Public Response to an Anthrax Attack: Reactions to Mass Prophylaxis in a Scenario Involving Inhalation Anthrax from an Unidentified Source

Abstract

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.

Public Response to an Anthrax Attack: A Multiethnic Perspective

“…Thus, in the aggregate, there is important common ground across these diverse populations in the communications and operations needed for improving mass dispensing programs. 9 The data also suggest there are some differences between racial/ethnic groups that may be important to consider in efforts to improve communications and operations to meet the needs of racial/ethnic minorities more effectively. In particular, we note 3 areas where African Americans and Hispanics are more likely to hold views that could become barriers to compliance with recommendations about going to dispensing sites and consuming prophylactic antibiotics.…”

“…This approach has been useful in other tabletop planning exercises, as well as our previous poll. 9,42,43 Second, despite evidence that polls provide data comparable to surveys with higher response rates in many cases, there may nonetheless be differences between the people who responded to this poll and those who did not. In particular, respondents may be more compliant than nonresponders, which would inflate the estimates of people who would be willing to adopt recommended behaviors, although it is less likely to affect differences between racial/ethnic groups.…”

“…9,31,32 The goal was to provide broad insights about possible differences in racial/ethnic minorities' responses to the program's key dimensions, which could help shape planning and communications at the time of a real attack. …”

“…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 antibiotic prophylaxis available at mass dispensing sites.…”

“…[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 antibiotic prophylaxis available at mass dispensing sites. If so, a more tailored approach with particular outreach to racial/ethnic minority communities may be needed to ensure equal access to prophylaxis and related information and to increase rates of adoption.…”