An attack with Bacillus anthracis ("anthrax") is a known threat to the United States. When weaponized, it can cause inhalation anthrax, the deadliest form of the disease. Due to the rapid course of inhalation anthrax, delays in initiation of antibiotics may decrease survival chances. Because a rapid response would require cooperation from the public, there is a need to understand the public's response to possible mass dispensing programs. To examine the public's response to a mass prophylaxis program, this study used a nationally representative poll of 1,092 adults, supplemented by a targeted focus on 3 metropolitan areas where anthrax attacks occurred in 2001: New York City (n=517), Washington, DC (n=509), and Trenton/Mercer County, NJ (n=507). The poll was built around a "worst-case scenario" in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within a 48-hour period. Findings from this poll provide important signs of public willingness to comply with public health recommendations for obtaining antibiotics from a dispensing site, although they also indicate that public health officials may face several challenges to compliance, including misinformation about the contagiousness of inhalation anthrax; fears about personal safety in crowds; distrust of government agencies to provide sufficient, safe, and effective medicine; and hesitation about ingesting antibiotic pills after receiving them. In general, people living in areas where anthrax attacks occurred in 2001 had responses similar to those of the nation as a whole.

The 2001 anthrax attacks emphasized the need to develop outreach that would more effectively support racial/ethnic minority populations during a bioterrorism incident. Given the importance of antibiotic prophylaxis in a future anthrax attack, it should be a priority to better support racial/ ethnic minorities in mass dispensing programs. To examine the needs and perspectives of racial/ ethnic minorities, this study used a nationally representative poll of 1,852 adults, including 1,240 whites, 261 African Americans, and 282 Hispanics. The poll examined public reactions to a "worst-case scenario" in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within 48 hours. Findings suggest willingness across all racial/ethnic groups to comply with recommendations to seek prophylaxis at dispensing sites. However, findings also indicate possible barriers for racial/ethnic minorities, including greater concern about pill safety and multiple HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript attacks as well as lesser knowledge about inhalation anthrax. Across all racial/ethnic groups, roughly half would prefer to receive antibiotics at mass dispensing sites rather than through the US Postal Service. People in racial/ethnic minority groups were more likely to say this preference stems from a desire to speak with staff or to exchange medication formulation or type. Findings suggest the need for tailored outreach to racial/ethnic minorities through, for example, emphasis on key messages and enhanced understandability in communications, increased staff for answering questions in relevant dispensing sites, and long-term trust building with racial/ethnic minority communities.During the 2001 anthrax attacks, public health officials were challenged with providing antibiotic prophylaxis to a racially and ethnically diverse group of people who had likely been exposed to Bacillus anthracis. [1][2][3] This experience emphasized the need to develop outreach and communications that would more effectively support racial/ethnic minority populations during a possible future bioterrorism incident. It should therefore be a priority to address the needs of racial/ethnic minority groups with respect to programs for mass dispensing of antibiotic prophylaxis, which form a central piece of the nation's capabilities for reducing mass casualties in the case of future anthrax attacks. [3][4][5][6][7][8][9][10][11] In order to improve mass dispensing programs for racial/ethnic minority groups, it is important to understand how people in racial/ethnic minorities might respond to such programs and whether that differs from majority white populations. 9 It may be particularly important to understand whether there are differences in attitudes about the dispensing programs or knowledge about disease etiology that might dissuade members of racial/ethnic minority groups from obtaining and taking antib...

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