RAND Study Reports on Lessons Learned from Anthrax Attacks

A new RAND Corp. study says communities around the United States may be able to improve their ability to deal with bioterrorist attacks and other health emergencies by studying why postal workers and U.S. Senate staffers in Washington lost trust in the public health system after they were exposed to a letter contaminated with anthrax in 2001.

To help other communities guard against communications problems that arose in the wake of the anthrax contamination in the nation's capital, the RAND Health report – titled "In Their Own Words, Lessons Learned From Those Exposed to Anthrax" – recommends that future communications on public health emergencies closely involve people from exposed population groups. The report says well-known people from the groups should be enlisted to help authorities spread information about each health emergency that is 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 lead author the report. "Our findings underscore the need to develop better ways deliver direct, consistent and accurate information to different groups during a health care emergency."

"The study underscores the need to tailor messages to different groups of people," added Blanchard, who also is an emergency room physician at George Washington University Medical Center in Washington. "Bioterrorism is no different from other public health issues. No 'one-size-fits-all' message is going to be right for every audience."

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 RAND study, published in the March edition of the American Journal of Public Health.

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

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."

Background

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 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.

Researchers from RAND Health examined the attitudes of workers directly affected by the crisis by organizing focus groups of workers from both the Brentwood Road post office and the Hart building. The researchers conducted four focus groups that included 36 workers from the Postal Service and one focus group that included seven workers from the Senate.

People from both groups said that officials from both the Centers for Disease Control and Prevention 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, who were predominately African American, reported that their primary source of information about the anthrax emergency was the news media, which they felt provided accurate information.

African American postal workers said their attitude toward health officials was influenced by the legacy of the 40-year-long Tuskegee experiment, in which 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.

Funding for the study was provided by the Robert Wood Johnson Foundation. Other authors of the study are Yolanda Haywood of George Washington University Department of Emergency Medicine and Bradley D. Stein, Terri L. Tanielian, Michael Stoto and Nicole Lurie, all of RAND. The research was organized through the RAND Center for Domestic and International Health Security, a part of RAND Health.

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