizing that some of the smaller health departments were at a severe disadvantage because they lacked Internet connections and other more advanced technologies, CDC has made access to technology an important component of its efforts to improve the public health infrastructure.
“During the anthrax attacks, CDC was issuing daily guidance, advice and updates that needed to get around the country quickly,” says Dr. Hughes. “The investments that had been made in developing HAN and Epi-X paid dividends. But the networks are not fully developed and there is still work to do.”
This year, $918 million has come to CDC to improve the preparedness of state and local health departments, including the necessary upgrades that enable systems like HAN. This money is being distributed to states in the form of cooperative agreements. State health departments, in turn, are making distributions to local health departments.
If the United States never experiences another bioterrorism attack, it will still benefit immensely from these investments in the public health infrastructure, says Dr. Hughes. “These improvements will help us prepare for what is inevitable: that is the next influenza pandemic – the worldwide epidemic of flu – of which there were three in the 20th century. We can be certain there will be another.”
- Karen McDonald