Exercise developed and produced by:

Johns Hopkins Center for Civilian Biodefense Studies

National Memorial Institute for the Prevention of Terrorism

Office of Justice Programs, National Institutes of Justice, U.S. Department of Justice

The Alfred P. Sloan Foundation

The People Talk Back:
Anthrax 2001 Public Communication Lessons

Transcript  [Listen to this talk] [View the slides]

DR. SCHOCH-SPANA: I wanted to, I guess, follow-up these wonderful presentations by bringing in additional voices. I want to talk to you about some preliminary findings that we are receiving from a set of facilitated small group discussions that we've been holding throughout the United States, that is the Biodefense Center. And it's those voices out of our small group discussions that I want to channel today, so that although we have a small group, we can allow some other constituents to sit at the table if it is in fact just their quotes that are shared with you today.

I wanted to thank the Memorial Institute for the Prevention of Terrorism for their generous funding of our project, which is entitled, "Epidemic Communications Advice For Decision Makers During Bioterrorism Response". And the Biodefense Center is looking forward to sharing with you the findings from this conversation or these conversations we've been holding around the United States.

There's emerging expert advice about how to interact, or how decision-makers can interact better with the public during a bioterrorist crisis, but there have been few attempts to find out what citizens themselves consider the elements of successful communication in such a scenario, in their own words, and that's what I wanted to share with you today.

I did want to thank members of my research team who are present here in the conference, Ms. Onora Lein and Ms. Sylvia Cohn. They worked very hard to help with this project.

So what are we doing? Well, we're going around the United States to six cities, which were selected based on their proximity or distance to the terror events of 2001. And we're talking to three groups of people, we're talking to the official responders, people such as yourselves. WE're talking to public health officials, senior executives in the mayor's office. We were talking to public safety executives, members of the press, physicians and nurses, and also the Red Cross typically. But apart from that, and I don't want to bore you with that. I'm going to focus in on the other groups that we're talking to, which are two proxy groups for the general public.

We're convening groups of 8 to 10 people who worked in occupations that were potentially at risk of Anthrax exposure last fall, so we're talking to Congressional staffers, people who work in media outlets. We talked to mailroom workers of all variations, from the U.S. Postal Service, to people who populate the mailrooms of large universities, government agencies and businesses, and talking to them about their experience with the Anthrax attack, and what they think went well, and what went poorly in terms of communication from the people in charge of the response to them.

We're also talking to civic and community leaders who are selected from various parts of the city. And we're just trying to get a different perspective on what the larger community was experiencing during the Anthrax attacks. So we're going -- we're almost completed. We're talking to folks in New York City, Baltimore, Washington, D.C., San Antonio and Seattle, and we've almost completed all of our focus group among the members of the general public. We just have 2 of 17 to finish up.

And what is it that we're asking them to talk to us about? Well, of course, we spend about an hour or so talking to them about the Anthrax attacks, and then, you know, we give them a break and then, of course, you know, we push them on to talk to us about a hypothesized Smallpox attack. And we serve a meal, and I want to say as a take-home point, that when we recruit for these small group discussions, people are delighted to participate. They are delighted that someone is willing to take the time to listen to them about what they experienced last fall, and what they think might work if unfortunately we have to face a future bioterrorist attack.

I want to emphasize the absolute critical importance of pre-event public education. What was interesting was that these focus groups, we were there to gather data in that sort of gorilla colonialist way. Right? Tell me what you know. But what people were taking -- what people seemed to be -- what was striking to us as the parachuter-type of researchers, is people were so grateful for an intimate gathering in which they could talk about esoteric things, such as Smallpox vaccine, what are the adverse effects? Anthrax, you know, what's the difference between cutaneous and inhalational? And people were just hungry for information, and so I feel that there was an indirect benefit of convening these groups throughout the United States, because we trained the trainer, basically. And we had friends and relatives of our participants calling to say, you know, we're glad you did that. And, you know, I'm a nurse and I want to get involved, and so there was feedback to us in a very positive way. And this is one small research project that was marked by extreme gratitude at the level of local community about experts parachuting in to learn what they had to say, and they were graciously accepted whatever, you know, expert facts we had about these diseases, so just to bring that to your attention. So we've talked to about 130 people, and we've logged almost 40 hours of conversations about Anthrax, and Smallpox among members of the public.

I want to bring in some direct quotes from these conversations, and underscore some of the larger themes that were raised in the conversation. I want to mention that I'm going to just focus on core matters of consensus. There's an extreme variation of opinion on the value of marshal law in terms of, you know, maintaining quarantine. The folks, just FYI, folks in San Antonio were okay with that. Folks in Washington, D.C., we're not okay with that. Kansas City seems to be pretty much okay with that, so there were big variations of opinions on some issues. The role of force was one of them, but there are, I think five military bases in San Antonio, so the military is not a faceless entity to San Antonions, and so we need to pay attention to those kinds of issues, as well.

And some of this has been, you know, reiterated by my colleagues in the first panel and here, but people are indeed capable of handling uncertain and unsettling news, provided its given candidly. And this is a manager of mailroom services in San Antonio. "I think the government tends to treat us more like children, the mommy mode of command and control. It tends to feel like they know what's best for us and they don't tell us enough."

Another critical point that's been expressed over and over by our participants, is that information flow is an antidote to panic, not its cause. And hopefully, they are shrinking in number, but government officials who feel that withholding information is going to prevent hysteria, panic and violence and the social chaos. We need to let go. WE need to let go of that assumption.

This is from a Congressional staffer in Washington, D.C. "I think if you give less information, then there's more uncertainty. And then you might inspire some more panic. At least if you give all the information possible, people know what they're dealing with. All the cards are on the table."

Now this was a corollary finding related to the first two. There seems to be a common assumption that government experts must have the answer somewhere. The scientists must know the answer to this. I mean they're smart, right? They're scientists. And the government should know, well because it's in power. It's in control. And there needs to be some readjustment or some sharing in the burden of uncertainty, of the uncertainty that characterizes a biological attack on both sides. I mean, the people in charge of a response need to speak to the limits of their knowledge about what's going on. And members of the public need to understand with our assistance that it may take some time to get a clear picture of what we're dealing with, and what potential solutions are.

This is from a Congressional staffer in Washington, D.C. "I guess I have a natural assumption that it's the government. Everyone is going to do the most rational thing, and we're going to be top of things and everything. But I really lost some confidence because I just got the sense that they were kind of making it up on the fly."

So along with that common assumption that the experts in the government must have the answer, was a brutal realization by members of the occupationally affected group that the folks in charge, you know, they were making it up on the fly in many cases, and that was unsettling to people. And on the issue of what Lee Clarke had brought up about the value of speaking in one voice, from the point of view of people who are in positions, or the occupationally potentially affected group, they were -- it was not an issue of one voice. It was an issue of agencies, and you'll pardon the French, "Getting their shit together", basically, and that was their message. And this is someone speaking to that topic. "It would have been good if they had chosen somebody, one person to deliver a streamlined version. This is what it is. We've all talked about it now. We concur that this is what's to be done."

And of course, as Brad has underscored, it is absolutely critical to members of the U.S. public that they are given meaningful and practical advice on how to protect themselves and their families, and that this was always at the top of the list in our conversations. And it was spoken very well by this health and safety officer at a New York City Hospital. "I wanted to see an actual exposure plan smacked in front of the television. This is what you do in case you come across Anthrax, and this is how it should be handled, as opposed to bits and pieces."

And my last point, in a media crisis - excuse me - in a crisis, and it can be a media crisis too, the media is an essential source of information, though fragmented and dizzying. People really were tuned to their media outlets to get information. There was an incredibly poignant exchange between an employee of the mail contractor to the Department of State. They had a co-worker who had a case of inhalational Anthrax. An exchange between that person and a Congressional staffer, both talking to the role of CNN in revealing how risky their respective jobs were, that they found out information on CNN quicker about what was going on in their own work places. Both a Congressional staffer and the postal employee, and it was a moment where sort of bridging the divide between well, maybe you guys on Capitol Hill, you got your own version of the shaft. And there was this wonderful sharing of the experience of what it felt like not to have one's public health and safety needs met.

And on the issue of while the media is absolutely critical in moving information to people, there was a common feeling that there is a noise of information during an emergency that they had a very difficult time finding the signal, what the critical public health and safety information, bits of information that they needed to know, that there wasn't a template or a filter in place. And they spoke to the need for some type of truly public broadcast system of a non-commercial and non-competitive nature that moved critical information. And people also underscored the importance of involving civic and community leaders. I'll give you anecdote, and I'd like to open up the floor for remarks.

We do need to enlist the mass media in getting out critical public health and public safety information during a bioterrorist attack, but that modality will not reach everyone. Our bilingual -- I should note that we conducted five groups in Spanish among Latinos and Hispanics, and both in San Antonio, Texas and New York City, which have wonderfully well-developed Spanish speaking news media, that the bilingual viewers could tell that they were getting information faster on the English speaking channels, that there was almost as much of a 24 hour delay in the information that was being streamed through the Spanish speaking channels, mostly because of the translation time that is involved. And also, the poor translation that was happening. And there's a sense of perhaps not being served well by mass media. And we really do need to tap our civic and community leaders. And I'll close on this with this note, because I think it brings in a lot of the things that have been raised by others. This is from a Latino community organizer up in New York City.

"We could do training through community leaders. I feel capable of going to the parks, the streets, wherever I can meet people because in my community, I don't believe much in papers. I strongly believe in look, let's go that place tonight, a meeting, and we can gather 500 without any problem." And it's those people who we really do need to tap in terms of building up our capacity to deal with the effects of bioterrorism. Thank you very much.

[return to top]