# Presentation: 102549

## Terrorism and Bioterrorism Communication Challenges

## Module Summary

- Working with new partners
- How terrorist events are different than other public health emergencies
- Issues specific to bioterrorism preparation, detection, and response
- How to tell the difference between a regular epidemic and bioterrorism
- Sample responses to the media
- Healthy responses to bioterrorism

## What Is Terrorism?

- U.S. regards terrorism as a potential threat to national security and a violent criminal act.

## New Partners

- Public health communicators will have new communication partners in a terrorist response.
- Many people worked with new partners during state and local responses to hoaxes or the October 2001 anthrax event.
- The FBI has the final say about information release during a criminal investigation.
- The DOJ/FBI will NOT slow the release of public safety information from health officials.

## Federal Response Plan 

- FBI leads on information release in crisis management
- FEMA leads on information release in consequence management
- Transfer from the FBI to FEMA by Attorney General
- Core federal response:
- DOJ/FBI	 DOE 	FEMA
- DOD	 EPA	HHS

## HHS Provides:

- Technical support, personnel, and equipment
- Disease detectives
- Agent identification and collection and testing of samples
- Medical management (NDMS)

- Medical supplies, drugs, and vaccinations (NPS)
- Regulatory followup (e.g., FDA)
- Outbreak/disease threat assessment
- Onsite safety
- Mass fatality management

## What’s Different in a Terrorism Response?

- Stronger reaction from the public
- Multiple events occur
- Incident location is a crime scene
- Incident expands geometrically
- Overload of specialized response possible

- Detection is delayed
- Responders are at higher risk
- Facilities are contaminated
- Response assets are targets

## Apply Risk Communication Principles

- Outside control of individual or community
- Unfairly distributed
- From untrusted source
- Man-made
- Exotic
- Catastrophic

## Terrorism and Public Information

- The FBI leads information to White House, Congress, and other federal officials.

## Joint Information Center

- FBI public information officer and staff
- FEMA public information officer and staff
- Other federal agencies’ PI staff
- State and local PIOs

## Bioterrorism Is Different

- Medical and public health systems are usually the first to detect bioterrorism.
- A delay is likely between the release of the agent and the knowledge that the occurrence is a bioterrorist act.
- A short window of opportunity exists between the first cases and the second wave.
- Public health officials must determine that an attack occurred, identify the organism, and prevent more casualties.

## What We Need To Prepare for Bioterrorism

- More trained epidemiologists to speed detection
- Increased laboratory capacity
- Health Alert Network
- Medical professionals “back to school”
- National Pharmaceutical Stockpile

## Natural Emerging Infectious Disease or Bioterrorism? No Assumptions

- Encephalitis
- Hemorrhagic mediastinitis
- Hemorrhagic fever
- Pneumonia with abnormal liver function
- Papulopustular rash (e.g., smallpox)
- Descending paralysis
- Nausea, vomiting, diarrhea

## Horses or Zebras?

- Outbreak of rare disease
- Seasonal disease at wrong time
- Unusual age distribution
- Unusual clinical symptoms
- Unusual epidemiologic features
- Outbreak in region normally not seen

## Learning Caution From the Past 

- 30 years, 30 outbreaks, 20 matched criteria for possible bioterrorism (none were bioterrorism)
- Legionnaires—Philadelphia, 1976, pneumonia of unknown origin
- Hantavirus Pulmonary Syndrome—U.S., 1993, pneumonia of unknown origin in healthy adults
- Ebola—Zaire, 1995, 99 percent genetic match to 1976 outbreak

## Mother Nature or Bioterrorism?

**West Nile Virus, New York City, 1999**
- First time in Western Hemisphere.
- Encephalitis and paralysis of lower limbs.
- Iraq is known to possess strain.
- Virus genetic match is nearly identical to the 1998 outbreak in Israel.
- The introduction route is unknown.

## Lesson Learned?

- Plan your policy now.
- Partner closely with the local FBI.
- Undeclared bioterrorism and emerging infectious diseases are a public health issue first, then a criminal investigation.
- FBI and public health officials will seek the same information for different purposes.
- The release of information and privacy rights must be carefully considered.

## Lesson Learned?

- Internal controls in public health departments protect FBI investigations.
- Saying “no” sets a precedent for the future which may be hard to maintain (i.e., media will speculate if you can’t say “no bioterrorism” while investigating)

## Media Are Sure To Ask:

- Is this bioterrorism?
- Could this be bioterrorism?
- Are you investigating this situation as possible bioterrorism?
- Is the FBI involved in this investigation?
- When will you be able to tell us whether or not this situation is bioterrorism?

## Is It an Emerging Disease or Undeclared Bioterrorism?

- A possible response to media from public health officials is:
- “We’re all understandably concerned about the uncertainty surrounding this outbreak, and we wish we could easily answer that question today.”

## Is It an Emerging Disease or Undeclared Bioterrorism?

- “For the sake of those who are ill or may become ill, our medical epidemiologists (professional disease detectives) are going to first try to answer the following critical questions: (1) Who is becoming ill? (2) What organism is causing the illness? (3) How should it be treated? (4) How can it be controlled to stop the spread?”

## Is It an Emerging Disease or Undeclared Bioterrorism?

- One question that disease investigators routinely ask is, “Could this outbreak have been caused intentionally?”
- Possible response: “[Your organization name] must keep an open mind as data in this investigation are collected and analyzed.”

## Is It an Emerging Disease or Undeclared Bioterrorism?

- “With public safety in mind, we should not speculate on the organism’s route of  introduction until we have enough data to put forward a theory.  We must consider that we may never have the data to answer this important question, based on epidemiology alone.”

## Is It an Emerging Disease or Undeclared Bioterrorism?

- “Any specific questions about the FBI’s involvement regarding this outbreak investigation should be referred to them. However, the FBI and [your organization] have a strong partnership regarding the investigation of unusual disease outbreaks and have worked comfortably together in the past in our parallel investigations.”
- (Don’t forget to coordinate this answer with the FBI—regardless of their current involvement or noninvolvement.)

## Healthy Psychological Responses to Terrorism

- What communicators can help with
- 1.	Never lose sight of the fact that a terrorist aims to cause feelings of uncertainty and fear.
- 2.	Our response can serve to support the terrorist’s aim or to oppose it.
- 3.	Psychological resiliency training before the fact can help.
- 4.	Information combats destructive rumors.
- 5.	Do whatever is needed to restore a sense of physical safety—widely publicize these efforts.

## Healthy Psychological Responses to Terrorism

- 6.	Enlist community leaders (political, educational, medical, religious, business) to calm fears.
- 7.	Reestablish normal routines quickly.
- 8.	Display of symbols can help reestablish community cohesion.
- 9.	Honor survivors, rescuers, and the dead, including carrying on with life.
- 10.	Don’t offer psychological support prematurely.