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PIRATE Project Stakeholders WorkshopCommunicating with the Public About CBRN Threats: State of the Art

The RAF Club, London, Tuesday, September 21, 2010

Improving CBRN Risk Communication:Research, Programs and Initiatives inthe United States

Steven M. Becker, Ph.D.The University of Alabama at Birmingham

Three Decades Ago: The Complexities and Challenges of Situations Involving Unconventional Agents

Three Mile Island (1979)• Unclear, inadequate and

conflicting information• For every person advised

to leave, about 45 actually did (Erikson, 1994)

• Some 150,000 people took to the highways Photo: Three Mile Island: A Report to

the Commissioners and the Public.NUREG/CR-1250, Volume 1. U.S. Nuclear Regulatory Commission.

9/11 Terrorist Attacks, Ground Zero, NYC

© SM Becker

The 2001 Anthrax Letter Incidents

FBI

Communication Challenges

• Unprecedented demand for information from public, clinicians

• Information needed right away• Agency resources stretched thin attempting to assess

and manage the disaster situation and its aftermath• Little time to put together messages• No opportunity to test messages• Unique characteristics of unconventional agents

The 2001 Anthrax Letter Incidents

“Many essential lessons have been learned since the anthrax letter incidents that occurred in September, October, and November 2001. Among the most crucial of those lessons is the importance of being better prepared for the massive communication challenges posed by terrorist incidents involving unconventional agents.”

Dr. Marsha VanderfordU.S. Centers for Disease Control andPrevention (CDC)

• Cooperative Agreement: Centers for Disease Control and Prevention (CDC) and the Association of Schools of Public Health (ASPH)

• Four main research centers: The University of Alabama at Birmingham, St. Louis University, University of Oklahoma, University of California at Los Angeles

• Multi-year effort– Year One: 2002-2003– Year Two: 2003-2004– Year Three: 2004-2005– PEMDP Follow-up: 2005-2006– 2006-Present: Follow-on studies

Pre-Event Message Development Project

• Four agent types– Plague– Botulinum toxin– Chemical/nerve agent– Radiation

• Radiological• Nuclear

• Total of 1013 participants– 79 focus groups (884 participants)– 129 cognitive responsive testing interviews


Demographic Characteristics of Study Participants, Pre-Event Message Development Project, 2002-2006(n=1013)

Wray RJ, Becker SM, Henderson N, Glik D, Jupka K, Middleton S, Henderson C, Drury A, Vincent R, Mitchell B ( 2008). Communicating with the Public about Emerging Health Threats: Lessons from the CDC-ASPH Pre-Event Message Development Project. American Journal of Public Health 98(5).


• General Public– Geographic Distribution:

• Mid-Atlantic, Southeast, Southwest, Midwest, West– Nine population subgroups:

• Urban African-American• Rural African-American• Urban Caucasian• Rural Caucasian• Urban Hispanic• Rural Hispanic• Urban Asian• English Second Language• Native American

What Do People Think About Emerging Threats and Agents?

What Are Their Main Concerns?What Information Do They Want?

From Whom Do They Want the Information?What Do They Think of Current Government

Informational Materials?What Terms Do They Understand or Not

Understand?How Would They Change or Improve

Emergency Messages?

Selected Findings

PEMDP Finding #1

• Biological, chemical, and radioactive materials hazards are seen as unfamiliar

• People often unsure, confused about key differences– infectious vs. non-infectious– radiological vs. non-radiological– exposure vs. contamination

People have many questions about CBRN threats

PEMDP Finding #1Focus group participant:“I’m not real clear on the difference between an actual nuclear explosion and a dirty bomb.”

Need to explain what incident is, and what it is not

People’s primary concerns and information needs center on health issues

• “How do I protect my family?”• “What are the symptoms that I need to look

for?”• “When do [we] need to get medical help?”• Should I go to the hospital?

PEMDP Finding #2

Trusted Sources: National

CDC 84%Doctor who is expert 83%U.S. Surgeon General 76%NIH 75%DHHS Secretary 69%DHS Secretary 68%

Trusted Sources: Local and State

• At the state government level, the “health departmentwas rated the highest for being honest with the public about terrorism.”

• At the local government level, “the fire department was rated the highest for being honest with the public about terrorism.”

Need for spokesperson(s) with high credibility onhealth issues

Another Trusted Source

• In areas where natural disasters are common,television meteorologists were seen as another good source of information– Seen to be apolitical and without an axe to grind

• “Why would he tell us something he didn’t believe in? It’s not like he will be voted out of office.”

– Considered well known, familiar figures that people regularly watched for daily weather information or, more importantly, for updates on weather emergencies

• “Usually, if something bad happens, it is weather. So when you go to the TV, there he is giving us the information.”

PEMDP Finding #3

• Pets – For many, a part of the family– “A pet can be affected just like me.”– “If it is safe to do so [to bring pet inside] – I mean,

how are you going to determine if it is safe or not.”– Dosing

Health concerns also extend to family pets

• Some fatalistic attitudes were evident, particularly among minority populations– “I don’t think we’d have a chance…”– “There is nothing you can do.”

• Fatalism can translate into lower likelihood of undertaking protective actions

PEMDP Finding #4

Becker SM. Emergency communication and information issues in terrorist events involving radioactive materials. Biosecur Bioterror. 2004;2(3):195-207.

PEMDP Finding #5

• Minority groups, in particular, were concerned that protective resources might not be fairly and equally distributed.– “Where is all that stuff going to go… we [aren’t] going to see… it…. I’m

telling you all of that is going to a certain part of the city. It [isn’t] coming over here.” (Urban African American)

• Fairness of preparedness and response measures is an important part of the message

Wray R, Rivers J, Whitworth A, Jupka K, Clements B (2006). Public Perceptions about Trust in Emergency Risk Communication. Int J Mass Emerg Disasters 24:45–75.

Fair distribution of protective resources is an important issue for people

PEMDP Finding #6• Consistent with other research, many participants

suggested that they would not comply with recommendations to shelter– “If you have kids, the first thing you do is to get to your kids.”– “You’re not thinking of covering up, you’re trying to get to that

child at that time.”– “I’m not gonna stay in the house. I’m gonna try and find my

kids.”– “My first response would be to go find my children.”– “I would still go get my children no matter what. Because to me

that is everything.”

• Importance of school role, planning

• “Who provides shelter, the Red Cross?”

• “Shelter in place. What does it mean? Does it mean stay where you are?”

• “I assume shelter in place means to go to the place that affords you the greatest protection.”

• “The word shelter sounds a little confusing….”

PEMDP Finding #7

Becker SM. Emergency communication and information issues in terrorist events involving radioactive materials. Biosecur Bioterror. 2004;2(3):195-207.

Common preparedness terms are not always clear

See http://www.bt.cdc.gov/radiation/

Communicating About CBRN Threats


Q&A Project

First HoursDeveloped by the Office of Public Affairs of the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC)

Based on extensive communication research, the “First Hours” website includes sample messages, templates, and other risk communication resources for use in radiation incidents and other emergencies.

Go to http://emergency.cdc.gov/firsthours/intro.asp


Emergency Responders

• Will be the front line in any effort to manage a CBRN terrorism incident

• Public trusts responders, looks to them for information

• High level of dedication to duty– “We are professionals” (clinician)

– “If you are wearing a badge you know that you are fixing to go to work - regardless of what kind of badge it is” (first responder)

– “We are duty bound” (hospital-based physician)

– “I would be ready as a health professional to do what I could to help” (public health)

Emergency Responders: Finding #1

Sources: Becker SM (2004). Emergency communication and information issues in terrorism events involving radioactive materials. Biosecurity and Bioterrorism 2: 195-207; Becker SM (2009). Preparing for Terrorism Involving Radioactive Materials: Three Lessons from Recent Experience and Research. Journal of Applied Security Research 4(1):9-20; Becker SM and Middleton S (2008). Improving Hospital Preparedness for Radiological Terrorism: Perspectives from Emergency Department Physicians and Nurses. Disaster Medicine and Public Health Preparedness 2(3):174-184 (American Medical Association); Becker SM (2010). Risk Communication and Radiological/Nuclear Terrorism: Perceptions, Concerns and Information Needs of First Responders, Health Department Personnel, and Healthcare Providers. Pages 271-280 in RH Johnson, editor, Radiation Risk Communication: Issues and Solutions, Health Physics Society (HPS), Medical Physics Publishing.


• But with respect to CBRN terrorism, also– Deep concerns about family– Deep concerns about readiness– Many questions about protective equipment,

gear

• For all responder groups, there is a lower level of familiarity, less training, and a lower “comfort level”with radiation as compared to other threats– “I just wonder if the training and equipment is up to it.” (first

responder)– “Although we have drilled on this, I would be concerned about how

prepared we are to take this on.” (healthcare professional)– “We know so little about radiation” (nurse)– “Radiation is one of my weakest points…I’ve had minimal

training in radiation” (public health professional)– “They focus more on biological aspects than they do for

radiological” (emergency department nurse)


• For some responders, the perceived newness and the lack of familiarity translate into greater apprehension than for other threats:– “A little anthrax, ok we can wear this. A little TB, we can wear

this… If it was a dirty bomb… how could you actually prepare for something like that?”

(emergency department clinician)

– “This is something that is kind of unforeseen… It’s more scary”(nurse)

– “I can see people being reluctant to go near patients when they don’t have any way of feeling safe.” (physician)


Emergency Responders

• Survey data• Gap between official policies and what some

frontline responders will actually do• In some cases (e.g., public health), role

uncertainty• Crucial to address

– Effectiveness and safety of response force– Public will be looking to them for information

AcknowledgmentsAcknowledgments

• U.S. Department of Homeland Security (DHS)• Centers for Disease Control and Prevention (CDC)•• U.S. Environmental Protection Agency (EPA)U.S. Environmental Protection Agency (EPA)•• National Association of County and City Health Officials National Association of County and City Health Officials

(NACCHO)(NACCHO)•• New York City Department of Health and Mental New York City Department of Health and Mental

Hygiene (NYC DOHMH)Hygiene (NYC DOHMH)•• Disaster and Emergency Communication Research Unit, Disaster and Emergency Communication Research Unit,

Department of Environmental Health Sciences, UAB Department of Environmental Health Sciences, UAB School of Public HealthSchool of Public Health

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