Public Resilience in CBRN Events:

Lessons Learned from 

Seven Cases

by

Michelle L. Spencer

Michael T. Kindt

Megan P. Stans

The Counterproliferation Papers

Future Warfare Series No. 52

USAF Counterproliferation Center

Air University

Maxwell Air Force Base, Ala.

Public Resilience in CBRN Events:

Lessons Learned from

Seven Cases

Michelle L. Spencer

Michael T. Kindt

Megan P. Stans

The USAF Counterproliferation Center was established to provide education, information, and analysis to assist the understanding of the U.S. national security policymakers and USAF officers to help them better prepare to counter the threat from weapons of mass destruction. This research was funded jointly by the Defense Threat Reduction Agency and the USAF Counterproliferation Center. Copies of this report and 

other publications are available from the USAF Counterproliferation Center, 325 Chennault Circle, Maxwell AFB AL 36112-6427. The fax number is (334) 953-7530; phone 

(334) 953-7538.

USAF Counterproliferation Center

Air University

Maxwell Air Force Base, Ala. 36112-6427

The Internet address for the USAF Counterproliferation Center is:

http://cpc.au.af.mil
ii

DISCLAIMER

The views expressed in this report are those of the authors and do not necessarily 

reflect the official policy or position of the U.S. Government, Department of Defense, 

U.S. Air Force, or the U.S. Air Force Counterproliferation Center.
iii

ACKNOWLEDGEMENTS

This report and workshop, sponsored by the Advanced Systems and Concepts Office (ASCO), Defense Threat Reduction Agency (DTRA), was conducted in 2007-

2008. We, the authors of this report, and the USAF Counterproliferation Center appreciate DTRA‟s tireless support of this important subject. We would like to extend 

our sincere appreciation to all workshop participants, who took time out of their hectic 

schedules to brainstorm on this critically important issue. In addition, the facilitators 

and recorders captured the thoughts and ideas of the attendees used to produce the informative and detailed workshop proceedings presented here.

Workshop attendees include: CDR Brad Austin, Penny Burke, Mary Dixon, Michael Dunaway, Dennis C. Dura, Jonathan Fox, Carol Freeman, Mr. John Gibeault, Robert K. Gifford, Ph.D., Catherine Kane, Rachel Kaul, Diane M. Kotras, Kathie 

McCracken, Mr. Ashley P. Moore, Jennifer Nuzzo, Steve O‟Brien, Jennifer Perry, Nancy M. Pomerleau, CAPT Dori Reissman, MD, Greg Saathoff, MD, Director, Lt Col Lisa 

Sayegh, Monica Schoch-Spana, Ph.D., James Scouras, Michael Shaw, Lt Col Renee 

Shibukawa-Kent, Stephen C. Stewart, Joel D. Wall, and Major Brec Wilshusen.

The authors especially would like to thank Lt Col Fred Stone and Dick Estes for 

their work as facilitators and Lt Col Renee Shibukawa-Kent for acting as a recorder.

Also noteworthy in support of this project was the staff of the USAF Counterproliferation Center. Without the editorial support of Dr. Schneider the project would not 

have been possible. Mrs. Brenda Alexander provided crucial assistance and coordination of administrative details. Finally, Mrs. Abbey Plant‟s work in editing, formatting,

and publishing were instrumental in the success of the project.

Michelle L. Spencer, co-author

Lt Col Michael T. Kindt, co-author

Megan P. Stans, researcher

v

ABOUT THE AUTHORS

Michelle L. Spencer is the Northrop Grumman Technical Services Program Manager 

for the USAF Counterproliferation Center. Previously, she worked on the Department 

of Defense‟s International Counterproliferation (ICP) Program acting as a liaison between the Defense Threat Reduction Agency and the Office of the Secretary of Defense. 

Prior to that time Ms. Spencer was on the Policy Staff of the U.S. House of Representatives Armed Services Committee. She is an alumna of the prestigious Robert Bosch 

Foundation Fellowship Program. She has a Master of Science in Defense & Strategic 

Studies from Missouri State University and Bachelor of Arts degrees in German and 

Political Science from the University of Missouri. Ms. Spencer has lectured and written 

on a broad range of foreign policy and national security issues. Her previous works include a chapter on border security in a series titled Countering Terrorism in the TwentyFirst Century.

Lt Col Michael T. Kindt, Ph.D. is the Chief of the Mental Health Branch at the Air 

Force Medical Operations Agency, overseeing mental policy and processes for the AF 

Medical Service. Prior to this assignment he was Director of Counterterrorism Studies 

at the USAF Counterproliferation Center. Lt Col Kindt has a M.A. and Ph.D. in clinical 

psychology from Bowling Green State University and is licensed to practice clinical 

psychology in the state of Alabama. His previous assignments include directing provision of mental health services at Moody AFB, Ga., and RAF Molesworth, UK. He also 

has extensive experience in education and training, having worked as an instructor, 

flight commander and squadron commander of the 382d Medical Training Squadron at 

Sheppard AFB. Lt Col Kindt has published a monograph entitled "Building Population 

Resilience to Terror Attacks: Unlearned Lessons from Military and Civilian Experience," (CPC, 2006), and co-edited "The World's Most Threatening Terrorist Networks 

and Criminal Gangs" (Palgrave-McMillan, 2009) 

Megan P. Stans is a researcher for Northrop Grumman Technical Services and has a 

Bachelor of Science degree in Psychology from St. Mary‟s College of California. In 

May 2007 she graduated from Auburn University with a Master of Arts degree in Sociology. She has worked with the USAF Counterproliferation Center and the USAF Culture and Language Center.

vii

TABLE OF CONTENTS

Page

Disclaimer........................................................................................................................ii

Acknowledgements.........................................................................................................iii

About the Authors............................................................................................................ v

Executive Summary........................................................................................................ ix

Introduction...................................................................................................................... 1

Case Studies

1. Anthrax Attacks............................................................................................ 13

2. Sarin Attacks on the Tokyo Subway ............................................................ 27

3. SARS Epidemic in Canada........................................................................... 37

4. Hurricane Katrina ......................................................................................... 47

5. UK Foot-and-Mouth Epidemic..................................................................... 59

6. 1918 Influenza Pandemic ............................................................................. 65

7. Tylenol Tampering ....................................................................................... 79

Resilience Workshop Proceedings

Workshop Description....................................................................................... 83

Group 1: Preparation.......................................................................................... 85

Group 2: Response............................................................................................. 92

Group 3: Recovery............................................................................................. 97

Recommendations and Conclusions............................................................................ 103

ix

EXECUTIVE SUMMARY

In the United States the term “resilience” does not conjure thoughts of a 

community‟s ability to endure a crisis. 

Even with the advent of “homeland security,” resilience usually refers to communications or other critical infrastructure, 

not human assets. The concept of public 

resilience is different in Israel and the 

United Kingdom, where resilience is existential and practical. 

This study focuses on resilience to a 

weapon of mass destruction (WMD)

event or crisis, which is defined as “the 

ability to respond effectively and recover 

from any stressor in responding to a 

Chemical, Biological, Radiological and 

Nuclear (CBRN) weapons event.” Simply stated it is the ability of an individual, 

a community and a nation to return to 

some semblance of normalcy after a catastrophic national event such as the 

Sept. 11, 2001, attacks or a regional 

event such as Hurricane Katrina. One of 

the major questions in the post-9/11 age is 

whether Americans could handle a major 

terrorist attack with an unknown source, 

duration, or perpetrator. 

The USAF Counterproliferation 

Center undertook a year-long project 

sponsored by the Advanced Systems and 

Concepts Office of the Defense Threat 

Reduction Agency (DTRA) to explore 

issues related to building public resilience 

to an incident involving WMD. The 

project entailed four elements. First, in 

order to fully examine the manner in 

which CBRN weapons may test human 

resilience, a thorough literature review 

was conducted which resulted in the 

second phase of the study: seven case studies that provide insight through historical 

examples of cataclysmic events. Next, a

one-day workshop was held with defense, 

homeland security, crisis management, 

legal and health experts. The event focused on methods for improving public 

resilience during the preparedness, response and recovery phases of a major 

WMD event. The workshop observations 

were combined with the case studies and 

literature review to form this report. Finally, recommendations for improving 

public resilience through government and 

public action provided the final phase of 

the project.

While varying measures of resilience 

exist at the individual level, this study determined “the combination of a positive 

individual perspective, strong social connectedness, and effective problem-solving 

skills, all of which form an individual‟s 

ability to cope with traumatic events such 

as a CBRN attack” were vital to human 

resilience. Taking that perspective to the 

next level, we focused on resilience at the 

community level to determine the requirements and how the federal government could support, but not necessarily 
x

provide all elements needed for a community to weather a crisis.

Seven case studies were chosen for 

their impact on and lessons learned regarding public resilience. Some occurred 

in the United States, some in other countries, while still others were global in 

scope. These case studies represent a 

range of threats that exist today and provide the major challenges facing the government in encouraging and supporting a 

resilient population. They include the 

2001 anthrax attacks, the 1995 Tokyo 

subway attacks, the worldwide SARS 

outbreak in 2003, Hurricane Katrina in 

2005, the 2001foot-and-mouth epidemic 

that occurred in Great Britain, the catastrophic 1918-1920 Influenza pandemic 

that swept the globe, and the 1982 case of 

Tylenol poisoning.

Commonalities found within the case 

studies were reviewed and led to five recommendations for government action. 

 Lack of planning and proper execution hampers government action 

and leads to unpredictable citizen 

response.

Many lessons on human and public 

resilience can be learned from the events 

leading up to and following Hurricane 

Katrina, which killed more than 1,500 

people and destroyed approximately

300,000 homes. Even though National 

Weather Service (NWS) advised local 

authorities to evacuate, no mandatory 

evacuation order was given for New Orleans until 19 hours before the storm hit 

the city. The delay caused irrevocable 

damage and highlighted the lack of planning and execution of the few existing 

plans. Specifically, citizens doubted the 

veracity of official statements when directions were finally given. Local and state 

governments made no provisions for 

those who had no means to leave the area. 

The city of New Orleans was aware approximately 100,000 people would be unable to evacuate in the event of a major 

hurricane. The final straw was that officials did not have contingency plans for a 

flooded New Orleans, even though they 

knew it was likely to happen. The lack of 

planning and the lack of attention to plans 

that did exist caused the greatest challenge: maintaining order in New Orleans. 

One of the greatest failures of Katrina was 

the almost immediate loss of command 

and control by local law enforcement due 

to lack of planning for continuity of operations during and after the storm. 

Another example occurred in the aftermath of Sept. 11, 2001, when the government warned Americans of additional 

terrorist attacks. Citizens bought gas 

masks and antibiotics to protect themselves. The U.S. Government was unprepared for a geographically dispersed biological attack with no known perpetrator. 

Federal, state and local agencies scrambled to answer the public‟s questions. 

The public responded to official directives 

which caused confusion given the statements were often contradictory or wrong. 

In the absence of clear official guidance 

the public reacted with common sense 

measures and vigilance, which strained 

first responder capabilities in many urban 

areas. 
xi

While each of the cases had at least 

one example of the failure of leadership, 

one case did stand out as an example of 

how a government (or company) should 

act to manage the crisis and maintain the 

trust of its people. When citizens of Chicago died of cyanide poisoning in 1982,

the makers of Tylenol, Johnson and Johnson (J&J), sprung into action. Within 

J&J, no rule book existed for managing a 

company-wide crisis; however, the leadership pushed a singular concept – to 

find out what happened with the product

and to tell the truth to the public. The Tylenol crisis was the most covered story 

since the Vietnam War with more than 

80,000 newspaper articles, and hundreds 

of hours of national and local television 

and radio coverage. In the years following 

the events, studies by Johnson and Johnson 

estimated 90 percent of the American population was aware of the murders within 

one week. However, due to Johnson and 

Johnson‟s quick response and willingness 

to take responsibility for the product tampering incident and solution (tamperresistant packaging), J&J‟s market share 

surpassed its 1982 levels within three 

years. 

 Trust in government is essential.

As Hurricane Katrina descended on 

the city of New Orleans, citizens turned to 

their leaders for instructions. When local 

leadership failed to give succinct and 

clear information, the population headed 

for higher ground. As the storm subsided,

60,000 people arrived at the doors of the 

Superdome, a “shelter of last resort,” with

hastily stockpiled supplies for 15,000 

people for three days. Another 20,000 

convened at the Convention Center, a location never planned as a shelter and 

therefore, had no supplies, governance or 

the ability to acquire either. Of all the 

cases examined, Hurricane Katrina demonstrates the most challenging scenario 

to personal and community resilience. 

Warnings were not provided early enough 

to be maximally effective, the needs and 

capabilities of many residents were not 

adequately prepared for, leaving many 

unable to follow evacuation guidelines. 

Long-term issues of trust between the 

people and the government exacerbated 

communication and compliance problems. 

The situation during “Spanish” influenza pandemic of 1918–1920 was complicated by the fact America was at war. 

Most of the deaths occurred in a 16-week 

period, from mid-September to midDecember of 1918, paralyzing social, political and economic life across the globe.

Even though the disease swept quickly 

across the globe killing an estimated 50 

million worldwide, patriotism and public 

morale were given priority over disease 

prevention. Public support for the war 

enabled war-bond fundraising, increased 

industrial productivity and buoyed relief 

efforts, all essential to winning the war. 

As the epidemic took hold in the United 

States, the first reaction of many national 

authorities was denial. As the disease 

spread, official reaction ran the spectrum 

of denial, obfuscation, confusion and contradiction, severely testing public trust. 

The government could not meet the needs 
xii

or expectations of the public even though 

the expectations were far below what they 

are today. The media played an important 

role partially through lack of coverage 

and misinformation provided by ignorant 

government leaders and advertising charlatans who preyed on public fear.

 Lack of information causes stress 

and confusion in people.

Studies have repeatedly shown the 

worst thing a government can lack is 

transparency. Unfortunately, if no plan 

for communication with the public exists 

prior to a crisis; few officials will know 

who is responsible for sharing information. During the foot-and-mouth outbreak 

in the UK, Scottish officials worked in 

conjunction with a national farmers association trusted by the local population. 

Other areas of Britain lacked coordination, leaving farmers to question lowlevel bureaucrats demanding destruction 

of their livelihood. 

Given the novelty of sarin, few 

Tokyo first responders or healthcare personnel had experience with the chemical 

agent used in the subway in 1995. Conflicting reports were given as to how citizens should react. These factors combined dramatically increased the number 

of persons seeking medical care. As many 

as 3,796 individuals were injured to some 

degree, but over 5,500 sought medical attention. According to some medical experts many of those who sought medical 

care were “worried well,” individuals who 

had minimal exposure, had minor symptoms or were near the incident and were 

unsure whether they had suffered any contamination. Local hospitals were flooded 

following the morning rush hour attack on 

the Tokyo subway. All who sought care 

were not necessarily medically required to 

do so; however, the lack of healthcare 

personnel with direct knowledge or experience with chemical weapons left a void 

of information quickly filled with questions by the media. 

 Government often lacks a plan to 

inform the people – how will it 

share information, who will share it, 

when will it do so?

During the events surrounding the 

2001 anthrax attacks, U.S. Government

officials realized they did not have a 

coordinated plan for sharing necessary 

information with the public during a bioterrorism attack, nor the ability to manage 

public perceptions when treatments and 

results changed with the circumstances. 

The need for a trustworthy, reliable 

source of information for both government and citizens was revealed.

A similar situation occurred in Japan 

in 1995 when a little known cult placed 

sarin on the Tokyo subway, killing 13 and 

wounding many. No group took immediate responsibility, and minor attacks 

followed with the most severe in March. 

The intensity of the media coverage during the events limited the ability of the 

government to use the news outlets to 

communicate with the public. Given the 

lack of direction from the government, 

sensationalism quickly overcame “need to 

know” reporting. A new word, “sarinoia” 
xiii

was born and heard repeatedly in media 

reports as Aum Shinrikyo, the group held 

responsible, and the situation surrounding 

the events were replayed and dissected 

daily. The Japanese government noted its 

lack of direct communication with the 

public (without damaging its legal case 

against Aum) as a hindrance in the official investigations following the 1995 attacks.

Another event highlighting the need 

for a plan for communicating with the 

public is the 2001 foot-and-mouth outbreak in Great Britain. Although the disease does not directly affect humans, the 

natural outbreak may mirror in many 

ways an agricultural biological attack. 

The UK Government reacted with the 

slaughter of millions of cattle. Rural 

communities were confused and anxious 

about the spread of the disease, while 

none desired the loss of livelihood. Government agents came in and quickly determined which animals were in danger of 

infection, and thus, required to be destroyed. The lack of communication left 

the public with feelings of fear and outrage. Much of the turmoil would have 

been avoided had the government explained policy and objectives and how 

these would also benefit the public in a 

real and tangible way.

 People (and organizations) often 

will help others even when it places 

them in harm’s way.

The 1918 pandemic killed an estimated 675,000 Americans, five times 

more than died in combat during WWI. 

With millions of people incapacitated, the 

social fabric frayed, governments ceased to 

effectively govern and many activities in 

the public realm halted. In September 

1918, 12,000 people died in the United 

States, which alone is a significant number; however, in October the number 

climbed to an astounding 195,000, crippling American society. Businesses, 

schools and public activities closed or

ceased. As government resources failed, 

philanthropic organizations prevailed. 

Led by women of prominence, these organizations took up the mantle of leadership, effectively managing and operating 

civic functions and preventing total collapse of society. They organized nurses, 

provided hospice and even made arrangements to collect and care for the 

dead. These groups do not exist in the 

same form today, making their role questionable in tomorrow‟s pandemic.

However, human resiliency is often 

the highest during times of crisis. It is 

then citizens choose to help their fellow 

man. The story following Hurricane Katrina has two groups of heroes: the National Guard/Coast Guard and private entities such as the Red Cross and small local groups who picked up the mantle of 

responsibility for their fellow citizens 

where the government failed. Together 

the Coast Guard and Louisiana National 

Guard rescued over 55,000 people. In 

addition, non-profit and non-government 

organizations came to the rescue of thousands of New Orleans residents, feeding, 

housing and caring for hundreds of thousands of people, victims and rescuers 

alike. These organizations are rarely in-
xiv

cluded in planning for crises, but their 

role is essential in the success of any government action.

 Novelty of CBRN attack and lack of 

surveillance hampers official reaction.

The lack of direct experience with 

weapons of mass destruction is a blessing 

and a curse. In Tokyo during the 1995 

subway attacks, medical personnel had 

little to no knowledge of the effects of 

chemical weapons. One doctor, who had 

previous experience with an earlier Aum 

Shinrikyo incident, called in his advice to 

the hospital receiving the largest number 

of casualties. At the onset of influenza in 

1918, doctors had never seen such virulent cases and thus misdiagnosed the disease as the plague, meningitis and dengue fever. During the 2001 anthrax attacks in the United States, doctors relied

on textbooks and empirical data from the 

1979 Soviet release, neither of which 

matched the circumstances of the October 

events. Medical experts gave improper

advice due to the dearth of knowledge. 

Interagency tensions arose when the U.S. 

Postal Service learned it had passed bad 

advice to its employees that had been 

provided by the Centers for Disease Control and Prevention (CPC).

During the UK FMD outbreak, the 

lack of disease detection for several 

weeks prior to the first recognized case 

limited government efforts to contain the 

outbreak. Nor did government planning 

and preparation anticipate the extent of 

the outbreak. Communication with the 

public lacked credibility due to widespread distrust of government motives, 

especially within the farming community. 

Disease eradication policies may have 

been more widely accepted had the government included English and Welsh farmers on the decision-making process and 

involved organizations the farmers trusted

like the National Farmers Union as in 

Scotland. The 2001 FMD outbreak may 

have been accidental or natural occurrence, but it offers insight into issues that 

could arise following a large scale chemical or biological attack, including the ability to manage perception, reduce confusion on the part of the citizenry and government officials, and create established 

relationships between government and 

trusted non-government organizations that 

can act as liaison with the public.

By February 2003, a viral respiratory 

illness that had first emerged in China in 

late 2002 was given the name Severe 

Acute Respiratory Syndrome (SARS) by 

the World Health Organization (WHO). 

Concern heightened among health officials due to the high transmission rate 

among humans. According to the WHO

by late spring, there were more than 7,000 

cases of SARS worldwide and over 500 

deaths. This case study focused on the 

actions of the Canadian government to 

combat the epidemic in British Columbia 

and Ontario. The difference in how these 

cases were handled within these provinces 

help to explain why Toronto came to be 

seen as the focal point of SARS, while 

cases in British Columbia were largely 

unnoticed by the rest of world.
xv

British Columbian health officials

were aware of the outbreak of SARS in 

China by early February. They monitored

the situation, and communicated information to healthcare providers. The same 

was not true in Ontario, where no systematic surveillance or communication system existed. The absence of a coherent 

pandemic plan limited Ontario‟s ability to 

manage the SARS outbreak. Preparation 

by the healthcare community in British 

Columbia minimized the impact of the 

outbreak not only on the victims, but also 

on the community at large. The lack of 

effective communication severely hampered Toronto‟s ability to control infection. This inability not only cost lives and 

millions of dollars in healthcare-related 

expenditures, but caused Toronto to lose 

over $1 billion in tourist dollars.

 Lack of interagency cooperation 

and info sharing significantly raises 

risks.

As federal and state resources descended on New Orleans following Hurricane Katrina, one of the greatest challenges was no one commanded all agencies and organizations involved. Coordination was managed on a case-by-case 

basis, which was greatly hampered by the 

lack of interoperable communications. 

National Guard troops could not communicate with active duty military, and neither could reach out to local resources, 

except with cell phones. The result was a 

haphazard response by all agencies, desperate to rescue the victims of the storm.

Similarly, during the 2001 anthrax attacks various agencies relied on others for 

information, which did not always arrive 

in a timely manner or was incorrect upon 

arrival. Even though organizations know 

the challenges they face during a major 

event as they did following the anthrax

attacks and Hurricane Katrina, the U.S. 

Government has been unable to solve the 

interagency issue. The mantle of leadership, responsibility for distinct aspects of 

response and coordination varies depending on the nature of the attack. Rarely 

have coordination efforts gone far beyond 

the written word. During normal execution of duties as well as crises exercises,

inconsistencies are glossed over as too 

difficult to solve. Katrina is a prime example of a case where most first responders and secondary support agencies have 

been involved in planning, staging and 

exercising national command structure, 

all of which was thrown out the window 

during the event.

Recommendations

The most critical finding uncovered 

from this study is contrary to common 

perception, there is no significant evidence to suggest individuals or communities are prone to panic in a CBRN event. 

In the incidents examined, and in the opinions of most workshop participants, 

people have typically responded to such 

events by trying to care for themselves 

and loved ones and applying the advice of 

authorities as they understood it. This 

positive, responsive behavior can at times 
xvi

still create challenges in response and recovery, such as when people were quick 

to report anything looking like suspicious 

white powder after the fall 2001 anthrax

attacks. Or, when people immediately 

sought medical help when they had been, 

or believe they had been exposed to a 

chemical as in Tokyo following the 1995 

sarin attacks. Despite these challenges, 

there is no evidence of large-scale irrational or counterproductive behavior in 

any of the cases reviewed for this report. 

This strongly suggests, rather than being 

looked at as a threat or problem to be managed in a crisis, the public should be 

seen as a potential partner in meeting the 

challenges of a community or of the nation following CBRN event.

This report recommends the U.S. 

Government undertake or implement five 

distinct actions: 

1.) Lead with Authority, Responsibility 

and Honesty.

Lack of a coherent communication 

plan and clear lines of authority were 

painfully apparent during both the anthrax 

attacks and the response to Hurricane Katrina. In addition to overlapping authorities at the national level, Hurricane Katrina proved the U.S. Government could not 

effectively coordinate federal, state and 

local efforts as quickly as the crisis required.

The reason for the inclusion of the 

Tylenol poisoning case was the astounding ability of Johnson and Johnson to regain public trust and thereby increase 

market share following the tragic events 

of 1982. Important lessons can be learned 

from J&J‟s experience, including the fact 

J&J took responsibility for the crisis and 

responded to the public with honesty and 

clarity. No excuses were made, even 

though it was first thought the problem 

had to have occurred during manufacturing. Even after the company discovered it 

was not to blame, it did not slow its actions to prevent a repeat occurrence. Instead J&J acted swiftly, costing millions, 

but the loss was easily overcome within a 

few years. The last lesson of the Tylenol 

case was to use a “reservoir of good will” 

wisely. Americans trusted a product and 

were reassured by the rapid response of a 

well-known entity.

2.) Improve Communication Among and 

Within Government Entities.

Many government agencies and organizations rely on others for accurate 

and timely information, especially in a 

situation involving public health. During 

the anthrax attacks in 2001, agencies were 

challenged to manage information released to the public. Postal workers pressured localities such as Washington, D.C. 

to make a decision about the closing of 

the Brentwood Postal Facility, as well as 

to determine who should receive treatment. The public health statements from 

CDC and HHS were sometimes confusing 

or vague, raising concerns over fairness 

and increasing confusion regarding treatment options.

Given the likely magnitude of a 

CBRN event, public trust in government 
xvii

statements and actions is essential. Mistrust leads to counterproductive activities 

such as refusing to be vaccinated or 

hoarding medicine against a vague threat. 

Not all citizens will conform, but clarity 

and uniformity will go a long way in easing confusion and chaos.

3.) Prepare and Inform the Public.

The average response time for the 

federal government to a disaster is 72 

hours. Those first three days may be vital 

to community or individual survival and 

recovery. Thus, it is incumbent on citizens and local communities to take action 

prior to an attack and be able to respond 

quickly when an attack does occur. 

The involvement of America‟s youth 

was seen by many workshop participants 

as crucial to increasing knowledge and 

improving overall resilience. While the 

U.S. Government has some initiatives 

aimed at children, they need to be expanded to utilize school, sporting and civic activities.

To make the most of their own resources, citizens need to know what is 

happening and what they can to do to help 

themselves and their families. One suggestion for encouraging individual preparedness is to expand current public 

awareness efforts.

The ability of the government to 

manage the expectations of its public is 

vital to recovery from any type of crisis. 

When people expect the government to 

take care of them, they are less likely to 

take steps to care for themselves. During 

the workshop, participants discussed methods for changing – not decreasing expectations. Therein lies the role of the 

media.

4.) Improve Medical/Public Health Infrastructure and Resources.

Medical resources are perhaps the 

most crucial resource following a CBRN 

event. Given the dearth of knowledge surrounding WMD, overcoming ignorance is 

likely to be a major challenge in managing an event. Following a WMD event, 

the public will need clear and decisive 

directions on what to do and who needs to 

seek medical care. There are likely to be 

many behavioral casualties or those who 

are uncertain of their status. The need for 

medical and support personnel could be 

overwhelming. This need is not discretionary. It is a strategic necessity that 

should receive priority as it has value in 

responding to almost any crisis situation.

5.) Use Existing Local Resources.

Advance preparation can alert citizens 

to a variety of possible CBRN and other 

crisis events and, thus, cut down on the 

number of unexpected surprises encountered. Further, during a crisis event, clear, 

consistent information from a reliable 

source is enormously helpful to those 

coping with a crisis or disaster. 

Following landfall of Hurricane Katrina, local non-profit organizations 

housed and cared for as many evacuees as 

the Red Cross, although many did not receive re-imbursement or government support after the crisis had ended. The gov-
xviii

ernment needs to engage these nontraditional sources of community support. 

They have connectivity to the population 

and can communicate to them prior to and 

even during an event. For this reason, 

these private organizations should also be 

involved in local planning. Their adaptability and responsiveness demonstrate the 

strength of local expertise, relationships, 

and capability to reach and serve vulnerable populations and communities. Local 

community organizations may be best positioned and capable of bridging the gap 

between federal and state governments 

and their citizens.

Conclusion

Webster‟s Medical Dictionary defines panic as “a sudden strong feeling of 

fear that prevents reasonable thought or 

action.” We found no empirical evidence 

to suggest citizens are likely to panic during a crisis even when WMD may be involved. The public needs information to 

be empowered to act on its own, knowing 

the government cares, but that selfreliance is key to being personally resilient and acting to support and encourage 

a resilient community and nation. Resiliency flows down from the government 

in terms of infrastructure, knowledge and 

capabilities; but it also grows outward 

from individuals and families who are 

prepared to maintain and sustain themselves within communities.

In order to foster a resilient society, 

the government needs to change its role 

from primary care provider to a more 

broad-based supporter of local and community resilience efforts. Focusing on 

personal preparedness at an early age, beginning at school, would go a long way in 

preparing citizens to cope successfully 

with future crises and disasters. 

Honesty and clarity in government 

communication creates public trust. Public trust is a requirement for a reasonable, 

orderly response to a traumatic incident 

such as a CBRN event. Government leadership will increase understanding of the 

situation and feelings of manageability of 

crisis, all of which are requirements for 

personal resilience. 

In looking back at major catastrophic 

incidents around the world, experts have 

noted the closer a person was to the crisis, 

the more realistic and reasonable the individual‟s behavior. Preparation for disasters, education, training and exercises, 

both physical and mental, can promote 

confidence in the public that they can 

cope with what comes. Advance preparation can also educate citizens to a variety of 

possible CBRN or other crises and, thus, 

lessen the number of unexpected surprises 

encountered. During a crisis, clear, consistent information from a reliable source is 

enormously helpful to those coping with a 

crisis or disaster. A prepared, informed 

and involved public is a resilient one.
1

INTRODUCTION

Public resilience is not a common 

concept in the United States. The term 

“resilience” is generally used in reference to communications or other infrastructure, but rarely in human terms. 

This is not the case in Israel and the 

United Kingdom, where resilience is 

widely accepted as a necessary part of 

everyday life. Resilience is generally 

defined as “the ability to respond effectively and recover from any stressor,” in 

this case, following a weapons of mass 

destruction (WMD) attack or accident. 

In the simplest terms it is the ability of 

individuals, a community and a nation to 

return to some semblance of normalcy 

after a catastrophic event. What would 

the U.S. Government need to do? What 

support would need to be provided for 

citizens to enable them to go about their 

daily lives, even though their lives may 

be irrevocably altered? These are the 

questions addressed in this study. 

The USAF Counterproliferation 

Center undertook a year-long project 

sponsored by the Advanced Systems and 

Concepts Office of the Defense Threat 

Reduction Agency to explore the issues 

related to building public resilience to 

Chemical, Biological, Radiological, and 

Nuclear (CBRN) weapons events. The 

project entailed four primary elements. 

First, in order to fully examine the manner in which CBRN weapons may test 

human public resilience, a thorough literature review was conducted, from which

case studies were chosen that cover a 

number of key areas. The case studies 

and literature review were followed by 

an identification of top experts on psychological resilience, panic mitigation, 

disaster preparedness, consequence management, and crisis management as it 

pertains to preparing the public for and 

guiding the public through a WMD 

event.

Experts knowledgeable about the 

Homeland Security Advisory System, 

the Citizen Corps, and efforts of the U.S. 

military to prepare its members for 

threatening events were also identified. 

These experts were invited to participate 

in a one-day workshop to exchange ideas 

and to make recommendations on this 

subject. The workshop observations were 

recorded and combined with the case 

studies to form this summary report 

drawing on information revealed in the 

literature search, case studies and workshop. Finally, this report advances a set 

of recommendations for improving public resilience by measures to be adopted 

prior to and during a crisis situation.

Project Overview

The project focuses on the concept 

of resilience and factors that can increase 

or inhibit the development of this vital 

capacity. The overview also examines 

issues related to CBRN weapons and their 

impact on individuals and communities 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

2

that may present unique challenges to 

their resilience. To thoroughly examine 

the subject, past incidents that might provide insights into the effects of catastrophic attacks were reviewed. These 

cases were examined from the perspective 

of community response to CBRN related 

incidents. Actions taken by government 

agencies and the media during these incidents were considered terms of their impact, both positive and negative, on effected populations. Such an examination 

necessarily crossed into a wide range of 

fields of study and areas of expertise, including emergency management, risk perception and risk communication. While 

these are all extremely important to the 

interaction between government and the 

public in a time of crisis, detailed analyses of these areas is beyond the scope of 

this paper. The focus of this study will 

enhance understanding of public responses to CBRN related crises, and provide suggested improvements in government actions. 

The incidents reviewed in this 

project can be broadly grouped in two 

categories. The first group includes events 

in which CBRN agents were used against 

a vulnerable civilian target. Fortunately, 

the number of events in this category are 

relatively few, and do not provide a wide 

range of cases for assessment. By necessity, a second category was reviewed. This 

group includes events that, although natural or accidental, simulated in some way 

the effects a CBRN event. Examining 

both types of events provided an opportunity to look at a wider range of possible 

responses to a CBRN attack. Finally we

provide recommendations for building 

resilience.

The Concept of Resilience

Resilience is a psychological concept 

that gained widespread usage in the 1980s 

as researchers focused on the varying 

outcomes of children raised under adverse 

conditions. Researchers observed, as 

many of us have seen in our own experiences, that some children raised in 

homes where they were exposed to abuse, 

addictions, extreme poverty or in institutional settings, developed their own emotional and behavior problems. Other 

children exposed to similar stressors appeared to thrive, and become capable, 

competent individuals despite the adversity they faced. 

A number of definitions of the term 

resilience were developed that captured 

this idea of coping well despite stress or 

adversity. One of the first and most referenced definitions of the term was advanced by Sir Michael Rutter who defined it as facing “...stress at a time and 

in a way that allows self-confidence and 

social competence to increase through 

mastery and appropriate responsibility.”1 

A more recent definition put forth by the 

American Psychological Association, describes resilience as “the process of 

adapting well in the face of adversity, 

 

1 Rutter, Michael, “Family and School Influences 

on Cognitive Development,” Journal of Child 

Psychology and Psychiatry, vol. 26, 683-704, 

(1985).
No Need to Panic: Public Resilience in CBRN Events

3

trauma, tragedy, or even significant 

sources of stress.”2

Both definitions make clear resilience 

is manifested in response to a stressful 

event. Such stressors can include chronic 

problems such as living with an injury, 

disability, or an extended dislocation from 

a home, or prolonged exposure to substandard living conditions. Other stressors 

can be described as more acute, such as a 

sudden injury, the death of loved one, 

traumatic exposure to the dead and dying, 

or a brief dislocation from a home. Any 

type of CBRN incident could create a 

wide range of both acute and chronic 

stressors that would challenge an individual‟s capability to respond in a resilient

manner. 

These definitions also highlight that 

resilience is comprised of several components. It involves facing a stress or a 

threat in a way that builds confidence in 

the individual‟s ability to master future 

threats. It also involves taking some personal responsibility for the successful response to that threat. That is, individual or 

group resilience is unlikely to grow from 

having someone else manage a crisis or 

threat.

Thus, one key to the development of 

resilience is having had the experience of 

being faced with responsibility in a threat 

or crisis and successfully managing it. 

Resilience does not guarantee an event 

will not have an impact on an individual 

or the person will never experience dis-

 

2

“The Road to Resilience,” American Psychological Association, On-line, Internet, 

http://apahelpcenter.org/featuredtopics/feature.php?

id=6&ch=2.

tress or difficulty coping. Rather, resilience is the characteristic that allows one 

to adapt to stressors while continuing to 

function with minimal disruption.

Further, resilience is not an all-ornothing characteristic. Everyone has a 

degree of resilience, and some may be 

more resilient to one type of stress than to 

another.3 For example, some people may 

manage the stress induced by time pressure at work much better than they handle 

relationship stresses at home. 

More relevant to the preparation for a 

terrorist attack, individuals and communities on America‟s gulf coast may have 

developed a significant amount of resilience to the effects of hurricanes and occasional displacements based on past experience of successfully preparing for, 

surviving and recovering from them. 

While this experience with hurricanes 

may instill confidence and resilience in 

coping with future storms, it may not 

translate well to the desired response to a 

chemical or biological terrorist attack. 

The degree to which resilience translates from one kind of event to another 

may depend on the extent an individual is 

familiar with a threat or feels a sense of 

control in the response to it.4

While different individuals may manifest resilience in different situations, 

there are a number of characteristics 

common to resilient individuals. The characteristics can be grouped into three gen-

 

3

“Promoting Resilience,” New York State Office of 

Mental Health; OMH Quarterly, (March 2003), Online, http://omh.state.ny.us/omhweb/omhq/

q0303/Resilience.htm.

4

Ibid.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

4

eral categories: (1) individual characteristics, (2) social ties and (3) coping strategies. 

One individual characteristic common to resilient people is optimism, the 

ability to see hope for the future even in 

difficult circumstances. Without a sense 

of optimism things can get better, an individual is unlikely to begin to think about 

or work toward improving their situation. 

Such an individual would see themselves 

as a victim for whom things will not improve. 

Another beneficial individual feature 

is self-efficacy, or a confident sense the 

individual can utilize available personal 

and external resources to cope with the 

imposed adversity or stressor. Even if one 

is optimistic, if they do not believe there 

is anything they can do to change their 

situation they will be unable to begin to 

help themselves. 

Self-efficacy is related to mastery, 

which is the ability to take control of the 

situation one is placed in, break a large 

problem down into smaller, more manageable pieces and begin with those small 

steps to work to resolve the problem. 

Hope that a bad situation can improve (optimism), the belief that one can 

work to improve it (self-efficacy), and the 

knowledge and experience of getting results when one takes initial steps toward 

recovery (mastery) combine to improve 

resiliency. Individuals are on their way to 

coping effectively with a traumatic event 

when they can achieve at least some level 

of optimism, self-efficacy and mastery. 

Finally, resilient people demonstrate 

a sense of coherence, which is the belief 

that events that happen in one‟s life make 

sense. Coherence allows individuals to 

place even traumatic events into a bigger 

picture of life.5 

Resilience to a WMD Event

While the definitions are informative, 

they do not directly illustrate how these 

individual characteristics relate to better 

coping during a terrorist attack.6In prepa-

 

5

“Fostering Resilience in Response to Terrorism: 

A Fact Sheet for Psychologists Working with 

Adults,” American Psychological Association. Online, http://www.apa.org/psychologists/pdfs/

adults.pdf.

6 A multitude of studies were undertaken following the attacks of Sept. 11, 2001. Several of these 

studies focused on whether New York area residents suffered from the symptoms of posttraumatic stress disorder and used that determination as a measure of personal resilience. The studies focused primarily on the individual and his 

immediate response to the event. Other post-9/11 

surveys defined resilience more broadly and found 

while as many as 90 percent of respondents stated 

they suffered from stress, they did engage a multitude of coping mechanisms that allowed them to 

weather the storm. For an example of personal 

resilience, see George A. Bonanno, Galea A. Sandro, A. Bucciarelli, and D. Vlahov, “Psychological Resilience after Disaster - New York City in 

the Aftermath of the September 11th Terrorist 

Attack,” Psychological Science, 17(3): 181-186, 

(2006). For an example of the resilience coping 

mechanisms see the RAND study, published as 

M.A. Schuster, B. D. Stein, L. H. Jaycox, R. L. 

Collins, G. N. Marshall, M. N. Elliott, A. J. Zhou, 

D. E. Kanouse, J. L. Morrison, S. H. Berry, “A 

National Survey of Stress Reactions After the 

September 11, 2001, Terrorist Attacks,” New England Journal of Medicine, Vol. 345, No. 20, (Nov.

15, 2001), 1507-1512, and Kenneth A. Rasinski, 

Jennifer Berktold, Tom W. Smith and Bethany L. 

Albertson, “America Recovers: A Follow-Up to a 
No Need to Panic: Public Resilience in CBRN Events

5

ration or response to a nuclear, radiological, chemical or biological attack, a resilient person would demonstrate optimism 

by believing he, the community, and the 

nation would be able to cope with the crisis and recover to see better days.

Self-efficacy would enable the individual to believe that by accessing and 

making use of available information and 

resources they can work to protect themselves and begin to recover. 

Mastery would allow them to build 

on those initial successes, or past similar 

experiences and personal resources to 

take further steps to develop and implement a plan to recover. 

Finally, a sense of coherence would 

allow the person to see the attack as part 

of a larger war on terror (rather than an 

unforeseen bolt from the blue) and part of 

a larger life that, although negatively affected by the attack, can still go on. 

These resilient personality features 

allow an individual to respond well and 

be maximally personally effective in the 

event of a crisis. An individual without 

one or more of these characteristics is 

more likely to be overwhelmed by the 

stress of crisis, to respond ineffectively or 

even counterproductively, and be much 

more reliant on the support of others, 

creating unnecessary drain on emergency 

responders and their healthcare and other 

support systems. 

In addition to these individual characteristics of resilience, the social ties 

 

National Study of Public Response to the September 11th Terrorist Attacks,” National Organization 

of Research, University of Chicago, (Aug. 7, 

2002).

that bind people together also contribute 

to resilience. People who are able to ask 

for and receive support from social 

groups such as family, friends, church or 

community are more resilient to stress 

than those who either cannot seek support 

or have none available. While it seems 

obvious receiving support would help an 

individual cope well with stress, there is 

evidence that providing support for others 

in times of crisis is helpful as well. Supporting others is one way of seeing the 

efficacy of your action and beginning to 

take at least a small step toward control 

over what may appear to be an overwhelming situation. This may explain 

why one in three Americans directly supported recovery after Sept. 11, 2001, by 

giving time, money or blood.7

The final set of factors contributing 

to resilience is related to coping strategies. Even with the individual characteristics identified above, a person must still 

utilize coping strategies to respond effectively to an attack. These strategies include stepping back to see the big picture 

before rushing to solve a problem, break-

 

7

Ibid. See also the National Tragedy Study, 

which showed that most Americans felt a surge in 

pride in being American, gained trust in national 

institutions, and increased their faith in fellow 

citizens. Forty-nine percent of those surveyed 

made charitable contributions; 24 percent gave 

blood and 84 percent said “special prayers” for 

those affected by the attacks. “Public Bounces 

Back After Sept. 11 Attacks, National Study 

Shows,” National Science Foundation Press Release, NSF PR 01-85, October 24, 2001 and 

Kenneth A. Rasinski, et al, National Organization 

of Research, University of Chicago, (Aug. 7, 

2002).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

6

ing large and potentially overwhelming 

problems into more doable tasks so 

progress can be made, and taking breaks 

from the crisis to rest or refocus energy.8 

Failure to cope effectively by trying to do 

too much or not recognizing personal limits can lead to poor decision-making 

which can make a crisis situation worse.

High resilience to stress, then, is the 

combination of a positive individual perspective, strong social connectedness and 

effective problem solving skills, all of 

which allow an individual to cope more 

positively even with traumatic events 

such as a CBRN attack. Although some 

individuals are by nature or experience 

more resilient than others, resilience is a 

trait that can be improved.9

Building Resilience

The American Psychological Association (APA) has produced a series of brochures on enhancing resilience and posted 

them on the APA website for public 

access. The APA identifies several factors 

toward building resilience that can not 

only be utilized by individuals but could 

also be enhanced by federal, state and local policy. The APA recommends that 

individuals build connections with others, 

including social and civic groups, to help 

develop avenues for social support in the 

event of a crisis. Creation or support of 

local organizations with abilities to bring 

individuals together to create support 

 

8

Ibid.

9

Ibid.

networks is one method of helping the 

population build resilience. 

Another technique for increasing resilience is taking decisive action. This is a 

way of reducing the anxiety of indecision. 

By taking action, one can focus on the 

action at hand, rather than feeling stuck in 

uncertainty. Government agencies could 

facilitate this aspect of resilience by providing clear guidance of actions that 

should be taken in preparation for the 

general possibility of future disasters and 

terror attacks. Additionally, immediate 

direct guidance should be provided for 

coping with specific threats as the perceived risk increases or immediately following an attack.

Keeping things in perspective is 

another method of enhancing resilience. 

As individuals improve their ability to 

look at the big picture, they can better direct their actions and moderate emotional 

reactions. Larger efforts to communicate 

clearly about the risk of terror attacks, 

particularly in comparison to the other 

threats inherent in modern life, can help 

reduce anxiety associated with terror attacks. 

For example, despite the emphasis 

placed on securing our nation from terrorism, the relative risk to Americans is rather low in comparison to those in the 

United States who have been killed by 

lightning over the last 40 years.10 Providing accurate comparative data to allow 

the population to place the threat of terror 

 

10 Mueller, John; “Simplicity and the Spook,” 

reprinted from International Studies Perspectives, 

Vol. 6, No. 2, (May 2005), AWC Terrorism Elective Reader.
No Need to Panic: Public Resilience in CBRN Events

7

attacks in the proper perspective would be 

one method of enhancing resilience. 

However, some CBRN attacks might inflict casualties well beyond our previous 

national experience.

A final technique for increasing resilience is to avoid seeing crises as too 

large to be managed, and by beginning to 

break down a crisis into more manageable 

pieces. Authorities could greatly enhance 

resilience in this area by providing preattack information, encouraging small 

steps that individuals, families and communities could take to improve their security. Such preparation may have a direct 

impact on an individual‟s sense of selfefficacy. Through pre-attack preparation, 

one would learn there are things they can 

do to improve their situation and be more 

likely to respond appropriately if an attack occurs. Thus, it appears clear with 

the proper motivation and allocation of 

resources, the nation could embark on a 

program to mobilize the population to be 

much more confident in its ability to respond to a significant threat. During an 

event, this power of resilience can be fostered by providing the public with accurate, timely information that gives guidance to those affected by the crisis.

Behavior in Crisis

This understanding of resilience and 

how it can be enhanced is particularly 

important in light of current knowledge 

regarding human behavior in the face of 

threat or disaster. Recent work by Anthony Mawson highlights the marked 

disparity between how people are presumed to behave during disasters and 

their actual behavior.11 He finds that in 

contrast to the prevailing belief that in 

the face of disaster there will be mass 

panic and/or violence as people recklessly flee to safety, there is little evidence to 

support this belief. Mawson‟s research 

suggests that rather than panicking and 

fleeing, people are much more likely to 

engage in activities that are supportive of 

others or involve seeking familiar people 

or places. 

He cites four mistaken assumptions 

that contribute to the belief that panic is 

likely in a disaster situation. The first 

mistaken assumption is the drive for self 

preservation will result in fleeing the 

scene or fighting others. The second mistaken assumption is most individuals 

will choose to move away, leaving the 

scene of the attack toward a safe location. The third mistaken assumption is 

physical dangers will create more panic 

than other types of stress. The fourth 

mistaken assumption is panic is only 

prevented by strict social discipline and 

leadership.12 

 

11 Mawson‟s article builds on a larger body of 

work on panic behavior and response to disasters 

that dates back to the 1960s. A full review of this 

literature is beyond the scope of this paper. For 

further information on the topic see Quarantelli, E. 

L. (1960); “Images of Withdrawal Behavior in 

Disasters: Some Basic Misconceptions,” Social 

Problems, 8, 63-79 and Quarantelli, E. L. & 

Dynes, R. (1977); “Response to Social Crisis and 

Disaster,” Annual Review of Sociology, 3, 23-49.

12 Anthony Mawson, “Understanding Mass Panic 

and Other Collective Responses to Threat and 

Disaster,” Psychiatry, 68, (Summer 2005).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

8

These mistaken assumptions can 

lead those in positions of responsibility 

and authority to attempt to avert such 

panic by not releasing information about 

a potential disaster or attack. Unfortunately, this behavior could potentially 

make panic more likely when a disaster 

occurs.13

Mawson outlines four corollaries to 

these mistaken assumptions that reflect 

research on actual human behavior in 

times of crisis or disaster. First, more than 

the drive to flee to safety, people are motivated by a desire to be with familiar 

people (family, friends, etc.) and in familiar places, even if this means moving toward the danger. Second, people tend to 

move not toward an objectively safe 

place, but toward people and places they 

perceive to be safe. Third, separation 

from these familiar people or places during a disaster may be more disturbing 

than the actual physical threat. Fourth, the 

key to avoiding panic may not be firm 

social control or discipline, but the presence of familiar people.14

These assumptions and their corollaries are keys to understanding and planning to strengthen the public response to 

CBRN attacks. If adopted, these concepts 

could encourage significantly different 

management of information and guidance 

provided to the public than a program 

based on the four mistaken assumptions 

cited previously. 

 

13 Ann E. Norwood, “Commentary on „Understanding Mass Panic and Other Collective Responses to 

Threat and Disaster:‟ Debunking the Myth of Panic,” Psychiatry, 68, (Summer 2005).

14 Mawson, Psychiatry, (Summer 2005).

Mawson‟s findings regarding public 

behavior in disasters are supported by 

other research that focuses on the likely 

public response to terrorist attacks. In a 

2006 study, Sheppard, et al., found that 

following five significant terror attacks 

while there was evidence that when the 

public changed their behavior in some 

ways to adapt to a perceived threat, such 

as decreasing travel, or using more caution when opening the mail, there was 

little evidence of public panic.15

The findings by Mawson and Sheppard mesh well with the basic concepts of 

resilience reviewed earlier. One of the 

key factors in resilience was the ability to 

reach out to provide support to, and receive support from, others in times of 

stress. This ability to affiliate with others 

during crisis or stress then appears to not 

only help individuals cope with a crisis, 

but, on a large scale, enables groups to 

avoid panic behavior. 

This drive for the familiar has both 

advantages and disadvantages for emergency planners. On the positive side, 

based on Mawson‟s research, mass panic 

is a much less likely outcome of disaster 

than is often feared. On the negative side, 

however, the tendency to seek out familiar people and places may lead many to 

ignore early warnings to evacuate or seek 

shelter leaving them at greater risk when 

danger occurs.16

 

15 Ben Sheppard, G. James Rubin, Jamie K. 

Wardman, and Simon Wessely, “Terrorism and 

Dispelling the Myth of a Panic Prone Public,” 

Journal of Public Health Policy; (2006), 27, 3.

16 Ibid.
No Need to Panic: Public Resilience in CBRN Events

9

This potential appears to have been 

clearly demonstrated by the behavior of 

tens of thousands of citizens of New Orleans who opted to remain in their homes 

and with their families despite warnings 

to seek higher ground during Hurricane 

Katrina. The desire for affiliation may 

also have contributed to emergency workers leaving their posts to tend to their 

families rather than performing their jobs. 

This unwillingness or inability to heed 

warnings and seek shelter resulted in an 

overwhelmed emergency response system. 

The challenge for those seeking to 

build population resilience to a CBRN 

attack will be to build on this desire to be 

with familiar others and support each other while enabling people to follow evacuation warnings and other directions. Having provided a basic understanding of resilience and public behavior in disaster, it 

will be helpful to examine some past incidents which help to shed light on these 

principles in practice. 

Resilience Incidents

Fortunately there have been few true 

CBRN attacks in recent years for analysis, 

and some CBRN attacks that have occurred may not shed light on U.S. public 

resilience due to the cultural or demographic nature of the target populations. 

This project examined a combination of 

true CBRN attacks and natural events 

that, in significant ways, represent or may 

shed light on the human response to future CBRN attack scenarios. 

The following CBRN attacks were 

reviewed. Those in bold were selected for 

inclusion in the study. The other events 

were excluded for a number of reasons. 

Several were excluded because they 

represented attacks on solely military targets and were not intended to have a direct effect on the civilian population.

The 1984 Rajneeshee biological attack in Oregon was not identified as an 

attack until well after it was perpetrated,

and so victims and the community did not 

respond to the CBRN terrorism implications of this incident. The 2007 chlorine 

vehicle borne improvised explosive device (VBIED) attacks in Iraq occurred in 

a context of near continuous violence and 

did not appear to create significant population response beyond that caused by 

conventional IED attacks. The 2007 UK 

Foot and Mouth Disease outbreak (although it may have been intentional) appears to have had only minor impact, perhaps highlighting the resilience gained by 

the British public and the agricultural 

community through managing the previous 2001 outbreak. 

Finally, the U.S. nuclear attacks on 

Japan at the end of WWII and Iraqi use of 

chemical agents on Kurdish civilians 

were not included for formal analysis. 

Although the Hiroshima and Nagasaki 

attacks represent the largest scale CBRN 

attacks on a civilian population, they occurred within a context of total war and 

resulted not in a return to normal functioning of the Japanese government, but 

military occupation. 

Likewise, the attacks by Saddam 

Hussein against the Kurds reflect intras-
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

10

tate violence by the government against a 

minority population rather than an attack 

by an outside nation or terrorist group. 

Thus, although there have been a 

number of intentional uses of CBRN 

agents, only those listed below in bold 

appear to have significant implications for 

likely CBRN attacks on the United States.

 WWI chemical attacks focused on 

fielded troops

 WWII atomic attacks on Japan

 Iran-Iraq War chemical attacks

 The Dalles, Oregon 1984 – Rajneeshee cult poisoned locals with salmonella

 WWII Japanese chemical and biological attacks on China

 Matsumoto, Japan, 1994 – Aum Shinrikyo attack on a residential area

 Tokyo, Japan 1995 – Aum Shinrikyo released sarin in subway

 United States, 2001 – Anthrax attacks

 Iraq 2007 – multiple VBIEDS attacks 

mixing high explosives with chlorine

 United Kingdom – 2007 Hoof and 

Mouth Disease Incident

To illustrate important resilience lessons, this review focuses on two true 

CBRN attacks, the 1995 Aum Shinrikyo 

sarin attacks in the Tokyo subway and the 

2001 anthrax letter attacks in the United 

States.

Further, given the limited list of true 

CBRN attacks that yield useful resilience 

lessons, a number of accidental or natural 

events with CBRN-like characteristics 

were also considered for review. Each of 

these events in some way mimics some of 

the effects following a CBRN attack. The 

events listed in bold were chosen for inclusion in this study.

 Pandemic Influenza 1918-1920

 Bhopal, India 1984 – methyl isocyanate accident

 Goiania, Brazil 1987 – accidental dispersion of Cesium-137

 South Florida 1992 – Hurricane Andrew

 United Kingdom 2001 – Foot-andMouth outbreak

 Toronto, Canada 2003 – SARS outbreak

 United States, 2004 Flu vaccine 

shortage

 New Orleans, LA 2005 – Hurricane 

Katrina

In addition to those listed above, the 

1982 Tylenol poisonings case was added 

for the lessons learned from the ability of 

Johnson and Johnson to maintain public 

trust in its product after the pain-reliever 

was used in a random serial murder case 

in the Chicago area. 

In total, seven case studies, some by 

terrorists, and others, naturally occurring 

disasters or accidents, were chosen for 

their impact on and lessons learned regarding public resilience. They include 

the 2001 anthrax letter attacks, 1918 influenza pandemic, 1995 Tokyo subway 
No Need to Panic: Public Resilience in CBRN Events

11

attack, 2003 SARS outbreak, 2001 footand-mouth outbreak, 1982 Tylenol poisonings, and 2005 Hurricane Katrina. 

In choosing these case studies, the 

authors are attempting to represent the 

range of threats that exist today and assist 

in determining how to improve public 

resiliency through government action.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

12
13

PUBLIC RESILIENCE CASE STUDIES

1. ANTHRAX ATTACKS

“Your guesses are as good as mine.”

–CDC Director Jeffrey Koplan, regarding the source of the 2001 anthrax attacks

Salient Points

 An attack was not immediately obvious.

 The public responded to official directives which caused confusion given the 

statements were often contradictory or 

wrong.

 In the absence of clear official guidance 

the public reacted with common-sense 

measures.

 While panic did not ensue, heightened 

alertness strained first responder capabilities.

 Lack of medical knowledge threatened 

the ability of laboratories and clinics to 

respond effectively.

 The U.S. Government did not have a 

coordinated plan for sharing necessary 

information with the public during a bioterrorism attack.

In September 2001, the United States 

suffered from the first major attack on its 

homeland since Pearl Harbor 60 years 

before. Following the terrorist attacks on 

Sept. 11, 2001, fears of follow-on attacks, 

including bioterrorism, loomed on the horizon. While the nation anxiously awaited 

additional attacks, one man fell violently 

ill and died in Florida. Other cases followed in New York and later, Washington, D.C. In August 2008 U.S. federal 

prosecutors indicted Bruce Ivins, a scientist at U.S. Government laboratory at Fort 

Detrick, Maryland. In February 2010, the 

Federal Bureau of Investigation (FBI)

formally closed their investigation. This 

case study will look at the events surrounding those attacks and how the U.S. 

Government and public reacted. Many 

hard lessons were learned by a government unaware of its inability to manage 

numerous attacks that did not fit the scenarios of the past. This incident magnifies an example of a CBRN attack against 

the American citizenry – already reeling 

from events of September 11th–and provides a number of insights into issues regarding public resilience.

On Oct. 4, 2001, public health officials confirmed the first case of intentional infection by Bacillus anthracis in 

the United States. During the following 

seven weeks the Centers for Disease 

Control and Prevention (CDC) reported 

10 confirmed cases of inhalational anthrax and 12 confirmed or suspected cases 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

14

of cutaneous anthrax.17 The outbreaks 

were concentrated in six locations within 

the United States: Palm Beach County, 

Fla.; New York City; Newark, N.J.; Capitol Hill in Washington, D.C.; the wider 

Washington, D.C. area, and Connecticut.18

By the end of November 2001, five people 

had died. The FBI stated four letters were 

found containing anthrax, while the Environmental Protection Agency (EPA) 

confirmed over 60 sites had been contaminated with anthrax spores.

The Attack Timeline

On Oct. 3, 2001, Florida state health 

officials contacted the CDC about a possible case of inhalation anthrax. CDC officials responded immediately knowing 

that only weeks before Florida officials 

had completed a CDC course in identifying biological agents. Two cases of inhalation anthrax were confirmed in Palm 

Beach County. The two individuals 

worked for American Media, Inc. (AMI). 

Contamination was widespread at the 

media office and six local postal facilities, resulting from two letters containing 

Bacillus anthracis. The first fatality, Robert Stevens, an employee of AMI in Boca Raton, Fla., confirmed he had opened 

a letter containing white powder that had 

 

17 While there were numerous other cases, some 

tested positive for anthrax, but never became ill 

and others began antibiotics early enough to have 

likely prevented illness.

18 According to the General Accounting Office, 

the Washington, D.C. area includes the investigations in Maryland and Virginia. Bioterrorism: 

Public Health Response to Anthrax Incidents of 

2001, (October 2003), GAO-04-152.

spilled out on his computer. He had disposed of the letter and had not given it 

any thought until healthcare officials 

questioned him. The letter was never recovered, but was likely the source of infection of a second AMI employee who 

was a mail handler for AMI.

An employee of NBC news anchor 

Tom Brokaw contracted cutaneous anthrax after opening a letter addressed to 

Brokaw around Sept. 20. The letter was 

postmarked Sept. 18 from Trenton, N.J., 

and contained a brown granular material. 

On Oct. 14, a police officer and two laboratory technicians who handled the 

letter were exposed to spores. All individuals recovered.

A letter containing white powder 

addressed to Senate Majority Leader 

Tom Daschle tested positive for anthrax 

after being opened by a member of his 

staff on Oct. 15. About 40 staffers were 

in his office at the time; 28 were found to 

have been exposed. The House of Representatives recessed on Oct. 17, while the 

Senate evacuated the office buildings 

and operated out of the Capitol building. 

According to the EPA the Capitol Hill 

site initially consisted of 26 buildings 

with suspected anthrax contamination. 

All 26 buildings were sampled; anthrax 

was detected in seven buildings, all of 

which were decontaminated at a cost of 

$27 million.

Also on Oct. 15, a 7-month-old son 

of an ABC employee tested positive for 

cutaneous anthrax. It was suspected, but 

not established, the child was exposed in 

a visit to ABC offices in New York City 

on September 28. The child was hospita-
No Need to Panic: Public Resilience in CBRN Events

15

lized, but fully recovered. On Oct. 18, a 

female staff member at CBS developed 

cutaneous anthrax. Four days later a 30-

year-old employee of the New York Post

also contracted cutaneous anthrax; the 

source of both were unknown but presumed to be letters. Two additional New 

York Post employees developed cutaneous anthrax. A letter was recovered later 

in the New York Post mail room.

On Oct. 18, two postal workers in 

New Jersey were reported to have cutaneous anthrax. These exposures presumably represent contact with letters mailed 

from this location. On Oct. 23, a female 

postal worker from Trenton was reported 

to have inhalation anthrax. All survived.

In Washington, D.C., on Oct. 21, a 

postal worker from Washington‟s Brentwood postal facility went to the emergency room and was sent home diagnosed with the flu; on Oct. 22, he was 

brought back by ambulance. Both he and 

another Brentwood employee, hospitalized the same morning, died on the Oct.

22. The next day, two additional workers 

were confirmed to have inhalation anthrax (one 35-year-old male who handled 

mail and one 41-year-old female postal 

union official); while nine others showed 

possible symptoms. In addition, one employee of the State Department, a mail 

handler, developed anthrax. All survived.

On Oct. 28, 2001, a 61-year-old Vietnamese hospital worker, Kathy 

Nguyen, was taken to New York City‟s 

Lenox Hill Hospital‟s emergency room.

She complained of shortness of breath, 

flu-like symptoms and coughing up 

blood-tinged mucus. X-rays revealed 

symptoms of inhalation anthrax. Antibiotics were administered, but Nguyen died 

on Oct. 31. FBI investigators tried to determine how Nguyen had been infected. 

It was assumed she contracted it from a 

letter, yet no evidence of such a letter or 

spores in her mail were found. Only the 

clothes she wore to the hospital were 

found to be contaminated. Another possible source, the subway system in New 

York City, was tested extensively to no 

avail. The source of her exposure was 

never identified.

Finally, in a small Connecticut town, 

Ottilie Lundgren, a retired 94-year-old 

woman, died of inhalation anthrax on 

Nov. 21. The investigation eventually 

indicated she was exposed through crosscontamination of mail. One of the anthrax letters mailed to Congress passed 

through a postal sorting machine 20 

seconds before a letter addressed to a 

location less than four miles from 

Lundgren‟s residence. This letter was 

presumably the letter mailed Oct. 9 to 

Sem. Leahy, which was misdirected and 

was discovered later in state department 

mail. The local post office handling 

Lundgren‟s mail was found contaminated by anthrax. No contamination was 

ever found at her house or in her belongings.

Public Reaction

Public response to the anthrax attacks as a separate incident from those 

that occurred on Sept. 11, 2001, is difficult to gauge. After Sept. 11, 2001, U.S. 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

16

government officials repeatedly warned 

the public of impending attacks. Only 

one week after the attacks, federal officials warned there were more terror cells 

ready to attack and some of the 19 hijackers had shown an interest in crop 

dusting. The specter of bioterrorism elevated to a realistic threat to public health. 

Federal authorities cautioned public 

health facilities to be vigilant for “unusual disease patterns associated with 

[the Sept. 11, 2001, terrorist attacks].”19

Health and Human Services (HHS) Secretary Tommy G. Thompson warned 

Americans to “be on the lookout for 

mysterious health symptoms.” Three 

weeks before any sign of anthrax was 

reported, the public responded to government warnings by purchasing the only 

FDA approved drug for anthrax, Ciprofloxacin, and sought vaccines for smallpox and anthrax. Many pharmacies ran 

out of their normal supply of antibiotics. 

Doctor‟s offices and clinics were inundated with requests for anthrax vaccine 

and antibiotics. The only U.S. producer 

of an anthrax vaccine received more than 

1,000 requests from the public in the two 

weeks following Sept. 11, 2001.20

In addition to vaccines and antibiotics for biological threats, chemical 

 

19 Rick Weiss and Ellen Nakashima, “Biological 

Attack Concerns Spur Warnings: Restoration of 

Broken Public Health System is Best Preparation, 

Experts Say,” The Washington Post, (Sept. 22, 

2001), p. A04.

20 Rick Weiss, “Demand Grows for Anthrax Vaccine; Fear of Bioterrorism Attack Spurs Requests 

for Controversial Shot,” The Washington Post, 

(Sept. 29, 2001), p. A16.

agents were a growing public health concern. Gas masks were snapped up from 

army surplus stores and internet websites. On Sept. 30, 2001, eBay had 54 

pages of gas masks for sale, many of 

which were useless against a chemical 

attack.

Studies following these attacks 

found that 57 percent of Americans modified their behavior in some way, including 12 percent who reported avoiding 

public events. But the most common behavior change was exercising caution 

when opening the mail, a very reasonable precaution reported by one-third of 

those surveyed.21 Such behavior highlights the responses that can be triggered 

by vague public statements regarding 

threats, particularly those not accompanied by specific recommendations for 

public action. In such circumstances, citizens want to do something to protect 

themselves and will begin to change their 

behavior in ways that make sense to 

them in the absence of other guidance. 

This highlights the need to provide behavioral guidance to the public to better 

direct its efforts and help foster a sense 

of efficacy during times of crisis.

While having intentionally raised 

public awareness, after events began to 

unfold, the government then tried to assure the public the situation was under 

control. Initially it was unclear if the first 

case was an attack. In their haste, offi-

 

21 Ben Sheppard, James G. Rubin, Jamie K. 

Wardman, and Simon Wessely, “Terrorism and 

Dispelling the Myth of a Panic Prone Public,” 

Journal of Public Health Policy, 27:3, (2006), p. 

231.
No Need to Panic: Public Resilience in CBRN Events

17

cials gave reassuring statements without 

facts to support their assertions. The 

most serious example occurred on Oct. 5,

2001, when HHS Secretary Thompson 

said the death of the first victim was not 

terrorism, but an “isolated case” – one 

that was most likely caused by natural 

events. By Oct. 21, 2001, events had 

evolved to the point that President Bush 

called the attacks an “act of terror,” stating that while no link to Sept. 11, 2001, 

had been established, clearly the incidents were intentional and, therefore, terrorism.

Americans were asked to be on alert 

and many responded exuberantly. Aside 

from hoaxes, thousands of reports were 

called in by vigilant citizens who came 

across white powder in their daily lives. 

While it is an overstatement to call this 

panic, the level of attentiveness was so 

high that white powder was suspect wherever it was found – from doughnut 

shops, to pharmacies, to makeup counters, to print shops. Common sense did 

not always prevail over anxiety. As cases 

continued to arise in Florida, New York, 

Washington, and New Jersey, responding 

to guidance to be on alert and perhaps 

fearful of becoming victims, new and 

generally false reports began to overwhelm first responders across the country. The FBI received 2,500 false reports 

of anthrax contamination. By Oct. 11, 

2001, Florida officials had received more 

than 1,000 often frantic calls. In Miami, 

police ran out of disposable protective 

suits after responding to 19 calls in one 

day.22 In the Washington, D.C. area, 

Prince Georges County hazardous materials teams responded to as many as 50 

calls a day, working round the clock for 

almost two weeks. First responder agencies scrambled to create protocols for 

threats. As one health official later commented, “a single anthrax-laden letter 

pushed the Washington area emergency 

response system to the limit.” False 

alarms were raised in all fifty states and 

were not limited to major metropolitan 

areas. They occurred from Darien, 

Conn., to Honolulu, Hawaii, and Covington, Ky., to San Francisco, Calif.

During the crisis the American public faced unprecedented uncertainty. 

While individuals appeared to have 

maintained personal and occupational 

responsibilities, a shift in leisure activities followed the attacks. Tourism declined precipitously in the fall of 2001. 

Retail, movie theaters and restaurants all 

saw a decline in sales. However, many 

retailers turned to internet sale to boost 

holiday figures. Online shopping rose 27 

percent in 2001, a figure attributed greatly to the Sept. 11, 2001, and anthrax attacks.23

Public Perception and Media Coverage

As events unfolded during the fall of 

2001, the media played a vital role in 

 

22 David Kocieniewski, “A Nation Challenged: 

The Jitters: Nervousness Spreads, Though Illness 

Doesn‟t,” The New York Times, (Oct. 11, 2001).

23 Leslie Walker, “Online Shopping Shows Signs 

of Renewed Growth,” The Washington Post, 

(Nov. 15, 2001), p. E01.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

18

informing the public. However, this service cuts both ways. While Americans 

gained vital details on conducting themselves in the face of daily threats, anxiety 

spiked after each new case was announced. There were many false reports, 

some of which were due to incorrect information, while others were based on 

false positives in testing for the bacteria. 

The level of coverage in print media was 

intense. Between Oct. 4, 2001, the initial 

government confirmation of an anthrax 

case, and Nov. 15, 2001, the Washington 

Post had 852 stories mentioning anthrax. 

By the end of 2001, the number had risen 

to over 1,200. The public had a strong 

desire for information, a fact reflected in 

the level of media coverage. Vigilance 

was high, but clarity was not. This led 

individuals to take actions that made 

sense to them.

In many cases access to some information prompted the desire for more. At 

the height of the crisis the U.S. Government as well as local entities struggled to 

respond. Most often, the public was directed to overburdened hotlines staffed 

by everyone from law enforcement to 

public health volunteers. On the internet 

websites of Federal Emergency Management Agency (FEMA), CDC, United 

States Postal Service (USPS), the Red 

Cross, and local entities such as Fairfax 

County, Va., tried to maintain accurate 

and up-to-date information. While the 

sources‟ effectiveness is unclear, it is 

certain better capabilities would have 

been required had the incidents continued beyond the eight weeks of crisis that 

unfolded across the East Coast.

As time wore on, the public was less 

concerned about a terrorist attack. However, the numbers varied geographically. 

By early November only 38 percent of 

Americans living in the middle of the 

United States felt they or their families 

could become victims of terrorism, compared with 50 percent of those living in 

“coastal urban areas.”24 Immediately 

after Sept. 11, 2001, the public highly 

appreciated the administration‟s counterterrorism efforts. However, with the confusion shown by government leaders 

during the anthrax attacks, public opinion ratings fell by 13 percent in three 

weeks.25

During the anthrax incidents most of 

the American public got their information from the media, rather than directly 

from government sources. Interestingly, 

46 percent of the public felt the general 

media got the facts correct, a rise of 11 

percent over early September and the 

highest grade for accuracy since 1992.26

Fifty-eight percent of Americans believed media coverage of the news on 

anthrax was accurate, and when it was 

not the public blamed “misleading information by the government” rather 

than sloppy reporting.27 Follow-up research on public perception of the access 

to information conducted by Dr. Monica 

 

24 “Worries about Terrorism Subside in MidAmerica,” Pew Research Center for the People 

and Press, (Nov. 8, 2001,), p. 1.

25 “Terror Coverage Boost News Media‟s Images,” Pew Research for the People and Press, 28 

November 2001, 1.

26 Ibid.

27 Ibid., p. 3.
No Need to Panic: Public Resilience in CBRN Events

19

Schoch-Spana at the Center for Biosecurity, at the University of Pittsburgh, drew 

several key lessons regarding sources of 

information.

1. People are capable of handling uncertain and unsettling news provided it 

is given candidly.

2. Information flow is an antidote to 

panic, not its cause.

3. “Government experts must have the 

answer somewhere” is a common assumption.

4. Meaningful, practical advice on how 

to protect one‟s self and family is a 

top priority.

5. In a crisis, media is an essential 

source of information, though fragmented and dizzying.28

Lack of Medical Experience

One of the greatest medical challenges of the anthrax attacks was the lack 

of first-hand experience with the virus in 

the United States. Scientists and doctors 

poured over textbooks and information 

from other countries. No one had seen a 

serious threat of exposure since a 1979 

release of the bacteria in the Soviet Un-

 

28 Monica Schoch-Spana; “The People Talk 

Back: Anthrax 2001 Public Communication Lessons,” presentation to The Public as an Asset not 

a Problem, A Summit on Leadership on Leadership during Bioterrorism, (2003), Online, 

http://www.upmc-biosecurity.org/website/

events/2003_public-as-asset/spana4/spana4_

trans.html.

ion. This dearth of information led experts to rely on the most common occurrences as a basis for their guidance. It 

proved to be an unavoidable pitfall that 

severely tested public confidence. One of 

the most blatant examples involved a 

case in New Jersey. Just hours before the 

first case of a postal worker developing 

cutaneous anthrax was announced to the 

public, a National Institutes of Health 

official stated “there have been no documented cases at all of an individual 

getting a letter personally from a contaminated facility and winding up getting 

the disease.”29

The Florida case of Ernesto Blanco, 

the AMI employee presumably infected 

by a tainted letter, was equally perplexing as he did not present with the most 

common symptoms. During treatment 

his doctor used a textbook from 1901 

with a case that mirrored Blanco‟s symptoms. After New York hospital worker 

Kathy Nguyen died of inhalation anthrax 

with no apparent linkage to the news 

media or postal service, federal authorities were baffled. CDC Director Jeffrey 

Koplan told reporters that in determining 

the source, “Your guesses are as good as 

mine.”

Stunned experts learned of the virulence of the anthrax spores released in 

the letter to Sen. Daschle. Alan Zelicoff, 

a senior scientist at the Center for National Security and Arms Control at San-

 

29 Avram Goldstein and Michael Powell, “Anthrax in Five More D.C. Buildings; Officials 

Troubled by Infection of N.J. Woman Who 

Doesn‟t Work in a Mailroom,” The Washington 

Post, (Oct. 30, 2001), p. A01.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

20

dia National Laboratory stated, “We 

didn‟t think that anybody could come up 

with the appropriate coatings for anthrax 

spores to make them float through the air 

with the greatest of ease...[exposing 28 

people with a single opened envelope] is 

no mean trick.”30

A fundamental assumption made 

was that a high number of anthrax spores 

were required to infect a human with 

anthrax. While scientists knew that humans could be exposed to Bacillus anthracis without developing an infection, it 

was not thought that individuals could 

get inhalation anthrax without exposure 

to at least 8,000 to 10,000 spores. In an 

effort to calm public fears, Patrick Meehan, director of Emergency Environmental Services at CDC stated people receiving mail were “essentially at no risk of 

inhalation anthrax.” However, two 

deaths by postal workers handling sealed 

envelopes, as well as two final victims 

whose contamination cannot be conclusively determined, changed the way experts thought about anthrax contamination. The CDC had to alter its underlying 

assumptions and its recommended actions released to the public.

To Cipro or Not to Cipro

One of the most contentious issues 

during the crisis was the decisions about 

what drugs should be recommended to 

protect the public. Officially the Food and 

 

30 Michael Powell and Ceci Connolly, “Experts 

Warn Bioterrorism Could Expand,” The Washington Post, (Nov. 1, 2001), p. A01.

Drug Administration (FDA) had approved only one drug for treatment of 

post-exposure anthrax. However, experts 

outside the government clarified throughout the crisis that Ciproflaxon (“Cipro”) 

was one of many antibiotics that could 

kill viruses such as anthrax. As the crisis 

wore on, the FDA quickly approved additional generic antibiotics for treatment. 

However, by then the branded version 

had received so much attention, specifically after NBC News Anchor Tom Brokaw ended his evening broadcast with “In 

Cipro we trust,” the public was wary of 

any other treatment. After thousands of 

Capitol Hill employees were given a 10-

day supply of Cipro, many postal workers 

were given generic antibiotic leading to 

calls of elitism and unequal treatment. 

Given the lack of a public explanation of 

FDA approval and CDC recommendations, public anxiety grew over whether 

the government was able to provide protection for its citizens. The CDC later determined it failed to adequately inform 

both clinicians and the general public of 

the evolving threat and the equally evolving solutions to the problem. This failure 

challenged the government‟s credibility at 

a critical time.

CDC guidelines for who would receive prophylaxis changed several times 

as events unfolded. When CDC announced on Oct. 31, 2001, it would not 

recommend additional postal workers 

receive antibiotics as it seemed the “outbreak had peaked,” Washington, D.C.,

officials stated they would take the information under advisement, but would 

make their own recommendations. The 
No Need to Panic: Public Resilience in CBRN Events

21

District government tried to manage 

three closed postal facilities, while results on others remained unknown. Previously the CDC had recommended that 

workers in public and private facilities 

that received bundled mail from the 

Brentwood facility should hire private 

firms to conduct environmental testing. 

This included as many as 4,000 private 

businesses.31

The precise number of individuals 

who either requested or were required to 

take prophylaxis varies widely. Numbers 

include employees who worked in contaminated postal facilities, media outlets 

and Capitol Hill, as well as citizens who 

claimed to have been in proximity of 

those locations during known dates of 

contamination. Most estimates state between 20,000-40,000 Americans took 

Ciprofloxacin or other antibiotics for 

possible anthrax contamination; however, as many as 40 percent of those prescribed Cipro reportedly did not take the 

full required dosage due to side-effects of 

the medication.

Lack of Effective Communication 

Impeded Response

After the first anthrax infection was 

announced, government officials tried to 

assure the public anthrax was not contagious and the most common type, cutaneous, was easily treatable with antibio-

 

31 D‟Vera Cohn and Avram Goldstein, “Anthrax 

Precautions May Be Relaxed; Many Who Handle 

Mail Could Stop Antibiotics,” The Washington 

Post, (Nov. 1, 2001), p. B01.

tics. The CDC scrambled to get accurate 

information to the nation‟s clinicians, as 

well as the general public. Many hospitals and clinics were overwhelmed with 

patients fearing that their common cold 

symptoms could actually be the initial 

phase of inhalation anthrax. The CDC 

had no method for contacting physicians, 

nor did individual physicians have any 

formal method for reporting suspicious 

cases to the federal authorities. Often 

times the CDC relied upon the news media to disperse information to medical 

workers as well as to the general public. 

One example cited was that outside of 

large metropolitan areas no organized 

method existed for contacting dermatologists, the physicians who instantly became the front line operators in identifying cutaneous anthrax.

The dearth of medical knowledge on 

anthrax had two major consequences. 

The first was the fact modern medicine 

had overtaken decades and centuries-old 

research on the risk of dying from inhalation anthrax. The death of only five 

individuals surprised many experts. The 

second consequence was physicians began to err on the side of caution. Hospitals across the country admitted and 

tested patients showing the slightest 

symptom related to anthrax. Hospital 

admissions coupled with the environmental samples collected by authorities 

due to hoaxes, fear, and legitimate concerns almost immediately overwhelmed 

laboratories, many of which were incapable of testing environmental samples. 

Testing requests besieged state and local 

labs. The state of New York reached out 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

22

to other states for help from colleagues in 

Massachusetts and Missouri, but technicians there also were swamped with 

samples from their own states. Only 81 

city and state laboratories were certified 

to test biological agents such as anthrax 

at the time of the 2001 attacks.32 The 

CDC and DoD completed most environmental testing. 

Many agencies and organizations relied on others for accurate and timely information. One of the most serious consequences of this was seen in contamination 

of the Brentwood postal facility in Washington, D.C. Postal workers unions were 

upset that even after the letter to Sen.

Daschle was found to be contaminated, 

the Senate buildings closed and congressional staffers placed on antibiotics, no 

connection was made to Brentwood until 

after a postal employee from that location 

died on Oct. 21. Postmaster General John 

Potter defended the United States Postal 

Service‟s actions, stating his agency had 

relied exclusively on the advice of the 

CDC. CDC relied on its knowledge about 

anthrax, which was a person could not get 

inhalation anthrax from a sealed envelope. 

While cutaneous anthrax infection was 

possible, it was easily treatable and not of 

great concern. Potter tried to reassure the 

American public by saying, “We deliver 

to 137 million addresses each day [and 

while] a handful of letters that have 

moved through the system have caused 

 

32 Ceci Connolly and Steven Gray, “Thompson 

Seeks $1.2 Billion to Expand Stockpile of Drugs; 

HHS Chief‟s Request is Part of Broader Bioterrorism Plan,” The Washington Post, (Oct. 18, 

2001), p. A19.

death and disease...what is in the mailbox 

is safe.”33 This issue highlights the challenge of presenting accurate risk information to the public without downplaying 

the concerns the public may have about 

novel threats such as CBRN agents.

Another example showing the importance of coordination occurred in 

Fairfax, Va., where one of the first cases 

of inhalation anthrax from the Brentwood postal facility was treated. The patient was admitted to the hospital without 

exhibiting the most common symptoms. 

Given his work location, tests were done 

simply as a precautionary measure. 

When he tested positive for anthrax, his 

doctors placed him on antibiotics and 

watched him carefully. He remained in 

good spirits, until one occasion when he 

watched a televised press conference 

held by local government officials regarding his condition, which they labeled 

as “gravely ill.” This information 

stunned his doctors since they had no

contact with the officials, nor, as later 

discovered, had anyone at the hospital. 

This incident shows the number of officials involved in an ongoing crisis can 

complicate communication, especially 

when the public demands details and solutions from government leaders.

After both federal law enforcement 

and public health officials were chastised 

for giving out incorrect information, HHS 

Secretary Thompson began his Oct. 30 

press conference by saying the informa-

 

33 Ellen Nakashima, “Potter Defends USPS Response to Anthrax Fears; Postmaster General 

Says Agency Relied on Advice of CDC,” The 

Washington Post, (Oct. 31, 2001), p. A17.
No Need to Panic: Public Resilience in CBRN Events

23

tion he was about to disclose was “what 

we know at this time. Information is developing that will likely alter these facts” 

given the ongoing nature of the investigation. CDC spokesman Tom Skinner admitted his agency faced a steep learning 

curve. He explained that CDC knowledge 

and understanding was evolving because 

the U.S. had no civilian experience with 

anthrax. He stated, “We‟re making decisions based on the best scientific information we have at the time.”34

Interagency Cooperation

The greatest challenge for the U.S 

Government during the anthrax crisis 

was the requirement to conduct a coordinated, integrated, coherent government 

response implemented across local, state 

and federal levels; and most importantly, 

to communicate effectively to the public. 

Many obstacles existed to this effort. 

While the CDC had made preparations to 

conduct and lead the national response to 

a bioterrorism attack, many aspects of 

the planning were based on certain assumptions. Those assumptions included 

the source and targets of the attack. The 

assumption was “the delivery of a biological warfare agent would come from a 

known weapon system; that the target 

would be a military installation; that the 

soldiers at the site would be protected by 

adequate training, clothing and prophylaxis; and that a high number of false 

 

34 Justin Blum, “Workers Question Response; 

CDC Says Policy Evolving,” The Washington 

Post, (Oct. 23, 2001), p. A01.

positive detections would not hinder the 

site‟s operations in any significant 

way.”35

The CDC had considered the possibility of the use of the mail as a delivery system. Due to the increasing number of 

hoaxes experienced in the preceding four 

years, however, the agency was not fully 

prepared to address the interagency requirements of managing such a geographically diverse threat. In the earliest cases in 

Florida, cooperation among local, state and 

federal agencies was haphazard at best and 

often included giving misleading and incorrect information to the public. It was 

unclear who was in charge. Was it a public 

health issue or a criminal investigation? In 

Florida, federal officials were involved 

from Oct. 3, 2001, but the FBI did not 

formally take over the investigation until 

Oct. 12. After the letter was discovered in 

the U.S. Senate, information varied wildly 

as politicians felt compelled to “keep their 

constituents informed.” Given the pace of 

the events, politicians and their staff regularly gave conflicting and incorrect information in live press conferences and interviews. This confounded the government‟s 

ability to deliver the most precise information about who should receive testing and 

treatment and where.

The level of coordination required at 

the federal level, as well as up and down 

 

35 Keith Rhodes, “Diffuse Security Threats: Information on U.S. Domestic Anthrax Attacks,” 

Government Accounting Office Testimony before

the Select Committee on Intelligence, U.S. Senate and the Permanent Select Committee on 

Intelligence, House of Representatives, GAO-0-

323T, (Dec. 10, 2002), p. 6.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

24

the levels of government had not been 

expected. This included the need for 

CDC to accept vast amounts of incoming 

information, organize and analyze it; and 

respond appropriately to law enforcement, public health officials, and the 

general public. There was little capability 

for the FBI and CDC to share information with each other, and virtually no direct means for them to share information 

with their state and local counterparts. 

When the federal government raised the 

alert level or added specific information 

to an ongoing case, it often released the 

information to media outlets as it rarely 

had a direct and on-going connection to 

local law enforcement or public health 

officials. During the investigation many 

patients were repeatedly interviewed by 

various law enforcement and healthcare 

officials. Much of the information law 

enforcement and public health investigators need to obtain was the same, but the 

efforts were not coordinated in the early 

stages. Repeatedly questioning victims 

led to conflicting statements, while having law enforcement and public health 

professionals involved in a single session 

allowed officials to focus on relevant information for both criminal and public 

health issues. 

Law enforcement officials repeatedly 

held information from public health officials due to their lack of security clearances. At the same time, due to medical 

privacy laws, public health officials were 

challenged with sharing all relevant information with law enforcement. While 

these issues were readily recognized at the 

federal level, it is not clear if they have 

been effectively addressed.

While the Department of Defense 

does not play a leading role in responding 

to a domestic bioterror incident, it does 

maintain significant assets, some of which 

are unique or scarce in the federal government tool box. First, DoD has the capability to respond very quickly, far outpacing most other departments of the U.S. 

Government. One HHS official acknowledged this by stating the HHS could not 

manage a large-scale biological attack, 

rather the government would rely on the 

capabilities of DoD, Veterans Affairs and 

the Federal Emergency Management 

Agency.36

During the anthrax attacks, DoD 

supported civilian public health and law 

enforcement entities with “unique weapons of mass destruction response capabilities to perform environmental assessments, transportation of contaminated articles, laboratory confirmation 

testing, and cleanup of locations suspected of anthrax contamination.”37 DoD 

laboratories conducted one quarter of all 

possible contamination testing. In addition, the 4th Marine Expeditionary Brigade‟s Chemical Biological Incident Response Force was seconded to the FBI‟s 

Hazardous Materials Response Unit to 

 

36 Ceci Connolly, “Public Health System is on 

War Footing; Officials Call Mobilization and 

Realignment of Resources Unprecedented,” The 

Washington Post, (Oct. 27, 2001), p. A14.

37 Paul McHale, in DoD response to “Bioterrorism: Public Health Response to Anthrax Incidents of 2001,” (October 2003), GAO-04-152, p.

41.
No Need to Panic: Public Resilience in CBRN Events

25

assist in the examination of congressional mail. The Defense Department‟s capabilities exist to support overseas missions, but should not be discounted in 

domestic response planning as the military will always have scarce assets and 

capabilities unlikely to be maintained at 

the readiness level of U.S. Forces. Finally all U.S. military personal are required 

to receive anthrax vaccines, making them 

America‟s largest protected community.

Lessons Learned for Public Resilience 

Although public health preparedness 

has improved since the 2001 anthrax attacks, more work is necessary to ensure 

public safety in the event of another attack. Examples from the anthrax attacks 

abound, from human resource issues to 

the lack of communication protocols affecting response time and the ability to 

effectively communicate among agencies 

and to the public. Many agencies and organizations relied on others for accurate 

and timely information. This issue highlights the challenge of presenting accurate 

risk information to the public without 

downplaying the concerns the public may 

have about novel threats such as CBRN 

agents. These government weaknesses 

must be addressed to enhance the public‟s 

ability to respond in an effective manner. 

To make the most of their own resources, 

citizens need to know what is happening 

and what they can to do to help themselves and their families. People need information to be accurate and consistent so 

they can make effective decisions. They 

also need to feel the government has an 

effective plan to help resolve the crisis, 

while understanding the crisis is evolving 

and thus, the solutions are too.

Despite the stress on the medical and 

laboratory facilities, first responders and 

investigators, the vast majority of Americans went on with their lives as “normally” as possible, demonstrating that even in 

the face of a deadly, widely dispersed attack, citizens responded in a largely resilient manner, following the guidance provided and continuing to carry out their 

responsibilities. While anecdotes exist, 

few employers noted lengthy absences. 

Most individuals reported to work daily, 

even when they worked on Capitol Hill or 

in a post office.

Employees raised concerns through 

unions resulting in the alteration of human resource policies across the federal 

government. Employees at the Agency for 

International Development requested the 

government ban public parking at the Ronald Reagan Building, where numerous 

United States and international agencies 

reside. Statements from the postal workers union showed its frustration at a presumed lack of rapid protection from contamination. Postal unions filed lawsuits in 

Florida and New York charging USPS 

had “been dragging its feet in efforts to 

protect its employees.”

Unions for other government workers 

also expressed anxiety in regards to the 

unknowns. A spokeswoman for the State 

Department workers stated while guidelines were being shared, employees feared 

health officials were unsure of the advice 

they gave.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

26

Another key issue was the impact of 

differential treatment among groups of 

potential victims. While the CDC had determined both generic antibiotics and Ciproflaxin were effective in treating anthrax, many senators and staffers were provided Ciproflaxin while postal workers 

were given the less expensive antibiotic. 

This prompted concerns about social class 

and racial biases in the treatments provided as the postal workers were clearly 

less affluent and more represented by minority groups. Such differences in treatment or access to care are unlikely to be 

seen as coincidences in a time of crisis, so 

treatments and other interventions must be 

planned to be fair as possible. Similar 

characteristics will be discussed in the 

Hurricane Katrina case study.

As one local health official stated, 

“the closer people have been to anthrax, 

the more realistic and reasonable they 

are.”38 This statement embodies the 

 

38 Marc Fisher, “Irrational Fear Is Untreatable,” 

The Washington Post, (Nov. 1, 2001), p. B1. 

This concept is reinforced in Fred P. Stone, The 

“Worried Well” Response to CBRN Events: 

Analysis and Solutions, (Maxwell AFB, AL: 

USAF Counterproliferation Center Future Warfare Series No. 40, June 2007), p. 5.

concept that a population will be more 

resilient the more prepared it is to deal 

with a threat. The examination of the 

anthrax attacks reveals despite widespread potential threat, conflicting information from official sources, inadequate flow of information to the public, 

incidents of different types of care being 

provided to different classes of victims, 

and the lack of closure to the threat, the 

public response was surprisingly unproblematic. Individuals, families, 

communities and businesses continued 

to function.

Improvements to these problem 

areas would allow the public to grow 

from this past experience and with clear 

and direct guidance on how to respond, 

may place more faith in the government 

system and respond even more positively in the future.
No Need to Panic: Public Resilience in CBRN Events

27

2. SARIN ATTACKS ON THE TOKYO SUBWAY

“Flee in the direction you see the fewest bodies.”

–Advice from a Japanese government official regarding follow-on subway attacks.

Salient Points

 First lethal case of CBRN attack on civilian population by non-state actor.

 No immediate perpetrator was confirmed.

 Lack of effective communication between government and public contributed to the confusion regarding whether 

to seek medical care.

 The intensity of the media coverage limited the ability of the government to 

use the news outlets to communicate effectively with the public.

 Dependence of U.S. population on 

emergency rooms for basic medical care 

will severely hamper the healthcare 

community‟s ability to manage large 

scale CBRN attack.

 Fear of the unknown can be as terrorizing as an actual attack.

In the spring of 1995 Japan experienced the world‟s first major terrorist 

attack using chemical weapons.39 On 

March 20, 1995, Aum Shinrikyo, a little 

known religious cult in Japan, killed 13

 

39 The March 20, 1995, attack was not the first 

incidence of a terrorist group using WMD against 

a civilian population. The perpetrator of the attack, the religious cult, Aum Shinrikyo, had previously used sarin in an attack on a Tokyo neighborhood in June 1994 where seven people were 

killed.

people in a a sarin attack on the Tokyo 

subway system. The incident was the 

first lethal case of a non-state actor using 

a CBRN agent against a civilian population.40 What follows is a brief discussion 

of the incident from March 1995, the atmosphere around the cult, and finally, 

observations related to the resilience of a 

government and its public. Societal differences must be considered in a few aspects of the case, however, for the most 

part the lessons Japan has learned from 

the Aum Shinrikyo attacks are relevant 

for the U.S. Government today.

The Incident

At 8 a.m. on March 20, 1995, during 

the busiest time of the Monday morning 

rush hour, sarin was released on the 

Tokyo subway. The nerve agent was car-

 

40 There was a preceding biological attack in the 

United States, but no deaths resulted. In 1984, 

followers of the Indian guru Bhagwan Shree Rajneesh spiked salad bars with salmonella at 10 

restaurants in a small Oregon town and sickened 

about 750 people. The cult members had hoped 

to incapacitate so many voters their own candidates in the county elections would win. The 

scheme failed, but the episode spread fear and 

drained the town‟s economy. See Gillian Flaccus, “Oregon Town Never Recovered From 

Scare.” Associated Press, (Oct. 19, 2001), 

http://www.rickross.com/reference/rajneesh/rajne

esh8.html.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

28

ried into the metro in plastic bags 

wrapped in newspaper by five teams 

working in coordination. The teams place 

their deadly packages on separate subway 

lines that converged at Kasumigaseki station, where the police headquarters, the 

seat of the Japanese government, and the 

largest fish market in the city are located. 

The two-man teams had one driver and 

one person responsible for releasing the 

agent. At the appointed time the individuals boarded their respective trains, set 

packages on the floor and punctured the 

bundles with sharpened umbrella tips. Sarin slowly leached out onto the subway 

floor. The nerve agent sarin is most lethal 

when dispersed through the air, but the 

less efficient method was chosen at the 

last minute due to a lack of preparation 

time. It is believed the goal was to divert 

police attention from cult activities and 

prevent a scheduled police raid. The timing was chosen to maximize police casualties during the early morning shift 

change at police headquarters located 

above the subway station. All perpetrators 

escaped harm.

Sarin is extremely potent and even 

low concentrations can be fatal. The chosen delivery method and the lack of purity of the agent likely saved thousands of 

lives. Had the cult been able to take more 

time to prepare the sarin, it likely would 

have been far more potent. Many experts 

cite those reasons for the fact there were 

only 13 deaths and 50 serious injuries 

from such a lethal weapon that had the 

potential to do far greater harm. 

The March 20, 1995, attacks were not 

Aum Shinrikyo‟s first or last foray into 

CBRN production or use. What is known 

in Japan as the “Matsumoto incident” was 

a sarin gas attack on a Tokyo suburb on 

June 27, 1994. Seven people died and 

over 200 hospitalized when sarin was 

aerosolized and sprayed in a residential 

area. No one claimed responsibility and 

the police investigation focused on one 

man until after the events of March 1995 

pointed to Aum Shinrikyo. Several Aum 

Shinrikyo members confessed to both 

events following their arrests in the wake 

of the March 1995 Tokyo attacks. Experts 

believe the Matsumoto attack was a dress 

rehearsal for a massive attack planned by 

the cult.41

It was clear Aum Shinrikyo was a 

threat to the citizenry of Japan, a fact 

continually debated in the public forum 

throughout 1995. In addition to Tokyo 

and Matsumoto, there were numerous 

attempted attacks on the Tokyo subway 

and other public locations throughout 

1995. Several copycat cases of toxins 

released in the Tokyo region made 

people ill without serious harm occurring; but several caused people to seek 

medical attention for watery eyes and 

 

41 Kyle B. Olsen, a member of the Central Intelligence‟s Nonproliferation Advisory Panel, visited Japan to investigate the Matsumoto incident 

and concluded that a group was clearly honing its 

capabilities. Only weeks before the attack on 

Tokyo, Olsen stated Aum Shinrikyo could have 

executed the attack on Matsumoto and been 

planning and preparing for a large-scale attack. 

Kyle B. Olsen, “Aum Shinrikyo: Once and Future Threat?” Emerging Infectious Diseases, 

Center for Disease Control, (July-August 1999), 

vol. 5, no. 4, http://www.cdc.gov/ncidod/EID 

/vol5no4/olson.htm.
No Need to Panic: Public Resilience in CBRN Events

29

burning throats. There were regular reports of people experiencing “foul smelling fumes” and being sickened in the 

subway and popular restaurants. However, at least two incidents attributed to 

Aum involved the use of large lethal 

doses of cyanide. Twice cyanide devices 

were found in bathrooms in subway stations before they could be dispersed. The

cult members‟ revelations during the trial 

that followed the March 1995 attacks

were even more frightening. After their 

arrest several members admitted to helping the cult produce hundreds of kilograms of mustard gas, VX, sarin, soman, 

tabun, and sodium cyanide.42 When raiding the Aum Shinrikyo compound, police 

found enough cyanide to kill 20,000 

people and chemicals to produce enough 

sarin to kill 4 million.

In addition to their attacks with 

chemical weapons, members of Aum 

Shinrikyo are also now known to have 

experimented heavily with biological 

weapons. They are known to have developed stocks of botulinum toxin and attempted to disperse this using aerosolized sprayers against seven different targets. These attacks failed either because 

they failed to develop sufficiently lethal 

toxin, or were unable to deliver large 

enough doses to cause death or serious 

illness. They also developed and attempted to disseminate anthrax as a bio-

 

42 Tim Ballard, Jason Pate, Gary Ackerman, and 

Sean Lawson, Chronology of Aum Shinrikyo‟s 

CBW Activities, James Martin Center for Nonproliferation Studies, Monterey Institute of International 

Studies, (March 15, 2001), p. 6, http://cns.miis.edu

/pubs/reports/pdfs/aum_chrn.pdf.

logical weapon. Again these efforts 

failed, not through lack of effort, but due 

to technical challenges in both development and means of dissemination. Finally, the cult also acquired and experimented with other biological agents including Q fever and Ebola, but attempted 

no attacks with these agents. Ultimately, 

the group caused no known deaths or 

injuries as a result of these biological 

efforts, which may have pushed them to 

focus on chemical attacks.43

The Response

The first calls for help came into fire 

and police stations at 8:19 a.m. from 

Tokyo‟s suburbs. In less than an hour, 

calls poured in from all over the city including 15 subway stations. Responders, 

however, did not link the emergency calls 

into a single crisis until much later in the 

day.44 The effects of the sarin attacks 

ranged from a foul-smelling odor to vapor-filled subway cars that caused passengers to cough, vomit, and convulse. At 

several stations subway operators were 

confronted with unconscious passengers 

on trains or on station platforms.45 When 

 

43 Seth Carus, Bioterrorism and Biocrimes: The 

Illicit Use of Biological Agents Since 1900; Amsterdam; the Netherlands: Fredonia Books, (2002).

44 Ibid., p. 21.

45 Amy Smithson, “Ataxia: The Chemical and 

Biological Terrorism Threat and the U.S. Response,” Chapter 3 – Rethinking the Lessons of 

Tokyo, Ataxia: The Chemical and Biological Terrorism Threat and the U.S. Response, Washington, 

D.C.: Publication of the Henry L. Stimson Center, 

(October 2000), p. 19, available from http://www.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

30

emergency responders arrived at the subway stops, victims stumbled out of the 

metro with impaired vision, some foamed

at the mouth and others simply collapsed

with no explanation. 

The police arrived at a subway station within minutes of the first call and 

donned protective gear, as they had only 

weeks before been trained in chemical 

response.46 However, while the police 

wore protective clothing, fire and rescue 

workers had not been trained, nor did they 

have protective gear. Their willingness to 

participate in rescue and treatment of the 

injured was not without risk, and to some 

extent created additional casualties. Approximately 10 percent of the 1,300 firemen who responded were injured during 

the incident.47 While creating additional 

healthcare problems, it also demonstrates 

the willingness of people to place themselves at risk in a crisis situation. Although the police officers had received 

chemical agent training, mistakes were 

made in executing command and control 

of the incident. The command post was 

set up near one of the subway exhaust 

systems, making 31 policemen seek medical attention, including the chief of police.

In less than one hour, over 500 people 

sought care at St. Luke‟s Hospital, which 

is within walking distance from the Kasu-

 

stimson.org/cbw/pdf/atxchapter3.pdf .

46 In government after-action reports it was admitted the training had been conducted because 

the police were aware of Aum Shinrikyo‟s chemical weapons production capability and the police 

prepared to raid the cult‟s compounds.

47 Smithson, p. 98.

migaseki station. As victims arrived at St. 

Luke‟s and other local hospitals, doctors 

tried to assess the symptoms and arrive at a 

diagnosis. At 9:30 a.m. a physician who 

had treated victims of the 1994 Matsumoto 

attack recognized the symptoms while 

watching the television coverage. The doctor called St. Luke‟s to suggest that sarin 

nerve agent may have been used in the attack. This was the first confirmation medical professionals had received of a chemical attack and specifically that sarin was 

the agent used. Japanese public health officials were unable to confirm that sarin 

was the agent for more than three hours. 

Given the uncertainty of diagnosis and the 

lack of medical experience in treating sarin 

exposure, it is not surprising over 100 staff 

members of St. Luke‟s as well as the majority of emergency personnel who transported the injured reported symptoms of 

exposure.

48

While the Japanese subway system 

is equipped with easily accessible panic 

buttons available to all riders, only one 

individual ever signaled a driver to stop. 

Thus, while calls came into emergency 

systems, unknowing transportation officials continued to move trains through 

the system, distributing lethal chemicals 

along the way. One of the trains continued to transport the undetected nerve 

agent for more than 90 minutes after the 

perpetrator stepped off the train. By 9:45 

a.m., the Japanese Ministry of Transport 

and Transportation halted all trains and 

placed all transportation systems in the 

country on the highest level of alert.

 

48 Ibid.
No Need to Panic: Public Resilience in CBRN Events

31

Behavioral Casualties49

One of the most significant aspects of 

the Tokyo subway attacks was the number 

of individuals who sought treatment after 

having been near or on the subway around 

the time of the sarin exposure. Three factors affected the number of individuals 

claiming to suffer from effects of sarin in 

Tokyo on March 20, 1995. First was the 

fact many people exited the metro, perhaps having smelled a foul odor,50 experiencing watery eyes, temporary blurred 

 

49 Scientists and public health officials vary in their 

opinions of the underlying causes for large number 

of people who sought medical care. Some experts 

place many patients in the category known as 

“worried well” or “behavioral casualties,” the term 

we use in this study. However, other health experts such as Dr. Jerrold Post, professor of Psychiatry and Political Psychology at George Washington University, warn that dividing the public 

arbitrarily between those thought to have real versus imagined symptoms is a false dichotomy. This 

study focuses on the implications of the numerous 

patients who sought medical care immediately and 

for months following the attack, without determining whether people should have sought care or 

how those individuals should be classified. We 

use Fred P. Stone‟s research on the “worried well” 

as a basis for this section. Fred P. Stone, The 

“Worried Well” Response to CBRN Events: 

Analysis and Solutions, (Maxwell AFB: USAF 

Counterproliferation Center No. 40, June 2007).

Surveys conducted years after the event showed 

that many victims were still suffering effects years 

after the attack. See “Survey: Subway sarin attack 

haunts more survivors" in Mainichi Online June 

18, 2001. Available: http://www12.mainichi.co.jp

/news/mdn/search-news/896300/aum-60-71.html 

50 While sarin itself is odorless, colorless and 

tasteless, the impurities of the sarin used on 

March 20, 1995, caused it to have a sulfur-like 

smell.

vision, or coughing; many had no idea 

that an attack had occurred. They went to 

work and only after hearing news reports, 

made their way to hospitals and clinics 

fearing for their well-being. Second, given the lack of nerve agent knowledge 

among healthcare professionals in Tokyo, 

little to no advice was given to metro riders who feared they might have been exposed, but were unsure of the symptoms 

or effects of sarin. Third, the mayhem experienced at subway entrances where victims arose from the underground choking, 

disoriented, and some violently ill, 

alarmed many individuals who were at 

worst tangentially affected. These combined factors dramatically increased the 

number of persons seeking medical care. 

As many as 3,796 individuals were injured to some degree, but over 5,500 

sought medical attention. More than 

1,000 required hospitalization.

According to some post-incident studies between 75 and 85 percent of patients 

who sought medical care were “worried 

well.”51 This highlights significant concerns about the public‟s tendency to seek 

medical attention in disasters. The size of 

this “worried well” or behavioral casualty 

effect in a disaster is frequently a matter of 

how one assesses whether or not one needs 

to receive emergent care, as well as why 

the patient presents for care. For example, 

while Smithson asserts 85 percent of 5,500 

patients were psychogenic or “worried 

well,” the Tokyo police record reports 

3,795 were “poisoned” and only 1,705, or 

31 percent, who arrived at medical facili-

 

51 Stone, (2007), pp. 6-7.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

32

ties required no treatment.52 This would 

reflect a significantly smaller “worried 

well” problem. Additionally, those who 

requested care without obvious evidence of 

exposure may reflect a very disparate 

group rather than a homogeneous cluster 

of overly anxious individuals. Fred Stone 

outlines several possible motivations for 

people to seek medical care in a CBRN 

event.53 These include:

Group 1. People who were exposed 

and had minor symptoms requiring minimal 

or no medical care. Many of the “worried 

well” who flooded hospitals had in fact 

been exposed to the gas. They were either 

in or near the subway when the attacks occurred but were initially unaware of the attacks. Before realizing they had been exposed, they exhibited symptoms including 

vomiting, eye irritation, and nausea. They 

went to the hospital only after being urged 

to go by others. The reception they received 

was not always welcoming.

Group 2. People who may have been 

exposed but had no clear physical symptoms related to an organic aetiology.54

 

This group thought they had been exposed 

and consequently went to local hospitals 

and clinics. Their motivation may have 

been preventative hoping to avoid future 

problems by being treated immediately. 

They may have also been anxious and mi-

 

52 Sheppard, et al., (2006), p. 231.

53 Stone, (June 2007).

54 Tanja M. Korpi and Christopher Hemmer, 

Avoiding Panic and Keeping the Ports Open in a 

Chemical and Biological Threat Environment, 

(Maxwell AFB: USAF Counterproliferation Center No. 30, June 2005), p. 5.

sinterpreted anxiety as symptoms of exposure.

Group 3. People who could not possibly have been exposed but came to the 

hospital seeking care for imagined illnesses or prevention. People who have imagined illnesses based upon one symptom 

have a condition known as hypochondriasis.55 It is estimated between four to nine

percent of patients in a general medical 

practice have this disorder.56

Group 4. Those hoping to profit from 

the event either financially or emotionally. 

There was little potential for financial gain

by feigning illness following the attacks. 

Although 4,000 people have filed workers 

compensation claims, few have actually 

received payments.57 Those exploiting the 

attacks for emotional gain could have also 

been among the “worried well” although it 

is doubtful they constituted significant 

numbers. Factitious disorder is a condition 

in which people deliberately make themselves sick in order to play the sick role. 

The prevalence of this condition is unknown but probably very low.58 Disasters, 

 

55 American Psychiatric Association, Diagnostic 

and Statistical Manual Mental Disorder (4th ed.), 

(Washington, D.C.: American Psychiatric Association, 1994), p. 465.

56 Ibid., p. 464.

57 Robyn Pangi, Consequence Management in the 

1995 Sarin Attacks on the Japanese Subway System,” BCAIA Discussion Paper, 2002-4, ESDP 

Discussion Paper, ESDP-2002-01, John F. Kennedy School of Government, Harvard University, 

(February 2002), p. 48.

58 American Psychiatric Association, p. 473.
No Need to Panic: Public Resilience in CBRN Events

33

however, represent the perfect opportunity 

to play the sick role.

Group 5. Those experiencing PostTraumatic Stress Disorders (PTSD). 

Traumatic events can spur serious psychiatric disorders. PTSD is a mental disorder 

that includes flashbacks of the traumatic 

event, avoidance behaviors, and increased 

psychiatric arousal.59 It can affect three to 

58 percent of persons exposed to traumatic 

events.60 Psychological consequences are 

the most likely adverse health outcome of 

a traumatic event.61

The Role of the Media and Educational 

Institutions

The role of the media in a cataclysmic event is a double-edged sword providing much needed information, but also can add an overwhelming amount of 

chaff with the wheat. At the scene of the 

subway incidents, the media begin live 

reports by 9 a.m., including via hovering 

helicopters. The noise of the helicopters 

increased the anxiety and confusion, as 

well as complicating communications on 

the ground. From the March 20 attack 

through the end of 1995, media coverage 

was very aggressive. The story dominated Japanese media, being reported daily 

in newspapers and television. The press 

was condemned repeatedly for its quality 

of coverage, reporting stories with few 

confirmed facts, often dramatizing the 

events and the group rather than present-

 

59 Ibid., p. 495.

60 Ibid., p. 426.

61 Stone, (2007), pp. 14-17.

ing the facts. The intensity of the media 

coverage also appears to have contributed to increased need for medical attention as many who had left the subway 

with minor medical concerns were 

prompted by the media coverage to seek 

care. The lack of clear information on 

what had happened (a chemical attack), 

with what (sarin), how it should be 

treated (determine who needs care) and 

who is responsible (terrorists) impeded 

the public‟s ability to determine what 

actions they should have taken.

Aum Shinrikyo was very adept at 

public relations using any open avenue to 

further its reputation prior to March 

1995. The Japanese media heavily 

bought into Aum‟s charms. One example 

is very telling. In October 1989, a national television station interviewed an. 

The attorney outlined many of Aum‟s 

illegal and immoral activities including

charges related to weapons acquisition 

and kidnapping. The station allowed 

Aum members to view the tape before it 

aired. Asahara was furious with the program and Aum pressured the station not 

to air the tape. The station folded; never 

showing the tape to authorities nor admitting to the events until the Aum trials 

made the issue public. While the station 

manager resigned, there were no repercussions for withholding the information 

on Aum‟s capabilities from government 

authorities.

Academics and religious figures 

were also used by the cult for additional 

credibility. At least two well-known 

scholars visited the Aum compound prior 

to March 1995 and made positive state-
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

34

ments about the movement. This came 

under great scrutiny after the 1995 attacks, leading to the firing of one professor for “bring[ing] his university into disrepute.”62 More striking was the fact that 

Shoko Asahara had met with the Dali 

Lama and used photos and quotes from 

the meetings in Aum propaganda.

A Japanese Phenomenon?

In Japan and across the globe the 

question of why this happened and 

whether it could happen elsewhere is 

continually studied. For the Japanese one 

of the most important aspects of the aftermath of the Tokyo subway attacks 

were the revelations about the Aum Shinrikyo cult and whether it was a “Japanese” phenomenon. Japan considered 

itself a well-ordered society with little 

serious crime. Some commentators and 

experts speculated the legacy of the emperor system, the demands of the education system, the alienation of young 

people from the greater society, and lastly, a corporate ethos that valued collective actions over personal achievement 

held at least some responsibility for the 

success of Aum.63

One of the greatest challenges in the 

days following the March 20, 1995, at-

 

62 Ian Reader, A Poisonous Cocktail: Aum Shinrikyo’s Path to Violence, (Nordic Institute of 

Asian Studies, Copenhagen: 1997), p. 109.

63 See Robert Jay Lifton, Destroying the World to 

Save It, for a discussion of the “Japanese Phenomenon,” (Macmillan: New York, 1999), pp. 232-

270.

tack was no individual or group took 

credit. Japanese citizenry feared the unknown. It was unclear where or when the 

next attack might come. Even after the 

media fingered Aum Shinrikyo for the 

attacks, arrests came slowly and many 

details of the case were not known until 

the trials of cult members. Experts across 

the globe were shocked as revelations 

about Aum‟s capability unfolded in the 

media. It was assumed an attack of this 

magnitude was beyond the capabilities of 

a minor religious cult like Aum Shinrikyo. Few Japanese citizens knew of 

Aum beyond its existence as a small 

strange sect that occasionally appeared in 

their neighborhood. Although the police 

had fielded numerous complaints regarding Aum ranging from kidnapping, torture, and missing members, as well as 

grievances from neighbors of its compounds regarding smells emanating from 

the area, no law enforcement action was 

ever taken. After considerable evidence 

was compiled linking the disappearance 

of an attorney critical of Aum, the police 

decided they had to act and preparations 

were made to raid the compound on 

March 22, 1995. However, these actions 

were well known to the cult as its members were among the police ranks.

The judicial system in Japan works 

differently than in the United States. 

While American law enforcement officials will arrest a suspect with only probable cause, the Japanese wait until their 

case can be made solidly in court. This 

difference leads to a 99 percent conviction rate. However, it also means law 

enforcement entities are unaccustomed to 
No Need to Panic: Public Resilience in CBRN Events

35

sharing information with the public until 

their investigation is complete. During 

the spring of 1995, information rarely 

flowed from government sources; instead 

police would leak information to the media. This challenged the public‟s ability 

to separate sensationalism from fact, 

since no facts came from official sources.

Following the attacks, the police, 

through media contacts, tried to assure 

the public the situation was under control. However, on March 30, Aum struck 

again, attempting to assassinate the chief 

of the National Police Agency, the official in charge of the Aum investigation. 

While the population was on edge, most 

continued about their daily lives, even 

with a bit more awareness of their surroundings and their fellow citizens. Extra 

security was hired for sporting events, 

shopping malls, and tourist destinations. 

Business for taxis surged as people 

avoided the metro whenever possible. 

Media coverage was a constant reminder 

of the threat posed by the cult. While 

members were being arrested on almost a 

daily basis, the leader, Shoko Asahara 

was not captured for 6 weeks. During 

that time Asahara and other Aum members continued to make statements, both 

declaring their innocence and prophesying more attacks. Asahara declared that 

April 15, 1995, would be a “Day of 

Doom” for Japan. Tokyo prepared for the 

worst. Sixty thousand extra police officers donned riot gear and took to the 

streets. Nothing happened. As one expert 

stated, after the subway attack, “the mere 

threat of another attack paralyzed Tokyo 

almost as effectively as nerve gas itself.”64 A new word, “sarinoia” was born 

and heard repeatedly in media reports. 

While fear and anxiety increased dramatically, life in Tokyo did continue. After 

the attack, subway trains were decontaminated overnight and the full metro system was up and running the following 

day.

One of the primary concerns following the subway attacks was the reality 

that terrorist groups could obtain weapons of mass destruction through both 

legal and illegal means. Aum Shinrikyo 

made many mistakes in the creation and 

formation of its weapon. Had the purity 

been higher and the delivery method 

more sophisticated, hundreds if not thousands could have died. Most startling, 

however, is the fact that regardless of its 

lethality, the Tokyo attack demonstrated 

the use of a chemical or biological agent 

does not have to inflict mass casualties to 

cause widespread disruption, panic and 

ultimately, terror.

By the end of 1995, over 350 cult 

members had been arrested. Most, however, were charged with crimes unrelated 

to the subway attacks. Shoko Asahara and 

his cult members were determined to be 

responsible for 27 confirmed deaths that 

occurred during the March 20, 1995, attacks, the June 1994 attack in Matsumoto, 

and other miscellaneous murders of cult 

members and those that spoke out against 

it. The Japanese citizenry was relieved 

when Asahara was arrested. However, 

 

64 David Kaplan and Andrew Marshall, The Cult 

at the End of the World, (London: Hutchinson, 

1996), p. 271.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

36

minor attacks continued to keep the population ill at ease. Much as the attacks of 

Sept. 11, 2001, were a wakeup call for 

Americans, the existence of the Aum Shinrikyo cult, its possession of mass quantities of weapons of mass destruction, and 

its attacks on the Tokyo subway, shattered 

the 50 years of peace and security in Japan. Japan changed from a virtually 

crime-free society to one that held its 

breath every time it boarded the metro. 

Aum Shinrikyo officially disbanded, then 

reorganized under another name. The 

name, Aleph, is not uncommon in Japan 

and all businesses that used it in their 

name came under suspicion of having 

links to the cult. Companies and educational entities were forced to change their 

name to protect their livelihood. Aleph is 

scrupulously watched by the Japanese 

government, but it operates legally causing concern fear for many who experienced the world‟s first major nerve 

agent attack on a civilian population by a 

terrorist group.

Implications for Resilience in the United States 

Although there are cultural differences between the United States and Japan, this attack provides several lessons 

for enhancing resilience. As with the 

2001 anthrax attacks, despite problems in 

emergency response, delays in identifying the attack agent, and unclear communication with the public, there was no 

evidence of panic or disruptive behavior 

in Tokyo, demonstrating that even in less 

than ideal circumstances the public can 

cope with attacks. The most significant 

concern noted in this incident is the potential problem of the “worried well.” 

The extent of this problem depends on 

where the line is drawn between those 

who should be seeking care and those 

who can safely care for themselves. As 

one expert noted, there may be many 

reasons why individuals present for care, 

most of which in the absence of other 

guidance are very reasonable on a personal level. It falls to the public health 

community and emergency planners to 

provide accurate information to the population to allow those who are able to 

make better decisions about what types 

of symptoms require emergency care. 

This problem may be more severe in the 

United States, where millions of people 

depend on emergency rooms as their 

primary source of medical care, and even 

more dramatic in poorer areas within the 

United States. With many people seeking 

care for non-emergent conditions on a 

daily basis, increased flow to emergency 

rooms during a CBRN event may be 

unmanageable. Specific guidance regarding symptoms and at-home care options 

may better enable possible victims care 

for, or reassure themselves rather than 

reporting to an emergency room. Another potential solution to this problem is to 

establish front-line triage locations away 

from the medical facilities that can provide initial screenings and observations

and ensure only those in need of urgent 

care are transferred to hospitals.65

 

65 Stone, 2007, p. 29.
No Need to Panic: Public Resilience in CBRN Events

37

3. THE SARS EPIDEMIC IN CANADA

“Let me be clear: It’s safe to live in Toronto and it’s safe to visit.”

–Mayor Mel Lastman

Salient Points

 The absence of a coherent pandemic plan 

limited Ontario‟s ability to manage the 

SARS outbreak.

 Preparation by the healthcare community 

in British Columbia minimized the impact of the outbreak not only on the victims but also on the community at large.

 Lack of effective communication severely hampered Toronto‟s ability to control 

infection.

In November 2002, Guangdong 

Province in China experienced a fast 

moving and highly contagious respiratory disease outbreak. By February 2003,

this respiratory disease that had first 

emerged in China was given the name 

Severe Acute Respiratory Syndrome 

(SARS) by a World Health Organization 

(WHO) epidemiologist in Vietnam.66

SARS “is a viral respiratory illness

caused by a corona virus, called SARSassociated corona virus (SARS-CoV).”67

 

66 Judith A. Johnson, “Severe Acute Respiratory 

Syndrome (SARS): Public Health Situation and 

U.S. Response,” Congressional Research Service 

Report for Congress (RL31937), (May 23, 2003, 

available from http://opencrs.cdt.org/rpts/

RL31937_20030523.Pdf, (Nov. 18, 2003).

67 Centers for Disease Control and Prevention, 

Basic Information about SARS, http://

It is similar to pneumonia with symptoms, such as a high fever, dry cough, 

and shortness of breath or breathing 

problems,68 with a mortality rate of 

around 15 percent. In individuals over 

the age of 65, those with chronic illnesses or individuals who seek treatment 

late in the course of the illness the mortality rate is 50 percent or higher. Transmission can occur through contact with 

infected persons “droplets of respiratory 

secretions created while coughing or 

sneezing as well as in their stool and 

urine.”69 By May 2003, there were an 

estimated 7,183 cases of SARS worldwide and 514 reported deaths.70

The Start of an Epidemic

The initial outbreak of SARS started 

in rural areas of Guangdong province in 

 

www.cdc.gov/ncidod/sars/factsheet.htm, (Nov. 

19, 2003).

68 The University of Toronto Joint Centre for 

Bioethics, Ethics and SARS: Learning Lessons 

from the Toronto Experience, www.yorku.ca/

igreene/sars.html, (Oct. 10, 2007.

69 Judith Johnson, (2003).

70 The World Health Organization, Cumulative 

Number of Reported Probable Cases of Severe 

Acute Respiratory Syndrome (SARS), (May 9, 

2003), http://www.who.int/csr/sars/country/

2003_05_09/en/print.html, (Nov. 19, 2003).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

38

November 2002, but was not officially 

recognized by the Chinese government 

until February 2003. On Feb. 1, 2003, an 

ambulance driver in Guangzhou transported a desperately ill patient from the 

Second Affiliated Hospital to the Third 

Affiliated Hospital. He was alerted the 

patient was ill with an extremely contagious respiratory illness. While in contact 

with the patient, he used all necessary 

precaution, including triple layer surgical 

mask and gloves. After transporting the 

patient, he cleaned and disinfected the 

ambulance. Three days later, the ambulance driver fell ill. He was hospitalized 

for observation, but no extraordinary 

precautions were taken. While in the 

hospital his wife cared for his daily needs 

without any protective equipment. His 

condition continued to decline and on 

February 21 he died. As he became ill, a 

similar respiratory disease infected other 

healthcare workers. This ambulance 

driver is thought to be the first of more 

than 1,700 healthcare workers to die of 

SARS. By June 2003, 32 countries reported cases of SARS with more than 

8,000 people infected.71

The SARS outbreak in Canada offers a rare opportunity to examine the 

reaction of a country to a potential pandemic from two different perspectives. 

The SARS epidemic was located mainly 

in two provinces: British Columbia and 

Ontario. The differences in how these 

cases were handled within these provinc-

 

71 T. Abraham, Twenty-First Century Plague: 

The Story of SARS, Baltimore, Md.: The John‟s 

Hopkins University Press, (2005).

es help to explain why Toronto came to 

be seen as the focal point of SARS, 

while cases in British Columbia were 

largely unnoticed by the rest of world.

British Columbia

On March 7, 2003, a man and his 

wife returned home to Vancouver from a 

trip to Asia. While in Hong Kong they 

stayed on the ninth floor of the Metropole hotel along with a woman from Toronto and a doctor from Guangdong 

province. During the third week of February, a number of people on the ninth

floor of the Metropole would become ill 

with SARS through contact with the doctor from Guangdong. Soon after the 

Vancouver couple‟s return home, the 

man was taken to Vancouver General by 

ambulance following a visit to his physician. Prior to his arrival, the emergency 

room was alerted to his condition and his 

wife was isolated upon arrival at the 

hospital. While at Vancouver General, 

there was no transmission of SARS to 

any hospital employee or patient. 

Vancouver General in Vancouver, 

British Columbia is the largest hospital 

in the province and is a major research 

and teaching institution. They practice 

vigorous infection control and have a 

strong culture of worker safety by taking 

a precautionary approach. This included 

the use of N95 respirators. At the time of 

the SARS outbreak, this was a novel approach in hospital management, but has 

gained credibility since 2003. When patients presented with an undiagnosed 
No Need to Panic: Public Resilience in CBRN Events

39

respiratory illness the healthcare staff at 

Vancouver General started with the 

highest level of protection and then 

scaled back as more information became 

available. Shortly before SARS was 

gaining strength in Asia, the emergency 

department of the hospital had undergone 

an infection control audit. This audit 

reinforced many of the practices that 

were standard procedure and made the 

department attuned to the precautionary 

approach of the hospital. This type of 

audit had been happening at Vancouver 

General for eight years prior to SARS. 

Vancouver General was only a small 

piece of a larger system. British Columbia had just released their pandemic plan 

in response to fears of Avian Influenza. 

Health officials also had a system of distributing health alerts to healthcare facilities throughout the province. In February 

2003, health officials thoroughly monitored the situation in China. Alerts were 

sent to healthcare facilities in late February. Emergency room doctors at Vancouver General actively looked for unexplained fevers and respiratory infections 

in patients who had traveled to Asia during this time. When the patient who had 

been in China presented to the emergency room, the staff was aware of his travel 

history and was able to take precautions. 

“Two and a half hours after arriving at 

Vancouver General the patient was isolated, examined by specialists, treated by 

health workers wearing full respiratory 

protections and moved into a negativepressure isolation room.”72 By April 2, 

 

72 Commission to Investigate the Introduction 

and Spread of SARS in Ontario, Volume Two: 

2003, the Workers Compensation Board, 

the labor department for British Columbia, performed systematic inspections of 

healthcare facilities.

Through all the precautions exercised by the medical staff in Vancouver, 

coupled with the coherent pandemic plan 

and clear communication between government officials and hospital staff only 

46 people were infected, and no SARS 

deaths were reported in British Columbia. The results of this preparation highlighted how effective planning for 

communicable disease outbreaks can not 

only minimize the loss of life as a result 

of the disease, but also dramatically reduce the impact of the outbreak on the 

larger community. 

Ontario

In contrast to the example of British 

Columbia, Ontario struggled through the 

outbreak with a number of fatalities, of 

which, several were in the healthcare 

community. In late February 2003, a 78-

year-old resident of Ontario returned 

from a trip to Hong Kong. She had unknowingly been exposed to SARS by the 

doctor from Guangdong Province who 

was on the ninth floor of the Metropole 

hotel. Shortly after her return home she 

died of what at the time was reported as 

heart failure. On March 7, 2003, two 

days after her death, her son went to 

Scarborough-Grace Hospital emergency 

 

Spring of Fear, (2003), p. 257, On-line, Internet, 18 November 2007, available from

http://www.sarscommission.ca/index.html.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

40

room complaining of a respiratory infection, only hours after the patient had been 

admitted to the hospital in Vancouver. 

The Ontario patient had been his mother‟s primary caregiver during her illness 

and had prolonged contact with her as 

well as his family during that time. He 

first went to his primary care physician 

who prescribed antibiotics and sent him 

home. When the medication failed to 

help he presented at the emergency 

room. He waited for more than 16 hours 

during which he is believed to have infected two other patients at the hospital. 

This is thought to be the start of the 

transmission chain in Toronto. From the 

time his mother landed in Ontario and his 

death there were a number of contacts 

with the community. Her physician, her 

son‟s physician and his medical practice, 

their large extended family, and the numerous people he encountered in the 

hospital were contacts he had days before 

he was quarantined. In the end, 44 died 

and 330 were infected with SARS.73

More than half of those infected were 

healthcare workers, three of which succumbed to their infections.74

Unlike British Columbia, Ontario 

had no comprehensive pandemic plan. 

Further, no system of communication 

existed between government health officials and the healthcare community. If 

health alerts had been generated by the 

provincial government it is unlikely the 

alerts would have been effectively communicated. Another problem the prov-

 

73 Ibid.

74 Ibid.

ince faced was a lack of education or misunderstanding regarding laws and regulations. For example, provincial law in 

British Columbia specifically states all 

respirators used by hospitals must first be 

tested and approved by government labs 

before use. Hospital workers therefore 

knew exactly what equipment should be 

used when confronted with suspect respiratory illnesses. In contrast, Ontario uses 

less specific wording regarding the use 

of regulators. The lack of specificity left 

both the healthcare facilities and workers 

confused regarding the appropriate 

equipment. When the Vancouver patient 

was intubated the dangers of this procedure were understood by the doctors and 

staff at Vancouver General. Even though 

this practice was extremely hazardous to 

the staff due to the risk of infection, no 

one at Vancouver General suffered ill 

effects. It was a different story at Scarborough Grace. Four workers were infected 

on March 17 after an intubation and later 

on March 24, an anesthetist, a medical 

resident and a nurse were infected by a 

patient they intubated in Toronto. One of 

the main reasons SARS spread quickly 

through the province was the lack of 

clear government control over hospital 

inspections to ensure compliance with 

safety standards.

While the provincial government in 

British Columbia was well-organized for 

a pandemic with a thoroughly practiced 

plan, a communication system, and inspections of healthcare facilities, Toronto 

had no coherent plan or system. The Ontario Ministry of Labour was officially in 

charge of public health, but throughout 
No Need to Panic: Public Resilience in CBRN Events

41

the 1990s had lost much of its resources 

to cost cutting measures. This left the 

office unprepared for a public health crisis like SARS. In 1992, the Ministry had 

19 physicians on staff, but by 1996 only 

three remained. Further, there were no 

lab or air sampling technicians and all of 

the occupational health and safety nurses 

had been laid off. Most importantly, inspectors had no real training for issues 

surrounding infectious disease and had 

never participated in an inspection of a 

healthcare institution specifically regarding an infectious disease before the 

SARS outbreak.

It is not surprising therefore that 

while provincial government inspectors 

in British Columbia made systematic inspections in early April, Ontario officials 

did not start the practice until June. It 

was in May the Ministry of Labour realized healthcare workers inadequately 

protected. One reason for the delay in 

inspections was fear for the safety of the 

inspectors. The Worker‟s Compensation 

Board in British Columbia had developed internal systems for protecting inspectors. In Ontario, the Ministry of Labour took a backseat to the Ministry of 

Health. “The Ministry of Labour was 

largely sidelined during the outbreak. It 

was not given a primary role at the Provincial Operations Centre, and it was not 

seen as having a central responsibility in 

protecting healthcare workers.”75

Ontario lacked any comprehensive 

method for recognizing and dealing with 

 

75 Commission to Investigate the Introduction and

Spread of SARS in Ontario, vol. 2, (2003).

a potential pandemic. There was also little communication from provincial 

health officials. Isolation was delayed by 

many days as Scarborough Grace stayed 

open to new patients. Patients with compromised immune systems who had been 

exposed to Mr. Kwan were transferred to 

other hospitals throughout the province. 

In addition to procedural problems, the 

health workers suffered great losses during this time.

Many of the nurses and doctors had 

never learned how to properly use N95 

respirators or other protective equipment. 

Due to the lack of precaution and not 

properly isolating workers from potentially contagious patients a number of 

nurses and doctors became ill, and three

died. This was both a physical and psychological drain to the medical community. Nurses complained to superiors, but 

much of what they said was disregarded 

or not acted upon. Those who became ill 

were eventually quarantined, but not until the disease was able to move through 

several hospitals. Those who remained 

on the job faced enormous pressure at 

home and at work. Fewer health workers 

meant longer hours for those still on the 

job, which took a physical and mental 

toll. In addition, those workers with family felt enormous pressure to either not 

return to work or quit for fear they might 

bring the infection home. Even in the 

workplace, those individuals who dealt 

with SARS patients were often shunned 

by co-workers. Some doctors even refused to treat people who were or may 

have been infected with SARS. Doctors 

from the United States were asked by 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

42

Canadian colleagues to come and help 

relieve some of the burden.76

Public Response

SARS had a significant psychological and economic impact on the people 

of Toronto. For the limited spread and 

lethality of the disease there was considerable anxiety among the population. 

To a lesser extent it had an impact on 

people in other provinces and in the 

United States. One finding suggests the 

attempts to educate the public through 

the media were mixed. Positive results of 

the media campaign included more frequent hand washing, especially among 

Ontario residents, and being fairly knowledgeable about the disease. This knowledge included the contagious nature of 

the illness, generally how it spreads and 

that there is no vaccination. One negative 

aspect included people in areas unaffected by the outbreak taking unnecessary precautions. A survey conducted in 

April of 2003 demonstrated 35 percent of 

adults in the United States were concerned they or their family members may 

have been exposed to SARS.77 This is 

close to the number concerned about terrorist attacks, which was around 42 per-

 

76 L.K. Altman, “The Doctor‟s World: Behind the 

Mask, The Fear of SARS,” New York Times, 

(June 24, 2003).

77 R.J. Blendon, J.M. Benson, C.M. DesRoches, 

E. Raleigh, K. Taylor-Clark, “The Public‟s Response to Severe Acute Respiratory Syndrome in 

Toronto and the United States,” Clinical Infectious Diseases, (2004), p. 38; pp. 925-931.

cent of surveyed adults in the United 

States. The United States had a handful 

of isolated infections as a result of the 

individual returning from a country highly affected by the disease but no deaths 

were reported as a result of SARS. The 

level of fear was not proportionate to the 

actual danger of contracting the illness. 

Ideally, in future incidents fewer people 

in unaffected areas would demonstrate 

fear responses to such an outbreak. The 

authors of the study suggest this problem 

may be rectified by the clinicians and 

public health officials who provide the 

public with information. In the future, 

public health officials and clinicians 

would work closely to communicate 

more effectively. A final finding suggests that media coverage is both positive and negative because it informs individuals in the area of concern, but it 

also can create fear in people far removed from the incident.78

Healthcare Worker’s Reaction

During a health crisis the healthcare 

workers are a vital resource. In Ontario 

during the SARS outbreak, the healthcare 

community was hit hard by the disease 

with health workers the main victims. 

Nearly 130 nurses, physicians, respiratory 

therapists and other health workers became 

sick. As previously discussed, this left a 

large burden, both physical and psychological, on those who remained at work. 

“Nurses lived daily with the fear that they 

 

78 Ibid.
No Need to Panic: Public Resilience in CBRN Events

43

would die or infect their families with a 

fatal disease.”79 One nurse was asked by 

her 9-year-old daughter if she was going to 

die. Almost two thirds of those workers 

surveyed felt their health and safety had 

been compromised during the outbreak. 

Some felt torn between continuing to work 

and quitting because of their families fear 

of infection. Some workers quit or refused 

to care for SARS patients; one radiologist 

locked himself in his office and would only review x-rays if they were slipped under 

the door. Physicians who worked with 

SARS patients were stigmatized by other 

doctors in the hospital. They would move 

to the other side of the room from a colleague who cared for SARS patients.80 Dr. 

Perl, a doctor from the United States, told 

of her experience helping at Scarborough 

Grace during the epidemic. After her departure, her children‟s babysitter in the 

states quit. Later Dr. Perl was told by the 

teen‟s father that they were endangering 

his daughter by exposing her to SARS. 

While in Toronto, Dr. Perl did not tell anyone at her hotel why she was in Canada for 

fear of being ostracized.

81

The Registered Nurses Association of 

Ontario surveyed healthcare workers after 

SARS to determine the psychological impact of the disease outbreak. A key finding in this report was that two-thirds of 

respondents had a change of attitude toward the nursing profession because of 

 

79 Commission to Investigate the Introduction 

and Spread of SARS in Ontario, Volume One: 

Spring of Fear, (2003), p. 1, http://www

.sarscommission.ca/index.html, (Nov. 18, 2007).

80 L.K. Altman, New York Times.

81 Ibid.

SARS. Those at SARS infected hospitals 

felt the effect more than those at nonSARS affected hospitals. Eighteen percent of respondents from North York 

General Hospital and 24 percent from 

Scarborough Grace Hospital reported 

feeling SARS symptoms during or after 

the SARS crisis.82 In contrast, 7.6 percent 

of total respondents reported the same 

experience. Nurses reported their family 

lives were impacted by anxiety, isolation, 

stress, depression and loved ones fearing

for the caregiver‟s health. Those nurses 

surveyed from North York and Scarborough Grace reported suffering from post 

traumatic stress at a rate of 57 percent and 

47 percent respectively. This finding is 

not surprising when nurses recount being 

shunned by neighbors and separated from 

colleagues while at work. One nurse described her experience of her neighbors 

refusing to leave their house if she was in 

her backyard. At work, “nurses were directed to sit two seats apart in the cafeteria in an area separated from non-clinical 

staff, and security staff was present to 

monitor compliance with this directive.”83

Of those nurses surveyed, 15 percent declined to work because of the SARS crisis, five percent refused to work and 34 

percent considered refusing to work. As 

discussed earlier, there was much confusion on how to properly wear protective 

equipment and exactly which gear was 

required. This fact is supported by the re-

 

82 Registered Nurses Association of Ontario 

(Sept. 29, 2003). SARS unmasked, http://

www.sarscommission.ca/hearings/01Mon.pdf/Mo

n_10_45_RNAO.pdf, p. 17.

83 Ibid.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

44

sults of the nurses‟ survey. Fifty-three 

percent of respondents felt confusion regarding which mask would provide adequate protection and only five percent 

were trained in the proper use and fit 

tested for respirators. Nurses reported 

problems trying to control infection because of the shortage of personnel. The 

lack of training with safety equipment and 

too few nurses created stress and frustration. The situation was exacerbated as 

personnel were put into quarantine or became sick.84 Twenty-nine percent of respondents were quarantined either at home 

or on the job. Of those who were quarantined during the outbreak, 57 percent were 

quarantined for 10 days or more.

Another critical issue does not directly deal with the healthcare worker, 

but their patients. During the SARS outbreak, many facilities were closed and 

procedures unrelated to SARS were 

postponed for fear of spreading the infection to people with already compromised 

immune systems. Both necessary and 

elective surgeries were cancelled due to a 

fear of contamination. Treatments for 

many illnesses, such as cancer, were 

postponed or cancelled. Those who died 

because they could not receive treatment 

on time or have a surgery vital to survival are not calculated in the deaths related 

to SARS. Those critically ill patients 

admitted to the hospital oftentimes were 

not allowed visitors, causing undue stress 

on them and their families. Often nurses 

were the only people patients saw for 

weeks at a time. In addition, the nurses 

 

84 Ibid., 19.

wore full protective equipment at these 

meetings which hampered communication, especially with the elderly. It also 

increased the patient‟s sense of isolation. 

They were not touched without gloved 

hands and would spend hours alone in 

between checks by hospital staff.85

The Travel Advisory

The World Health Organization issued a travel advisory for the Toronto 

area on April 23, 2003, advising travelers 

to avoid this area. This announcement 

angered Toronto which felt unduly punished for an illness thought, at the time, 

to be on the run. The SARS Commission 

estimates the travel advisory led to an estimated $950 million loss, and $570 million of that total was in tourism and travel 

dollars. In Canada, only 44 people succumbed to the disease and most deaths 

occurred in the elderly or chronically ill 

individuals. These facts did little to assuage the public‟s fear of SARS, especially when faced with headlines such as, 

“SARS death toll rises; health officials 

quarantined.”86 The article describes how 

some public health officials working to 

contain the disease had gone into quarantine. Overall economic impact of the 

SARS outbreak was estimated to be $1.5 

billion, with two thirds of that impact in 

the Toronto area, and the remainder 

spread throughout the country. The study 

 

85 Ibid.

86 C. Abraham, “SARS Death Toll Rises; Health 

Officials Quarantined,” The Globe and Mail, 

(April 2, 2003).
No Need to Panic: Public Resilience in CBRN Events

45

noted no other single area experienced a 

significant enough economic impact to be 

measured in the study.87

Lessons Learned

It is clear the Vancouver area hospitals weathered SARS more effectively 

than Toronto. There are three main differences between the reactions of the 

healthcare facilities in both regions.

1. Disease surveillance. Province 

health officials in British Columbia were 

aware of the mysterious illness moving 

through China early in February and monitored the situation for new developments. In Ontario few people seemed to 

be aware of what happened in China and 

were not on alert for any suspect illnesses. 

2. Communication. British Columbia was both aware of what was happening in Asia, and that information was also effectively communicated throughout 

the healthcare system. Physicians 

throughout the province were actively 

looking for individuals with suspect respiratory illnesses. This allowed Mr. C‟s 

physician to act quickly to get his patient 

isolated in a facility equipped to deal 

with infectious diseases. Likewise, Vancouver General had specialists available 

to assist in handling him safely. In addition, Vancouver General also had effective organizational communication. In-

 

87 Paul M. Darby, “The Economic Impact of 

SARS,” The Conference Board of Canada, 

(2003), http://www.dfait-maeci.gc.ca/mexicocity/economic/may/sarsbrief

May03.pdf.

formation flowed both up and down the 

chain of command. The duties of the 

staff were well known and left little 

room for confusion. This was not the 

case at Scarborough Grace where many 

of the nurses were confused on which 

protective equipment was appropriate 

and in which circumstances it was warranted. Further, Ontario did not have the 

benefit of an established system of electronic bulletins to facilitate communication between government health officials 

and healthcare facilities. 

3. Preparedness. Just prior to the 

outbreak of SARS, British Columbia had 

developed a pandemic plan that 

represented a clear plan of action in the 

case of an infectious disease outbreak. 

Coupled with this was the overall focus 

on worker safety and infection control at 

Vancouver General. Worker safety was 

well ingrained in the hospital staff and 

was practiced regularly. In Toronto, 

worker safety and infection control were 

not as rigorously practiced.

Implications for Resilience 

The primary difference between the 

government‟s response in British Columbia and Ontario was preparedness. 

Just prior to the outbreak of SARS, British Columbia had developed a pandemic 

plan that had been transmitted, operationalized and practiced throughout the 

provincial healthcare system. The preparedness of the healthcare sector in British Columbia minimized the impact of 

the outbreak not only on the victims but 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

46

also on the community at large. The differences in management and overall impact of disease outbreaks in Ontario and 

British Columbia highlight the critical 

role planning and preparedness within 

healthcare systems can have not only 

on preventing loss of life but also on 

the social and economic health of the 

greater community. Despite the poor 

management of the crisis in Toronto 

there was no evidence of panic, but 

many citizens in Toronto and other areas

of Canada reacted reasonably and calmly in an attempt to prevent infection. 

Fortunately, there appears to have been 

little stigma attached to the city as a result of the outbreak as the Toronto tourism board reported by 2004 tourism has 

returned to pre-outbreak levels and visits 

continued to increase in 2005. This 

shows the willingness of tourists to accept announcements that locations impacted by such events are again safe, and 

over time resume their normal behavior.
No Need to Panic: Public Resilience in CBRN Events

47

4. HURRICANE KATRINA

“Considering the dire circumstances that we have in New Orleans, virtually a city that 

has been destroyed, things are going relatively well.”

–Michael Brown, director, FEMA

Salient Points

 Loss of command and control by local 

law enforcement led to chaos and lawlessness.

 Delayed pre-landfall decision making 

by local and state government officials in Louisiana led to unnecessary 

loss of life and misery for thousands.

 Lack of communication between levels of government and between the 

government and its people contributed 

to mistrust, misunderstanding and 

unwillingness to follow direction, 

once it was finally given.

 The role of non-profit organizations 

was vital to the safety and well-being 

of the citizens of Louisiana and Mississippi.

 U.S. Government lack of decisionmaking on cleanup and repopulation 

challenged New Orleans residents‟ resiliency, likely mirroring events following a radiological attack.

Many lessons on human and public 

resilience can be learned from the events 

leading up to and following Hurricane 

Katrina. It seemed everything that could 

possibly go wrong did. American society 

had not seen that level of social fraying 

since the 1918 pandemic. Along the Gulf 

Coast of the United States for a few days 

in August 2005, anarchy reigned, people 

died unnecessarily and government officials spent much of their efforts blaming 

one another for all that had gone so horribly wrong. 

Hurricane Katrina was one of the 

most devastating hurricanes in U.S. history. On Aug. 23, 2005, Katrina started in 

the Atlantic Ocean as a tropical depression and by August 29 had reached the 

Gulf Coast as a category five hurricane. 

Katrina killed more than 1,500 people and 

destroyed approximately 300,000 homes. 

The damage cost the U.S. Government 

between $125 and $150 billion, exceeding the total of Hurricane Andrew and the 

terror attacks on Sept. 11, 2001, combined. As a result of the storm, 95 percent of the daily oil output from the Gulf 

of Mexico ceased and almost two million 

people were without power.88 Some of 

the most challenging long-term recovery 

issues seen in New Orleans may be representative of the challenges posed in the 

 

88 Committee on Homeland Security and Governmental Affairs, U.S. Senate, Hurricane Katrina: A Nation Still Unprepared, (Special Report 

109-322), Washington, D.C., (2006), p. 133.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

48

recovery from a radiological or nuclear 

attack.

Timeline

 August 25: Tropical Storm Katrina 

developed in the Atlantic and headed 

toward the coast of Florida. 

 August 26: As Katrina entered the 

Gulf of Mexico it continued to strengthen, forecasted to make landfall in 

Mississippi and Louisiana in 72 hours 

as a category four storm. 

 August 27: Katrina‟s winds extended 

almost 160 miles from its eye and had 

nearly doubled in size. By 8 p.m. the 

director of the National Hurricane 

Service spoke with the governors of 

Mississippi and Louisiana warning of 

the danger toward their states and 

suggesting evacuation orders.

 August 28: The National Weather 

Service issued a bulletin forecasting 

“devastating” damage from storm 

surges would most likely overtop levees. Tropical-force winds reached 

230 miles from the eye. Finally mandatory evacuation is ordered in New 

Orleans, the second to last Louisiana 

parish to order evacuation.89

 August 29: When hurricane-force 

winds hit the coast, the eye of Katrina 

was more than an hour away, and the 

storm was a category four. Some areas 

of New Orleans experienced an 18-to-

 

89 Mandatory evacuation was never ordered in 

Jefferson parish, one of the most heavily populated parishes in the state.

25-foot storm surge and flooding occurred in much of the city.90

State and Local Leadership 

While the National Weather Service 

(NWS) can offer advice, only state and 

local officials have the power to order 

evacuation of a population. As the storm 

approached the Gulf Coast, officials in 

Alabama, Mississippi and Louisiana 

faced difficult decisions. Louisiana officials chose to stall, waiting to determine 

whether the severity of the storm would 

require total evacuation. Much of the 

able population departed voluntarily as 

early as August 27, while others prepared 

to weather the storm. Louisiana officials 

declared in repeated television interviews 

the storms were likely to overtop the levees and massive devastation could occur, but no mandatory evacuation order 

was given for New Orleans until 19 hours 

before the storm hit the city. 

The delayed mandatory evacuation 

order had three serious consequences. 

First, the wavering of the government 

meant citizens doubted the veracity of 

statements when the mandatory evacuation order was finally given. Second, local and state governments made no provisions for those who had no means to 

leave the area. The city of New Orleans 

was aware approximately 100,000 people 

would be unable to evacuate in the event 

of a major hurricane making landfall on 

the coast of Louisiana.91 During the 

 

90 Committee on Homeland Security and Governmental Affairs, U.S. Senate, (2006).

91 Ibid.
No Need to Panic: Public Resilience in CBRN Events

49

summer of 2005, this gap was noticed and 

draft memoranda of understanding 

(MOU) were created among bus, train and 

airline companies for assisting in evacuations, but the documents were never finalized. Some felt it was not feasible to plan

for hurricane evacuation during hurricane 

season. In addition, the transportation 

MOUs were only feasible if there were 

places for the evacuees to go after arriving at a safe destination. The planning 

process never got that far. 

There were, however, some nongovernmental organizations that had plans 

that were executed – at least in part. The 

most accomplished was a program named 

Brother‟s Keeper. Church leaders and 

other community figures helped match

people without transportation with those 

who would be willing to drive them to 

safety. This plan had the hope of some 

success, but was not fully developed. 

There were no predetermined meeting 

places and no contact information exchanged between the participating individuals. Like so many of the other plans 

for evacuation, the lack of follow-through 

kept it from being a viable solution.92

The situation highlights the need for 

planners to be able to assess the needs of 

a community in a disaster. 

Thus, as Hurricane Katrina descended on the city of New Orleans, the 

population turned to its leaders for help. 

When local leadership failed to give succinct directions, the population headed for 

higher ground. As the storm subsided 

60,000 people arrived at the doors of the 

 

92 Ibid.

Superdome, a “shelter of last resort” that 

had hastily stockpiled supplies for 15,000 

for three days. Another 20,000 convened 

at the Convention Center, a location that 

was never planned as a shelter and therefore, had no supplies, governance, or the 

ability to acquire either.

The final straw was that officials did 

not have contingency plans for a flooded 

New Orleans, even though they knew that 

it was virtually inevitable. There were no 

plans for evacuating “shelters of last 

resort” hastily designated in the city, nor 

were vital resources protected or sent to 

higher ground so they could be retrieved 

as the waters subsided. The lack of planning and the lack of attention to existing

plans caused the greatest challenge: maintaining order in New Orleans.

Command, Control, and Coordination

One of the greatest failures of Katrina 

was the almost immediate loss of command and control by local law enforcement due to lack of planning for continuity of operations during and after the 

storm. Police headquarters was underwater, decimating the ability to direct and 

manage emergency response.93 Transportation was limited by the rising water. 

Both dispatch and 911 resources ceased 

to function.94 Communication was re-

 

93 Emergency Management Assistance Compact 

(EMAC) 2005 Hurricane Season Response AfterAction Report, 1-11, 

http://www.tisp.org/files/pdf/news/emac_2005_hu

rricane_season_aar[1].pdf.

94 Select Bipartisan Committee to Investigate the 

Preparation for and Response to Hurricane Katri-
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

50

stricted to the use of private cell phones 

that operated sporadically and had little 

capacity for battery recharge. The police 

department set up a command center in 

the parking lot of Harrah‟s Casino, but 

was unable to connect with as many as 

two-thirds of its officers.95 Eventually it 

was determined as many as 320 had evacuated, abdicating duty.96

As the magnitude of the destruction 

unfolded emergency response organizations across the United States kicked into 

action readying for deployment primarily 

through Emergency Management Assistance Compact (EMAC), a “a congressionally ratified agreement that provides 

form and structure to interstate mutual 

aid, and through which states make available to each other in times of crisis their 

emergency response assets, such as National Guard troops.”

97

 The challenge 

was multifold. State officials led by Governor Kathleen Blanco repeatedly delayed 

requesting federal assistance, further 

 

na, U.S. House of Representatives, “A Failure of 

Initiative: The Final Report of the Select Bipartisan Committee to Investigate the Preparation for 

and Response to Hurricane Katrina,” (2006), p.

246.

95 Committee on Homeland Security and Governmental Affairs, U.S. Senate, (2006).

96 Interview by Select Comm. Staff with Maj. 

Ralph D. Mitchell, Jr., Region 1 Commander, La. 

State Police and LtC. Joseph Booth, Deputy

Superintendent, La. State Police, in Baton Rouge, 

LA (Nov. 9, 2005). Select Bipartisan Committee 

to Investigate the Preparation for and Response to 

Hurricane Katrina, U.S. House of Representatives, 

(2006).

97 The White House, The Federal Response to 

Hurricane Katrina: Lessons Learned, (February 

2006), p. 17.

stressing responders capabilities when 

they did arrive. The level of devastation 

was not anticipated (although many experts believed it should have been). The 

coordination of EMAC support (National 

Guard troops and first responders from 

other states) occurred at the state level, 

while active military and other resources 

including FEMA assets occurred at the 

federal level. As these resources descended on New Orleans, no one commanded all agencies and organizations 

involved. Coordination was managed on 

a case-by-case basis, which was greatly 

hampered by the lack of interoperable 

communications. National Guard troops

could not communicate with active duty 

military and neither could reach out to 

local resources, except with cell phones.

No one seemed to have a clear understanding of their organization‟s or agency‟s role, nor those of others. Anecdotal 

evidence abounds that the national system 

of response hierarchy, known as National 

Incident Management System (NIMS) 

was misapplied, misunderstood or ignored all together. The result was a haphazard response by all agencies, desperate to rescue the storm victims.

As the storm surge faded relief agencies went into high gear. A first priority 

was to rescue and get as many citizens 

out of the area as quickly as possible. 

However, only one-third of the evacuees 

were in Red Cross centers, leaving the 

remaining two-thirds in local shelters or 

in “shelters of last resort” such as the 

Superdome and Convention Center. 

Transportation was challenging, but when 

the process was finally put into place, 
No Need to Panic: Public Resilience in CBRN Events

51

FEMA shipped people out as quickly as 

possible. Most were not captured in a 

Red Cross database for survivors; resulting in the loss of contact with family 

members. The residents of New Orleans 

were sent to shelters across the 50 states, 

with little to no capability to reconnect to 

family or community.

Over one and a half million people 

evacuated from Louisiana, mostly in private vehicles. The rest relied upon government assistance inefficient for survivors or for the shelters to which they were 

sent. Numerous examples existed of localities across the United States preparing

to receive weary souls, only to learn the 

people were re-routed last minute for 

seemingly no reason.98 The lack of coordination among FEMA (the mover), the 

local haven (receiver), and the Red Cross, 

the only agency with extensive experience 

in resettlement, was extensive and cost 

many citizens, community and family 

connectivity they required to begin the 

road to recovery. 

The success story of Katrina has to be 

the efforts of the National Guard and 

Coast Guard. More than 70,000 citizens 

stayed in New Orleans, many of whom 

were stranded on roof-tops without food 

and water. Together the Coast Guard and 

Louisiana National Guard rescued over 

55,000 people.99 The difficulties came in 

 

98 Select Bipartisan Committee to Investigate the 

Preparation for and Response to Hurricane Katrina, U.S. House of Representatives, A Failure of 

Initiative: The Final Report of the Select Bipartisan Committee to Investigate the Preparation for 

and Response to Hurricane Katrina, (2006).

99 Ibid, 116.

that there was no designated rescue location, thus boats and helicopters deposited 

people on dry land, resulting in massing 

of the population without food or water 

and without government evacuation 

plans.

Communication Failure

The destruction of communication 

infrastructure significantly impaired the 

government‟s ability to respond to the 

crisis left in the wake of the storm. Efforts by local, state and federal agencies 

to coordinate actions were complicated by 

this destruction. Local authorities undertook little to no advance planning for continuity of communications. After Katrina‟s landfall the only method for Mayor 

Ray Nagin to communicate with the 

city‟s emergency managers was to walk 

across the street. One hotel was able to 

maintain communications with its corporate offices and kept guests and workers 

in contact with families throughout the 

storm and evacuation periods. 

The efficiency and planning of commercial operations able to maintain power 

and communications offers a useful model for future incidents.100 Additionally, 

difficulty in communication and decisionmaking among local, state and federal 

government agencies, created an environment in which it was unclear who was 

in charge, fueling uncertainty in the affected communities. 

 

100 Committee on Homeland Security and Governmental Affairs, U.S. Senate, 2006, 133.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

52

Medical Calamities

The level of dysfunction in medical 

and nursing home facilities in New Orleans astonished and shamed many Americans. The House of Representatives Report on Katrina summed it up by saying, 

“Medical care and evacuations suffered 

from a lack of advance preparations, inadequate communications, and difficulties 

coordinating efforts.”101 That said, the 

level of individual heroics cannot be understated. 

One of the greatest problems for 

medical facilities was the loss of communication with virtually the entire outside 

world. Hospitals had emergency plans, 

most of which assumed only temporary 

loss of power. With prolonged power 

outages, batteries ran out and institutions 

were incapable of requesting help from 

rescue agencies. Emergency 911 services 

were down or so clogged that relief was 

rarely a result. 

Most hospitals did not have concrete 

guidance on evacuation, nor were they 

prepared for a full evacuation. Most 

plans called for shelter in place, or required a minimum of 36 to 72 hours to 

evacuate hospitalized patients.102 With 

only 19 hours of notice, New Orleans 

evacuation became untenable, and occurred ad hoc and without coordination 

with law enforcement.

 

101 Select Bipartisan Committee to Investigate the 

Preparation for and Response to Hurricane Katrina, U.S. House of Representatives, (2006), p. 267.

102 Ibid, p. 268.

Role of Private Entities

The size and scope of the disaster 

following Hurricane Katrina and her 

“sibling” Hurricane Rita are difficult to 

put into perspective. One after-action report summed it up by saying, “one million people had to be evacuated from an 

area the size of Great Britain.”103 The 

resources required to respond to that 

magnitude of a disaster had not been truly 

understood by the government and, therefore, failure to act with appropriate speed 

and efficacy was seen at the federal, state 

and local levels. While the response of 

the government has been highly criticized, the “bright spot” following Katrina 

was the role played by private volunteer 

entities commonly housed under the umbrella terms non-profit and nongovernment organizations.104 Many of 

these entities were local churches and 

community organizations that had never 

before provided disaster relief, yet were 

capable of action due to local expertise, 

networks and relationship to the community.105

 According to one report, in the 

days after the storm nearly as many evacuees stayed in shelters operated by 

churches and other small non-profits as 

stayed in American Red Cross shelters.106

Of course, the Red Cross itself is a private 

international humanitarian organization, 

not a U.S. Government entity.

 

103 The Aspen Institute, Weathering the Storm: 

The Role of Local Nonprofits in the Hurricane 

Katrina Relief Effort, Washington, D.C., (2006).

104 Ibid.

105 Ibid., p. 9.

106 Ibid., p. 2.
No Need to Panic: Public Resilience in CBRN Events

53

The Red Cross responded to its fullest capacity. The organization spent $2 

billion on responding to Hurricane Katrina alone, a remarkable sum when one 

considers the annual revenue for the organization in 2004 was $3 billion.107

 In 

the aftermath of the storm, the Red Cross 

was criticized for the lack of support provided to “shelters of last resort” such as 

the Superdome and Convention Center. 

The mandate of the Red Cross, however, 

dictates it does not place workers in 

harm‟s way. Given the dire circumstances at the Superdome, the organization 

decided to bend the rules to provide some 

relief to those trapped in the Superdome, 

but workers were refused entry by law 

enforcement entities who declared the 

area unsafe.

One of the challenges of the role of 

private entities was there was a great deal 

of confusion and difficulty integrating 

these organizations into the “normal” 

process under which FEMA operates, 

specifically how to reimburse some of 

their costs for providing “mass care” in 

the immediate aftermath of the storm.108

This led to difficulty in accurate accountability of evacuees including reuniting 

families and providing government assistance in relocation and distribution of 

funds. The situation shows the necessity 

 

107 Select Bipartisan Committee to Investigate the 

Preparation for and Response to Hurricane Katrina, U.S. House of Representatives, (2006), p. 351

108 General Accounting Office, National Disaster 

Response: FEMA Should Take Action to Improve 

Capacity and Coordination between Government 

and Voluntary Sectors, GAO-08-369, (February 

2008).

of engaging non-government organizations to tap into their capabilities and resources at the local level.

Public Distrust

On Sunday, Aug. 28, 2005, the first 

mandatory evacuation in Louisiana‟s history was ordered. As noted earlier, for 

many, separation from family and loved 

ones may be more frightening than physical danger, prompting many to choose to 

stay rather than leave family, friends or 

even pets behind. However, mistrust 

played a prominent role in decisionmaking. In 1927, a flood of the Mississippi threatened to destroy affluent areas 

of New Orleans. To avert this, a decision 

was made to create a controlled breach in 

the levee that flooded the poor section of 

town. 

Since then there has been the perception, mostly in the predominantly black 

neighborhoods, that poor areas of New 

Orleans have been sacrificed for the good 

of the city. In a qualitative study done after Katrina in shelters around the South, 

individuals demonstrated a marked lack 

of trust for those in charge of New Orleans, as well as for those people participating in the rescue.109 Some felt the 

Lower Ninth Ward had been purposely 

flooded to save the tourist areas, while 

others believed rescue attempts began in 

 

109 K.M. Cordasco, D.P. Eisenman, D.C. Glik, J.F. 

Golden, and S.M. Asch, “They Blew the Levee: 

Distrust of Authorities among Hurricane Katrina 

Evacuees,” Journal of Health Care for the Poor 

and Underserved, 2007, vol. 18, pp. 277-282.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

54

wealthier areas of the city. This lack of 

community engagement in the planning 

and execution of hurricane response efforts contributed to this mistrust and miscommunication.110 To ease the problems 

created by mistrust, community leaders 

should have been included in the planning 

process. They would have been able to 

lend credibility to the city‟s efforts to 

evacuate the population. This would have 

only been effective had there been a plan 

for removing those people unable to evacuate to a safe location.111

While some communities may have 

high percentages of individuals and families who can cope with a crisis independently, if given accurate guidance, other 

communities (such as the Lower Ninth 

Ward) have great numbers of people who 

are unable to act on reasonable guidance. 

Barriers to following emergency guidance 

may include lack of access to communication channels, inability to understand guidance due to cultural or language barriers, 

inability to act on guidance due to medical 

or mental health conditions, or lack of necessary resources to follow directions. All 

of these issues must be taken into account 

when planning for a CBRN event and in 

providing guidance to a community following an attack to ensure the people can 

respond in the most effective manner.

Repopulation of New Orleans

After any major disaster, man-made 

or natural, rebuilding takes time and plan-

 

110 Ibid.

111 Ibid.

ning. The questions that still linger are 

how much of the city should be rebuilt 

and how it should be repopulated. The 

economic losses from the hurricane are 

great, but the city of New Orleans continues to suffer as tourist and business dollars are lost every year. It is not just the 

disaster that must be understood, but how 

a population can effectively rebuild and 

return to normal. 

Reconstruction is part of a sequence 

of four identifiable post-disaster periods: emergency, restoration, reconstruction and commemorative or 

betterment reconstruction. A retrospective study of San Francisco after 

the earthquake and fire of 1906 first 

examined these four periods. The 

emergency period is characterized 

by search and rescue, emergency 

shelter and feeding, the establishment of order, the clearing of major 

arteries, and the draining of floodwaters. Before this period ends, the 

restoration period is started, where 

the repairable essentials of urban 

life are restored. And well before 

this stage is over, replacement reconstruction begins to provide the 

infrastructure, housing and jobs for 

the destroyed city and pre-disaster 

population, followed often by a 

commemorative or betterment reconstruction.112

 

112 R.W. Kates, C.E. Colten, S. Laska, and S.P. 

Leatherman, “Reconstruction of New Orleans 

after Hurricane Katrina: A Research Perspective,” 

Proceedings of the National Academy of Sciences 
No Need to Panic: Public Resilience in CBRN Events

55

The extent of the damage and the 

post-disaster failures extended the emergency period. The restoration was further 

complicated by the numbers of people 

forced out of the city. “The result is that 

much repairable, but populationdependent, infrastructure has not been 

restored or used.”113 Reconstruction can 

often create conflict between groups for 

resources and time.

While there are lessons regarding resilience to be learned from all stages of the 

Hurricane Katrina response and recovery, 

a unique feature of this disaster is that, unlike the others examined in the study, recovery has been slow and in some areas 

non-existent. For more than three years 

some areas of New Orleans have remained 

essentially abandoned as residents, governments and businesses debate how to 

move forward in areas such as the Lower 

Ninth Ward. 

In some key ways this may reflect the 

same kind of problems seen if a radiological dispersion device were detonated. In 

such an event, a large area of a city may 

need to be abandoned, or reclaimed only 

through a very expensive clean-up effort. 

In such a case, some residents may insist 

the area be cleaned so they can return 

home, while others question whether such 

an investment is worthwhile, or whether 

funding such a project is even possible. 

Such delays in planning for recovery inevitably make it impossible for some 

people, or even entire communities, to re-

 

of the United States of America, (Sept. 26, 2006), 

vol. 103, no. 40, 14653-14660.

113 Ibid.

turn to a state of normal functioning in the 

interim.

The levee breaches that allowed much 

of New Orleans to flood created a toxic 

situation in the city. The water that 

flooded in was a mixture of oil and toxic 

chemicals from nearby manufacturers. 

This situation left many citizens wondering how contaminated the city may be after the water was pumped back into the 

lakes and the levees rebuilt. One question 

that must be addressed in the case of environmental contamination is what level of 

contamination is acceptable for human 

habitation? Prior to Katrina, New Orleans 

residents lived with a moderate level of 

environmental contamination. The soil

throughout the area was contaminated with 

arsenic, lead and other chemicals. “Evaluating the risk to human health associated 

with contaminant levels in post-Katrina 

soil and sediments is complicated by the 

lack of clearly acceptable standards.”114

Many of the environmental risks 

come from the demolition of damaged 

buildings as a result of mold growth or the 

release of chemical or biological material 

trapped in the buildings by flood waters. 

This creates a number of issues for city 

planning, and a number of questions must 

be answered. The legal issues must be fully addressed regarding homeowners attempting to return to their properties and 

 

114 D.D. Reible, C.N. Haas, J.H. Pardue, and W.J. 

Walsh, Toxic and Contaminant Concerns Generated by Hurricane Katrina, The Bridge, Vol. 36, 

No. 1, (Spring 2006), http://www.nae.edu/

Publications/Bridge/TheAftermathofKatrina/

ToxicandContaminantConcernsGeneratedbyHurricaneKatrina.aspx. (Jan. 15, 2008).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

56

the need to demolish a house undamaged 

structurally, but inhabitable.

Communication with the public is important to gain support and to explain the 

reasons behind government decisions. “In 

all decisions, communications need to be 

consistent, clear and sensitive to the needs 

of the local population...communicating 

the extent of the destruction of housing 

may be the most important first step.”115

This problem was recently faced by the 

New Orleans city government when the 

U.S. Department of Housing and Urban 

Development decided to demolish 4,500 

units of public housing. This decision 

caused frustration and resentment within 

the community to boil over and protestors 

engaged in violent clashes with police.116

This conflict demonstrates the problems 

that face reconstruction after a disaster. 

This demonstrates how groups and institutions fight for equitable division of resources and time after a disaster.

Lessons Learned

Of all the cases examined, Hurricane 

Katrina demonstrates the scenario that has 

been most challenging to personal and 

 

115 Centers for Disease Control and Prevention & 

U.S. Environmental Protection, Environmental 

Health Needs and Habitability Assessment, Agency, Joint Taskforce Centers for Disease Control 

and Prevention & U.S. Environmental Protection 

Agency, (Sept. 17, ),p. 22 

www.epa.gov/katrina/reports/envneeds_hab_asses

sment.html, (Jan. 11, 2007).

116 J.M. Gonzales, and M. Kunzelman, “After 

Clashes With Police, Protestors Vow to Press on 

against Demolitions in New Orleans,” International Herald Tribune, (Dec. 21, 2007).

community resilience. Warnings were not 

provided early enough to be maximally 

effective, the needs and capabilities of 

many residents were not adequately prepared for, leaving many unable to follow 

evacuation guidelines. Long-term issues 

of trust between the people and the government exacerbated communication and 

compliance problems. The need for affiliation and the desire to be with loved ones 

was highlighted by an unwillingness to 

leave family and pets unable to be evacuated. 

Federal, state and local authorities‟ 

actions were reactive, not proactive. Ramifications of decisions were not thought 

through. Some of those decisions cost 

lives, others resulted in mayhem, and 

many were detrimental to resilience of 

New Orleans‟ residents. The most glaring example is although city and state officials warned that Katrina would most 

likely breach the levees, little to no planning was undertaken to manage the consequences of the flooding. As the U.S. 

House of Representatives Report stated 

the lack of a full evacuation of New Orleans combined with the ruptured levees 

required “a post hurricane evacuation, for 

which federal, state and city officials had 

not prepared” and one that subsequently 

had to be made during the crisis and 

without full “situational awareness.”117

The difficulties and inequities in rebuilding areas of the city left many citizens in a state of limbo, not knowing in 

what direction they should proceed to re-

 

117 Select Bipartisan Committee to Investigate the 

Preparation for and Response to Hurricane Katrina, U.S. House of Representatives, (2006), p. 104.
No Need to Panic: Public Resilience in CBRN Events

57

build their lives. Some of these most challenging long-term recovery issues seen in 

New Orleans may represent the challenges posed in the recovery from a future 

radiological or nuclear attack and should 

be critically reviewed for lessons that 

could be applied to a CBRN event on the 

U.S. homeland.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

58
No Need to Panic: Public Resilience in CBRN Events

59

5. UK FOOT-AND-MOUTH EPIDEMIC

“The MAFF [UK Ministry of Agriculture, Fisheries and Food] killing machine is as 

relentless as Rommel.”

–John Gouriet, UK political activist

Salient Points

 No UK pandemic pre-event plan or 

procedures existed to manage the outbreak or to inform the public.

 All UK veterinarians were not familiar with the disease, limiting diagnosis.

 The national government did not have 

an effective strategy for engaging 

communities.

 The level of public distrust ran high 

due to lack of understanding.

Another naturally occurring incident 

that may shed light on resilience to CBRN 

attacks is the 2001 foot-and-mouth outbreak in Great Britain. Although the disease does not directly affect humans, the 

natural outbreak may mirror in many 

ways an agricultural biological attack. 

Foot-and-mouth disease (FMD) has a 

long history in Britain with numerous 

outbreaks of the disease. “In Britain, 

throughout the early part of the 19th century, no attempt was made to eradicate 

FMD.”118 The most recent outbreak prior 

to 2001 happened in 1967 and cost the 

 

118 The Cabinet Office (UK), Foot and Mouth 

Disease: Lessons to be Learned Inquiry Report 

HC888, (July 2002), p. 21.

government around £27 million, primarily 

for farm compensation. By 1968, approximately 400,000 animals were slaughtered 

in order to bring the disease under control.119 In contrast, over four million animals had to be slaughtered before it was 

eradicated in 2001.120

The Disease and the 2001 Outbreak

FMD is a virus that primarily infects 

bovidae, such as cattle, sheep, goats, 

swine and all wild ruminants. It is easily 

spread through four main methods: direct 

or indirect contact between animals in the 

form of droplets; animate vectors; inanimate vectors; and by airborne transmission. Animate vectors include humans 

and other animals not susceptible to the 

disease. Inanimate methods of transmission include spreading by vehicles and 

machinery. In temperate climates, FMD 

viruses can spread through the air up to 

60 km overland and 300 km over water. 

 

119 “1967: Foot-And-Mouth Slaughter Rate 

Soars,” BBC On This Day, http://news.bbc.co.uk/

onthisday/hi/dates/stories/november/21/

newsid_3194000/3194490.stm, (March 2008).

120 Department for Environment, Food and Rural 

Affairs (U.K.), Animal Health and Welfare: FMD 

Data Archive, http://footandmouth.csl.gov.uk/secure/

fmdstatistics/slaughtmonth.cfm, (March 14, 

2008).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

60

The disease can survive in the body in 

marrow and lymph nodes at a neutral pH. 

Destruction of the virus can occur in the 

muscles after rigor mortis has set in as the 

pH level increases. Outside of the body 

the virus can survive in the fodder and 

environment for up to a month. Survival 

in this state is dependent on the pH of the 

soil and temperature. This disease is highly contagious, but causes a relatively low 

mortality rate among adult animals, but 

causes a much higher mortality rate in 

young animals. The incubation period can 

be from two to 14 days, followed by pronounced symptoms in cattle, such as anorexia, lip smacking, lameness and vesicles 

on feet which can rupture after 24 hours. 

In sheep the symptoms can often go unrecognized, since they may display less obvious lesions. FMD is also clinically indistinguishable from three other common 

diseases.121 The similarity challenges diagnostic capabilities of veterinarians with 

little experience with foot-and-mouth. In 

2001, some of the clinical specifications 

of FMD were important to how the disease spread and why the outbreak was so 

widespread. 

On Feb. 19, 2001, a farmer in Brentwood, Essex, alerted a local veterinarian to 

a problem with a herd of sows. After testing it was confirmed the pigs were infected 

 

121 The diseases are Vesicular stomatitis, swine 

vesicular disease, and vesicular exanthema of 

swine. See OIE – World Organisation for Animal 

Health, Foot and Mouth Disease Aetiology, 

www.oie.int/eng/maladies/fiches/A_A010.HTM

(March 14, 2008).

with FMD.122 In addition, the disease was 

not limited to pigs, but also nearby sheep. 

The symptoms of FMD are often overlooked because often sheep display only 

mild symptoms of the disease. However, 

for three weeks prior to the pig diagnosis 

the disease had spread throughout the 

country by sheep sent to market.

The Public Response

The public‟s response to the foot-andmouth outbreak varied depending on its

position relative to the farming community. Much like the United States, Britain‟s 

economy over time has become centered 

on service jobs and has moved away from 

agriculture. The outbreak of FMD had a 

much more devastating impact on rural 

communities than urban areas. There were 

three aspects of the foot-and-mouth outbreak with an impact on urban and rural 

communities: time between outbreaks, quarantining of the countryside and mass 

slaughter. The first was the time that 

elapsed between major outbreaks of disease. The last major outbreak of FMD was 

in 1967, and it devastated British rural 

communities. By 2001, FMD was believed 

to be a disease of the past. This feeling 

seemed to be shared by farmers and government entities. One reason was the 

length of time between outbreaks. In terms 

of population resilience there was no sense 

of mastery of this problem. The public had 

little experience with this type of crisis. 

Many current farmers were children at the 

 

122 The Cabinet Office (U.K.), Foot and Mouth 

Disease: Lessons to be Learned Inquiry Report 

HC888, (July 2002), p. 21.
No Need to Panic: Public Resilience in CBRN Events

61

time of the last major outbreak and had 

only vague memories of their parents handling of the situation. The issue of mastery 

was coupled with a limited perception of 

self-efficacy. Farmers could do little, but 

try to limit the spread of disease on their 

own farms. Contamination of a farm could 

come from a bird, wild animal or simply 

airborne viruses. Once the contamination 

occurred, the farmer‟s livelihood was at 

the mercy of government policies. This 

lack of experience, lack of planning, and 

lack of any clear control over the situation 

created feelings of frustration and despair 

in the farming community.

The second major impact on the UK 

was the ban on animal movement and quarantine over much of the countryside. 

Preventing animal movements creates two 

major problems for farmers. First, money 

is made when farmers acquire animals, 

fatten them up and send the herd to market for a profit. The slaughter of infected, 

or suspect animals, compounded with the 

lack of movement created a dire financial 

situation for most farmers. Second, 

movement is important to animal welfare. 

Farms are not equipped to maintain large 

numbers of animals over long periods of 

time. There is neither the space nor the 

feed to support long-term care. Farmers 

who did not have animals infected with 

foot-and-mouth disease were often worse 

off financially because they did not fall 

within the government‟s compensation 

scheme, yet they were unable to sell their 

livestock and earn a livelihood. Rural 

areas suffered generally from a loss of 

revenue generated by vacationers and 

tourists to the countryside. The entire 

country of Great Britain was declared a 

Controlled Area on Feb. 23, 2001, with 

the associated restrictions lasting approximately nine months.123

 The tourist sector 

of the UK economy was estimated to 

have lost almost $5 billion. Most of this 

loss was felt in rural areas as a direct result of reduced spending from domestic 

tourism. The British government spent 

almost $1.5 billion in compensation for 

lost livestock, and the rural community 

bore the rest of the cost.

The way animals are perceived and 

treated has changed over the decades. In 

the 2001 outbreak, animal welfare was an 

important aspect for many rural and urban 

communities. The large-scale slaughter 

and burning of animals left many communities traumatized.124 The situation became particularly distressing when the 

animals were left where they were 

slaughtered for weeks on end. In addition 

to concern for animal welfare, communities were also worried about possible environmental contamination from the carcasses and the pits where the animals 

were eventually disposed. Because burial 

was a novel solution to disposal of so 

many animals, communities worried 

about water and air contamination. 

People also feared animals not in danger 

of infection, but who could spread the 

disease. Owners quarantined dogs and 

horses for fear they might transmit the 

 

123 Ibid., p. 63.

124 Tara Womersley, “Villager‟s Tears as the 

Slaughter Begins,” The Daily Telegraph, (June 20, 

2001), http://www.telegraph.co.uk/news/

main.jhtml?xml=/news/2001/02/26/nfnm126.xml

(Dec. 15, 2007).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

62

disease. Rural communities were confused and anxious about the spread of the 

disease. One farmer with about 50 horses 

had limited their movement to his property in order to limit the potential of his animals spreading the disease. Another 

stated he felt anxiety every time he saw a 

bird fly over his property.125 The lack of 

communication left the public with feelings of fear and outrage. Most did not understand the need for culling and pushed 

for vaccination. Much of this turmoil 

would have been avoided had the government explained its policy, objectives 

and public benefit in a real and tangible 

way.

The Government Response

The government‟s response to the 

FMD outbreak varied depending on the 

region. Scotland dealt with the outbreak 

more effectively than both England and 

Wales. Many farmers had little financial 

room for error at the time of the 2001 

outbreak. Stopping the movement of all 

animals and destroying all infected or potentially infected animals created a great 

deal of stress, fear and resentment among 

the farming community toward the national government. Tony Blair and the 

Labour party were seen as being urban-

 

125 Tara Womersley, “Flames Fan the Fears of 

Traumatized Community,” The Daily Telegraph, 

(June 20, 2001), http://www.telegraph.co.uk/

news/main.jhtml?xml=/news/2001/02/27/nfnm527

.xml, (Dec. 15, 2007).

centric and not sensitive to the issues 

faced by rural communities in England.126

At the beginning of the outbreak a 

number of agencies developed a plan for 

halting the disease. These agencies included the State Veterinary Service, Ministry of Agriculture, Forestry and Fisheries (MAFF) and the Food Standard 

Agency. Government epidemiologists 

came together to evaluate and model the 

potential spread of FMD. Through the 

findings of these epidemiologists, the 

three kilometer cull radius was determined to be a viable method for stopping 

the outbreak.127 “Although culling contiguous premises was a blunt policy instrument, it had the benefit of speed in 

decision-making.”128 Government agencies began implementing the policy without adequately explaining it and thus, 

many farmers in England did not understand the logic behind it. In areas where 

the policy was rigorously applied the 

government met with opposition and frustration from farmers.

Communication was limited to formal announcements. The lack of communication left many farmers feeling victimized by careless implementation of policy. At times junior ministry officials 

faced threats of violence and harassment 

by angry and frustrated farmers. This 

created a great deal of stress working 

within the government at a time when 

 

126 Ibid.

127 Ibid.

128 The Cabinet Office (U.K.), Foot and Mouth 

Disease: Lessons to be Learned Inquiry Report 

HC888, (July 2002), p. 96.
No Need to Panic: Public Resilience in CBRN Events

63

workers spent long hours at their jobs

with no time off. In terms of population 

resilience the communication failure lowered the farmer‟s perception of selfefficacy. Farming has become a difficult 

profession as national and international 

economies have evolved. Many farmers 

have few financial resources to fall back 

upon during times of disease outbreaks. 

The stress of financial hardship and the 

perception of abuse by uncaring and unreasonable policy makers eliminated any 

sense of a farmer‟s ability to manage his 

own situation. Farmer‟s Unions stepped 

in and created a 24-hour suicide hotline to 

support farmers and avoid self-inflicted 

wounds by those in despair.

Implementation of the cull policy became problematic when the extent of the 

epidemic was realized. The State Veterinary Service did not have the resources 

necessary for mass slaughter. The lack of 

resources became noticeable when, in 

Cumbria, four cases meant 1,458 cattle 

and 17,270 sheep needed to be slaughtered with an additional 15 farms classified as dangerous contacts. Carcasses 

awaiting disposal overwhelmed the system and in some areas were left in the 

fields. At the height of the epidemic, over 

600,000 animals were marked for slaughter and more than 200,000 carcasses had 

to be disposed of after they were killed.

In Scotland, many of the issues surrounding the FMD outbreak were avoided 

by the government‟s pragmatic approach. 

Scotland‟s response differed from England in both communication and implementation. The State Veterinary Service 

implemented national-level policies, yet 

because of the power vested in the Scottish national government; local government had some discretionary power. The 

National Farmers Union (NFU) of Scotland aided the communication between 

the government and local farmers.. The 

NFU helped to communicate the goals of 

the three km cull radius around infected 

farms. The farmers were aware of the rationale of this plan and the clear communication of policy objectives helped the 

program to gain at least some support 

from the farmers. The policy was supported by an organization within the 

community, the NFU, and the policy was 

explained in sensible terms.

The second way in which the Scottish response differed from England and 

Wales was the implementation of the national cull policy. The policy was implemented pragmatically and was limited to 

the edge of the outbreak area. Ninetyeight percent of animals slaughtered in 

Scotland were burned on the contaminated farms, limiting movement of the 

disease. In contrast, many of the carcasses 

in England were transported to other locations where the carcasses could be destroyed, raising public fears of further 

disease contamination. 

Lessons Learned

The 2001 FMD outbreak in the United Kingdom highlights important public 

resilience issues and problems faced by 

both citizens and a government during the 

crisis. The lack of disease detection for 

several weeks prior to the first recognized 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

64

case limited government efforts to contain 

the outbreak. Government planning and 

preparation did not anticipate the extent 

of the outbreak. Communication with the 

public lacked credibility due to widespread distrust of government motives, 

especially within the farming community. 

Disease eradication policies may have 

been more widely accepted had the government included English and Welsh farmers on the decision-making process and 

involved organizations the farmers 

trusted, such as the National Farmers Union such as in Scotland. The 2001 FMD 

outbreak may have been accidental or 

natural occurrence, but it offers insight 

into issues that could follow a large-scale 

chemical or biological attack, including 

the ability to manage perception, reduce 

confusion on the part of the citizenry and 

government officials, and create established relationships between government 

and trusted non-government organizations 

that can act as liaison with the public.
No Need to Panic: Public Resilience in CBRN Events

65

6. 1918 INFLUENZA PANDEMIC

“There is not the slightest danger of an epidemic... [because disease seldom attacks] a 

well-nourished people.”

–Royal Copeland, health commissioner, New York City, 1918

Salient Points

 Official reaction ran the spectrum of 

denial, obfuscation, confusion and 

contradiction severely testing public 

trust.

 The government could not meet the 

needs or expectations of the public 

even though the expectations were far 

below what they are today.

 Use of media for public communication was problematic given wartime 

efforts.

 The role of home-centered healthcare 

and volunteer service programs was 

crucial in caring for patients at home.

The “Spanish” influenza pandemic of 

1918–1920 caused an estimated 50 million deaths worldwide and sickened nearly one- third of the world‟s population. 

With millions of people incapacitated, the 

social fabric frayed, governments ceased 

to effectively govern, many activities in 

the public realm halted. On Oct. 18, 1918, 

the surgeon general of the United States

predicted “if the epidemic continues its 

mathematical rate of acceleration, civilization could easily disappear from the 

face of the earth within a few weeks.”129

The pandemic was like no other, with a 

mortality rate surpassing even the Black 

Plague by modern estimates. In one study 

of the era, 97.5 percent of the people who 

died did so of either influenza or pneumonia resulting from the flu.130 Most of 

the deaths occurred in a 16- week period, 

from mid-September to mid-December of 

1918, paralyzing social, political and economic life across the globe. In the United 

States, businesses, schools and public activities closed or ceased. Public services 

failed. Machinery dug mass graves as cities ran out of coffins and grave diggers 

were among the dying. As quickly as it 

had come, the virus faded in late 1918, 

reoccurring in the spring of 1919 and sporadically until June 1920 when it disappeared.

The epidemic was startling, quick, 

and deadly. Experts were left with more 

questions than answers – questions scientists grapple with yet today. Why was this 

influenza strain so deadly? Why did it 

kill those in their prime as readily as the 

old and the young who are the normal 

 

129 John Barry, The Great Influenza, (London: 

Penguin Books, 2005), p. 365.

130 Michel Garenne and Andrew Noymer, Spanish Influenza of Demographic 1918: Consequences in The Long Run, Pasteur Institute, (no 

date) [powerpoint presentation in French].
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

66

victims of influenza? What is its relationship to other influenza viruses? And finally, where and how did it originate? This 

case study will not attempt to answer all 

those questions, but rather will review the 

outbreak, the U.S. Government‟s reactions and the public‟s ability to persevere 

through one of the greatest crises Americans have ever faced.

The Beginning

Ninety years after the pandemic, 

scientists still search for answers about 

the lethal 1918-20 influenza strain that 

swept through virtually every country in 

the world. While there are many theories, no one has been able to definitively 

determine precisely where the virus began. One of the leading hypotheses is it 

began in January 1918 in Haskell County, Kansas, “an isolated and sparsely 

populated county in the southwest corner of the state.”131 From this remote 

area, draftees reported to Camp Funston 

at Fort Riley, Kansas. From Camp Funston, soldiers went to other camps across 

the United States, took trains to the East 

Coast to prepare for departure, and unknowingly carried the influenza virus to 

hundreds of thousands of soldiers and 

civilians worldwide along the way.

 

131 Several other theories exist regarding where 

the virus originated including France and China. 

John Barry details his findings in “The Site of the 

Origin of the 1918 Influenza Pandemic and its 

Public Health Implications,” Journal of Translational Medicine (2004), pp. 2:3.

The flu killed an estimated 675,000 

Americans, 10 times more than would 

die in the “war to end all wars.” The virus of 1918-1920 was most deadly for 

people ages 20 to 40, a highly unusual 

statistic, as influenza usually kills the 

young and the old. The death rate for 15 

to 34 year olds of influenza and pneumonia were 20 times higher in 1918 than 

in previous years.132 Twenty-eight percent of the American population was 

stricken. In San Antonio over 90 percent 

of households reported at least one person sick. The effect of the influenza epidemic was so severe in 1918 the average 

life span in the U.S. was shortened by 

11.8 years.133 The life expectancy of an 

American male dropped as many as 17 

years between 1915 and 1919 owning to 

both the war and the pandemic.134

Influenza was not unknown in the 

early 1900s. There had been significant 

epidemics during the 1850s and in 1889. 

Influenza was thought to be mildly 

worse than the common cold. Symptoms included body and headaches, stuffy nose, and a cough that usually lasted 

no more than three days. Thus, in 1918 

when patients began presenting with 

much more dramatic symptoms and 

 

132 Jeffery K. Taubenberger and David M. Morens, “1918 Influenza: The Mother of All Pandemics,” Emerging Infectious Diseases, (January 

2006), http://www.cdc.gov/ncidod/

EID/vol12no01/05-0979.htm (Dec. 14, 2007).

133 The Deadly Virus: The Influenza Epidemic of 

1918, 

http://www.archives.gov/exhibits/influenzaepidemic, (Jan. 8, 2008).

134 Garenne and Noymer.
No Need to Panic: Public Resilience in CBRN Events

67

many deaths, doctors misdiagnosed influenza as the plague, meningitis or other serious diseases. As one historian 

noted, “Many of them did not identify it 

as influenza because, it didn‟t fit the definition. Influenza does not kill people 

in great numbers; influenza does not 

particularly affect young adults; influenza is a pest, it‟s not a slaughterer of human beings.”135

Some claimed German saboteurs arriving on U-boats had released poison 

gas in U.S. harbors. The United States 

was in the middle of the WWI, shipping 

hundreds of thousands of men and materiel to fight in Europe. In the spring of 

1918, America‟s role in the war increased. In March 84,000 American soldiers set out for Europe; followed by 

another 118,000 in April.136 But soldiers 

arrived in Europe sick or dead. By summer influenza was reported in Russia, 

North Africa, India, China, Japan, the 

Philippines and New Zealand.137

“Spanish Influenza”

Influenza hit Spain in May 1918, 

killing an estimated 8 million people. At 

 

135 Alfred Crosby, The American Experience: 

Influenza 1918, Public Broadcasting Service, 

http://www.pbs.org/wgbh/amex/influenza/filmmo

re/reference/interview/index.html, (Dec. 19, 

2007).

136 “People & Events: The First Wave,” The 

American Experience: Influenza 1918, Public 

Broadcasting Service, http://www.pbs.org/wgbh/

amex/influenza/peopleevents/pandeAMEX86.ht

ml, (Jan. 4, 2008).

137 Ibid.

the time, Spain was one of the few neutral countries in Europe and had no wartime censorship. Media reports of the 

illness were much more numerous than 

most countries, leading to the claim by 

other nations the outbreak originated in 

Spain. It was later determined to be untrue; however, the name “Spanish Influenza” remained in perpetuity.

The influenza pandemic roughly can 

be broken into three phases: Phase 1: 

March – June 1918, Phase 2: end of August 1918 – March 1919 and finally, 

Phase 3: March 1919 – June 1920. While 

scientists believe the same virus caused 

the three waves, they have samples only 

from the second wave, which caused the 

greatest amount of death and social 

chaos. Virologists continue to study the 

outbreak attempting to pinpoint its origin 

and prove or disprove the linkage among

the three outbreaks.

The first wave caused a great number of illnesses, but not a noticeably 

higher rate of death, as was the case with 

the second wave. In 1918 influenza was 

not a reportable disease in any country 

and thus pinpointing its precise rate of 

illness and lethality is difficult. The only 

way to measure the severity is through 

mortality rates. Most cases of pneumonia 

in spring 1918 are now linked to the epidemic, but at the time were considered 

normal. While the origins are argued, the 

first major outbreak seems to have begun 

in early March 1918 in Camp Funston at 

Fort Riley, Kansas, followed closely by 

illness in New York City and other locales. In August 1918, a more virulent 

strain appeared simultaneously in Brest, 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

68

France; in Freetown, Sierra Leone; and 

in Boston, Mass.

Patients suffered and died from varying symptoms complicating diagnosis 

as well as the lack of helpful information 

to prevent infection. The symptoms were 

so unusual that initially influenza was 

misdiagnosed as dengue, cholera or typhoid. Some patients died suddenly, 

seemingly perfectly healthy one minute 

and dead the next. Several anecdotes exist of people dropping dead on the streets 

with no warning. Other patients suffered 

from the onset of “normal” influenza followed by a rapidly development of a ferocious pneumonia that would fill their 

lungs with fluid, killing a patient by 

drowning. This variant was the most 

brutal as a patient‟s lungs were unable to 

function, oxygenation of blood failed 

causing victims to turn blue and even 

black. One army physician in Boston 

noted in many cases race could not be 

determined by skin coloration alone. 

Some patients coughed so violently they 

broke ribs. Other patients suffered from 

morbid bouts of bleeding from virtually 

every orifice of their bodies. The last 

group had less virulent forms of secondary bacterial pneumonia, suffering for 

longer periods of time. Scientists believe 

there is a possible link between the 1918 

flu and mental health problems later in 

life including dementia and Alzheimer‟s 

disease.138

 

138 Barry, pp. 378-381.

War as a Catalyst

By late September 1918, the United 

States had over 2 million soldiers in Europe and was planning on sending another 2 million as quickly as possible. Germany was under pressure; a pressure that 

could only be maintained with addition 

of young, able-bodied Americans to the 

fight. The U.S. Government needed soldiers, but it needed public funding and 

industrial support as well. As government leaders became aware of the possibility of epidemic spreading from military instillations to the general public, 

the threat had to be weighed against the 

war effort. In hindsight, the war ended in 

early November 1918, however, at the 

time, it was unclear when Germany 

would capitulate. The difficult decision 

was made to maintain troop movements, 

although some were curtailed or delayed. 

Historian Alfred Crosby explains:

There were two enormously 

important things going on at 

once and they were at right angles to each other. One, of 

course, was the influenza epidemic which dictated that you 

should sort of shut everything 

down; and the war which demanded that everything should 

speed up – that certainly the 

factories should continue operating. You should continue to 

have bond drives. Soldiers 

should be drafted and sent to the 

camps jammed into barracks, 

put on boats with bunks six 

high, and sent off to France. 
No Need to Panic: Public Resilience in CBRN Events

69

One of the great tragedies of the 

situation is that there was no 

correct thing to do. You can‟t 

look back and say, „If our officials had only done the correct 

thing.‟ There wasn‟t any correct 

thing to do.139

Thus, when the city of Philadelphia 

was planning its fourth Liberty Loan parade on Sept. 28, 1918, the possibility of 

raising millions of dollars to help the war 

effort outweighed the fears of a few 

health officials voicing concern over illness spreading through military camps, 

including the local Navy yard. Within 

seven days after the parade attended by 

over 200,000 people, Philadelphia‟s hospital beds were filled to capacity with 

victims of influenza. The flu killed almost 11,000 Philadelphia residents during October 1918.

Soldiers from all countries were hit 

hard by influenza. According to a report 

in the New York Times in June 1918, the 

German troops suffered from an epidemic “all along the German front.”140 The 

flu may have even delayed the Germany 

offensive in the battle of Château-Thierry 

in June 1918.141 Of the U.S. soldiers who 

 

139 Alfred Crosby, The American Experience: 

Influenza 1918.

140 “Spanish Influenza Is Raging in the German 

Army; Grip and Typhus Also Prevalent among 

Soldiers,” The New York Times, (June 27, 1918).

141 Rex W. Adams, “The 1918 Spanish Influenza, 

Berkeley‟s “Quinta Columna,” Chronicle of the 

University of California, 1, (Spring, 1998), pp.

51-52.

died in Europe, the influenza killed half.

An estimated 43,000 servicemen mobilized for WWI died of influenza while 

621,000 were sickened.142 The mortality 

rate for army camps in the United States 

ran between five–10 percent.

Unraveling the Cause

Between 1890 and 1917, medicine 

had made many great strides. Scientists 

had learned to counter or control smallpox, cholera and yellow fever. Pasteur 

had linked germs to diseases boosting a 

feeling of innovation and invincibility. 

As one noted historian explained, “It was 

a time of great optimism in infectious 

disease control mainly because Pasteur 

had advanced knowledge to such a tremendous degree that we were following 

one success right after another success.”143 That optimism came to a 

screeching halt as the influenza pandemic took hold of the planet. National decision makers turned to science for answers; the medical community, however, 

was just as flummoxed. In 1917 it was 

strongly believed bacteria caused influenza. It was not until 1933 that it was 

determined to have been caused by a virus.

 

142 Alfred Crosby, America’s Forgotten Pandemic: The Influenza of 1918, (Cambridge: Cambridge University Press, 2006 [reprint]), p. 205.

143 Dr. Shirley Fannin, A Time for Great Optimism, The American Experience: Influenza 1918,

Public Broadcasting Service, http://www.pbs.org/

wgbh/amex/influenza/filmmore/reference/intervie

w/drfannin1.html, (Dec. 19, 2007).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

70

The lethality of the 1918 virus had 

never been experienced before or since, 

rising to over 2.5 percent, compared to 

less than 0.1 percent in other influenza 

pandemics. In some areas, mortality was 

as high as 35 percent of the population. 

Scientists do not know why. The virus 

moved about unexpectedly. In some 

areas, only a few were sickened, while in 

other areas whole communities were 

wiped out. Even when mortality was low, 

so many people were incapacitated that 

everyday life came to a halt. Commerce 

was limited to people standing in the 

streets yelling orders to clerks behind 

closed doors. Human contact was limited 

even within families. The state of public 

healthcare was in disarray with virtually 

no help or leadership from the federal 

government.

The Public Health Response

In the fast-paced, just-in-time world 

we live in today, it is hard to imagine the 

impact of the 1918 epidemic. But in the 

fall of 1918, it seemed there might be no 

end to the nightmare that worsened each 

day. In September 1918, 12,000 people 

died in the United States, which alone is 

a significant number; however, in October that number climbed to an astounding 

195,000, crippling American society.

In 1918, the resources and capabilities of the federal government in the public health sector were marginal, limited

by lack of personnel, resources and infrastructure. Much of the existing resources 

were used in support of the war effort. 

One-third of the American medical establishment – doctors, nurses and support 

personnel – served in the military stationed in Europe. In some towns and cities the shortages were more extreme. 

Private hospitals had closed due to personnel shortages, a dearth that would severely challenge many locales in caring 

for the sick.

As the epidemic reached the United 

States, the first reaction of many national 

authorities was denial. The health commissioner of New York City denied influenza had reached his city or that it was 

an epidemic. He argued no danger existed, but rather panic was unjust and 

panic itself was the cause of illness. As it 

became clear the epidemic was going to 

spread across the United States, public 

health officials issued statements, albeit 

sometimes contradictory. As one expert 

noted, one of the greatest challenges for 

decision-makers was “the consistent inability to predict when the epidemic was 

going to increase and decrease, the absence of really strong epidemiological 

evidence...left the public pretty well disarmed.”144

The responses of the public health 

officials represented the prevalent medical concepts of the times. Given that a 

bacterium was believed to be the cause, 

good ventilation and fresh air were extolled as the best measures of prevention. 

In many areas public gatherings were 

 

144 Dr. Barbara Rosencrantz, The American Experience: Influenza 1918, Public Broadcasting Service, http://www.pbs.org/wgbh/amex/

influenza/filmmore/reference/interview/

drbarbara5.html, (Dec. 19, 2007).
No Need to Panic: Public Resilience in CBRN Events

71

limited in hopes of stemming the tidal 

wave of infection. However, the severity 

of the regulations was dependent upon 

local authorities. A 1918 article in the 

Journal of American Medicine stated the 

Committee of the American Public 

Health Association (APHA)145 issued a 

report recommending limiting public gatherings. The APHA said:

The committee held that any 

type of gathering of people, 

with the mixing of bodies and 

sharing of breath in crowded 

rooms, was dangerous. Nonessential meetings were to be prohibited. They determined that 

saloons, dance halls, and cinemas should be closed and public 

funerals should be prohibited 

since they were unnecessary assemblies. Churches were allowed to remain open, but the 

committee believed that only 

the minimum services should be 

conducted and the intimacy re-

 

145 The Committee on American Public Health 

still exists today as the American Public Health 

Association. According to its website, APHA “is 

the oldest, largest and most diverse organization 

of public health professionals in the world and 

has been working to improve public health since 

1872. The Association aims to protect all Americans and their communities from preventable, 

serious health threats and strives to assure community-based health promotion and disease prevention activities and preventive health services 

are universally accessible in the United States. 

APHA represents a broad array of health professionals and others who care about their own 

health and the health of their communities.” 

http://www.apha.org/, (Dec. 19, 2007).

duced. Street cars were thought 

to be a special menace to society with poor ventilation, crowding and uncleanliness. The 

committee encouraged the staggering of opening and closing 

hours in stores and factories to 

prevent overcrowding and for 

people to walk to work when 

possible.146

The report concluded the disease 

was extremely communicable and 

“spread solely by discharges from the 

nose and throats of infected persons.”147

In 1918, most laborers shared living 

quarters, cooking and eating utensils, in 

addition to common work space. Generations of families lived under one roof, 

making the infection prevention a daily 

challenge for all. The law prohibited 

coughing or sneezing without covering 

one‟s face and the use of common cups 

in factories. Public education campaigns 

were initiated, espousing hand-washing 

and general hygiene. 

Recent research has suggested nonpharmaceutical interventions such as effective and timely implementation of 

school closures and bans on public gatherings had significant impacts on death 

rates. Markel et al. examined the utilization of these interventions in 43 American cities. They found cities that utilized 

 

146 Molly Billings, “The 1918 Influenza Pandemic: The Public Health Response,” (June 1997), 

http://virus.stanford.edu/uda/fluresponse.html, (Jan. 

3, 2008).

147 Ibid.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

72

combinations of social contact restrictions and early implementation of these 

measures, such as New York City, experienced lower death rates than cities that 

delayed such actions or utilized such restrictions in isolation, such as Philadelphia.148

 Recognition of an outbreak and 

knowledge of how to respond are not the 

only factors that contribute to decisions 

to implement such measures and their 

ultimate effectiveness. Other social and 

political factors play a role as well.

Telling White Lies

The most important aspect of American life was the war, not illness. As one 

expert stated, “patriotism was more important than truth.”149 Another noted, 

“The pressure to maintain the war effort

made so many other things lose their importance.”150 The value of public honesty 

was weighed against public morale. Morale won. At times, public health officials 

were at odds with political leadership. In 

Pittsburgh, the mayor told the public they 

should ignore public health official 

statements.

The media and public officials, 

however, were complicit in most cases, 

 

148 Howard Markel, et al, “Nonpharmaceutical 

Interventions Implemented by US Cities During 

the 1918 Influenza Pandemic,” JAMA, (2007), 

pp. 298 (6), 644-654.

149 John Barry, “Pandemic Influenza: Past, 

Present and Future,” CDC Workshop, (Oct. 

17,2006), p. 7.

150 Richard Hatchett, Ibid., p. 9.

supporting the idea there was no epidemic and thus, no need to worry. People 

were forced to judge the juxtaposition 

among closing of businesses and limiting 

human contact and authorities telling 

them not to worry. A Chicago official 

stated, “Worry kills more people than the 

disease itself.” Newspaper stories stating 

public officials had the outbreak under 

control ran side-by-side with advertisements for goods used in “preventing” the 

flu including snake oil, castor oil, laxatives, Vaporub, pine tar, cayenne pepper 

and camphor. Advertisements in newspapers declared, “Wear a mask and save 

your life! A mask is 99 percent proof 

against influenza.” Many cities, including San Francisco, passed ordinances 

requiring gauze masks to be worn in 

public. Penalties for violation included 

up to $100 fine and 10 days in jail. Spitting, coughing and sneezing publicly 

were fineable offenses in many cities. 

“Open face sneezers” were equated with 

the Kaiser.

Cities across the eastern part of the 

country were losing control. Bodies piled 

up in the streets. Some corpses stayed in 

homes for days, as family members were 

too ill to remove them. Telephone networks were overwhelmed. In New York 

City authorities begged citizens to use 

the phone only in case of emergency because influenza had decimated the ranks 

of operators and jammed the lines with 

people seeking help. By Oct. 4, the U.S. 

Public Health Service advised state and 

local officials to enforce closure of all 
No Need to Panic: Public Resilience in CBRN Events

73

public gathering places.151 This notice 

was only a recommendation as the federal government did not have the authority 

to enforce the measure, requiring local 

entities to issue their own ordinances –

on their own terms and timelines.

Assistance from Private Sources

The importance of private relief organizations cannot be overstated. Philanthropic organizations, whose members 

were women of prominence, took up the 

mantle of leadership, effectively managing and operating civic functions and 

preventing total collapse of society. In 

Philadelphia, women‟s groups picked up 

where the local government collapsed, 

organizing nurses, supplies and even 

scheduling pick up of the dead. They

took out full-page advertisements in local 

papers, pleading for volunteers with any 

medical background to join their ranks. 

The Red Cross played a vital role in organizing nurses and providing infrastructure nonexistent within the federal government. The Red Cross sought graduate 

nurses, undergraduates, nursing aides and 

retired medical personnel. By Oct. 8, the 

Red Cross operated full force across the 

country.

Another organization, the Society of 

Visiting Nurses, was busy around the 

clock going to homes caring for sick who

could not make it to a hospital. Nurses 

across the country reported entering 

houses where all the occupants died or 

 

151 Crosby, America’s Forgotten Pandemic, p. 74.

all the adults died and the children and 

those too ill to care for themselves 

starved. Without the corps of nurses the 

death toll would have been significantly 

higher. Hospitals, too, were overwhelmed. Not only was there staff and 

resource shortages, but generally every 

hospital bed was full. In larger cities, including Philadelphia, the sick lined the 

hallways and even stood out in the street 

waiting for treatment. Private homes 

opened in many cities for convalescing, 

freeing up hospitals for the urgent cases.

Where the Virus Hit and Why

Looking at mortality rates from the 

pandemic, scientists have spent decades 

trying to determine trends and linkages. 

Were some populations genetically predisposed to death from influenza? If this 

were true then perhaps the key is in our 

genetic code. Few countries escaped the 

illness.

 An estimated 7 million died in India, 

about 2.78 percent of India‟s population at the time. In the Indian Army, 

almost 22 percent of troops perished 

from the flu.

 In Britain, as many as 250,000 died.

 In France the number of dead was 

more than 400,000.

 In Canada, approximately 50,000 

died.

 In Australia an estimated 12,000 

people died.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

74

 In Fiji, 14 percent of the population 

died during only two weeks.

 In Western Samoa the number was 

22 percent.152

 Entire villages in Alaska and southern Africa perished. In one Alaskan 

village 178 of 396 residents died in 

one week.153

In the U.S., about 28 percent of the 

population contracted influenza, and approximately 675,000 died. ItalianAmericans had one of the highest rates of 

mortality, although scientists believe living conditions were likely the greatest 

factor. Twenty-four percent of American 

Indians living on reservations caught the 

flu, with a 9 percent mortality rate, almost four times higher than rates of big 

cities in the United States. Interestingly, 

African-Americans tended to fare better 

as a population than did whites. An anomaly, historian Alfred Crosby states, is 

African-Americans normally suffered a 

much higher rate of mortality from respiratory illnesses than whites, except during the 1918-1920 influenza.154

Scientists believe the most likely 

reasons for the variation among cultures 

 

152 http://

en.wikipedia.org/wiki/Spanish_flu.

153 Gina Kolata, “The 1918 Flu Killed Millions. 

Does It Hold Clues For Today?,” The New York 

Times, (March 26, 2006), 

http://www.nytimes.com/2006/03/28/science/

28flu.html?_r=1&oref=slogin&pagewanted=print.

154 Crosby, America’s Forgotten Pandemic, pp. 

228-9.

were the cultural practices and living 

conditions, rather than genetic weakness.155 Where families groups were 

crowded together under one roof, influenza flourished. However, statistics 

show no clear division among class lines. 

In many aboriginal cultures it is customary for families to gather with the dead, 

possibly leading to greater infection of 

the population.

Collective Conscience

The “Spanish flu” killed more 

Americans than all the wars of the 20th 

century combined yet no monuments exist to its dead. It is estimated no family in 

the United States went unscathed. In fact, 

it was rare to find a family that did not 

suffer at least one death, whether a cousin or an aunt, if not an immediate family 

member. In one study of 1,000 life insurance claims during the epidemic, the average age of the victim was 33, while the 

average age from previous years had 

been 55-60. The report estimated the 

death total in the United States to be at 

least 400,000 and stated each death 

represented an economic loss of 25 productive years resulting in a 10,000,000 

year productivity loss to the American 

society as a whole.156

Given the brevity of events, why 

then does the Spanish Influenza not have 

a place in our collective conscience? 

There are many theories for this, the first 

 

155 Ibid., p. 228.

156 “Experts See Heavy Cost of Influenza,” The 

New York Times, (Dec. 6, 1918).
No Need to Panic: Public Resilience in CBRN Events

75

of which is the speed at which events occurred. The epidemic took more lives 

worldwide in 25 weeks than AIDS has in 

25 years. The events brought many 

communities to a breaking point, and 

then as suddenly as it began, it was over. 

There were three waves of the outbreak 

through 1918 and 1919; however, the fall 

of 1918 was the apex of the crisis. As the 

epidemic culminated, WWI came to an 

end. Delegations suffering from the flu 

delayed peace talks on more than one 

occasion.

Another reason for the lack of remembrance, as one expert suggests, is 

few “famous” people died – possibly 

given the age at which most of the victims succumbed. Those aged 25-40 had 

yet to make their mark on the world. 

Many dignitaries including the Kaiser, 

President Wilson, and Franklin D. Roosevelt suffered from influenza, but none 

died of it. Literary giants including John 

Dos Pasos, William Faulkner, Ernest 

Hemingway, Thomas Wolfe and F. Scott 

Fitzgerald were all affected by the flu, 

either by the loss of a loved one or suffering from the illness themselves, but 

the disease rates not even a mention in 

their novels of the times.157

The epidemic changed many scientific, social, political and economic aspects of the time; however, it did not 

withstand the test of time in collective

conscious as it likely did in personal 

ones. It is unlikely anyone who lived 

through it failed to remember its horrors, 

 

157 Alfred Crosby, America’s Forgotten Pandemic, pp. 315-317.

but as communities and nations we did 

not allow it to linger.

Lessons Learned

There are many lessons to be 

learned from the events of 1918-1920, 

some of which have already been described. Below are five broad themes to 

categorize the primary lessons relevant 

to public resilience.

1. Public trust in government statements 

and actions is essential

Industrial productivity, fundraising 

through war bonds and relief efforts were 

vital aspects of the war. Maintaining 

public morale was a priority. News was 

carefully censored to ensure war efforts 

were not undermined. Newspaper reports 

of the war were carefully worded to encourage strong support of U.S. efforts. 

Additionally, local news was reviewed to 

keep a positive outlook for the reader. 

When reviewing newspapers from the 

fall of 1918, few stories focus on the influenza outbreak. Some papers barely 

mentioned the flu, with the exception of 

the obituaries that required more space 

with each passing day. Government officials regularly decried the concerns as 

overblown. On the West Coast, Los Angeles and San Francisco‟s health officials 

loudly proclaimed their doubts influenza 

would even reach their fair cities – only 

days before public places were ordered 

closed to stem the tide of infections.

War and ignorance played significant roles in government actions at the 

federal, state and local levels. Only a few 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

76

brave public health officials took preventative measures, while most stood by until illness brought their constituency to its 

knees. The lack of leadership, the censorship of the media and the dearth of understanding of the illness severely tested 

the public‟s ability to trust elected leaders.

In Philadelphia, public infrastructure 

strained to the breaking point, until private organizations came in, took control 

and restored order. In New York City, 

every statement from the city‟s health 

commissioner was incorrect, overstated 

or incomprehensible – even after his city 

was overcome with the epidemic.

The public requires trusted figures to 

give sound advice – what to do, where to 

go and how to get help. Without those 

elements chaos ensures. A 2006 Center 

for Disease Control and Prevention 

(CDC) Workshop summed it up by saying:

False reassurance is the worst 

thing you can do. Don‟t withhold 

information, because people will 

think you know more. Tell the 

truth –don‟t manage the truth. If 

you don‟t know something, say 

why you don‟t know, and say 

what you need to do to know. 

Drown people with the truth, rather than withhold it...The key is 

trust. It is when people feel totally alienated and isolated that the 

society breaks down.158

 

158 John Barry, CDC Workshop, (Oct. 17, 2006),

p. 8.

2. The role of the media is vital

The media, as in all crises, played an 

important role, partially through its lack 

of coverage and its misinformation provided by ignorant government leaders 

and advertising charlatans who preyed 

on public fear. The role of the media in a 

modern day epidemic would be vital. 

Networks and media outlets would have 

to work with governments to provide 

truthful and vital information. The current trend toward sensationalism could 

greatly hamper a government‟s ability to 

lead its population through a crisis. Cooperation would be essential for extreme 

measures such as quarantine. Transparency in communications is key to successful implementation of policy. One 

expert concluded, “Today, we have the 

opportunity to frame how the public 

perceives what is happening.”159

3. The government should encourage 

reliance on self, family, community

The war had brought people together, united in one cause. Influenza had the 

opposite effect – dividing families and 

communities into isolated and helpless 

camps. In some cases children or those 

too sick to care for themselves starved to 

death because no one was there to help 

them. People were so afraid of the contagion, once close-knit communities who 

had shared the good and the bad closed 

their doors to one another. However, 

there are numerous examples of bravery 

and fortitude at the individual level. In 

many areas, specifically big cities, pri-

 

159 Richard Hatchett; Ibid., p. 10.
No Need to Panic: Public Resilience in CBRN Events

77

vate philanthropic groups literally saved 

society through organizing efforts. These 

local groups do not exist in the same 

form they did in 1918. Societal roles are 

different today – making philanthropic 

groups an addition to a resume, not the 

extent of it. The level of community effort in cities such as Philadelphia is hard 

to imagine in the modern age, including 

caring for the sick and managing sanitation, removal and burial of the dead. 

More thought needs to go into how the 

government can support communities 

and private entities in improving selfreliance.

Communities were more selfsufficient in 1918 than today and had local support networks nonexistent today. 

The family also played an important role. 

While many families suffered with several members ill, the fact they lived together or near one another meant those 

who were well could care for one another. Demographics have changed. Today, 

families are smaller and often live far 

away from familial support networks, 

forcing many to rely on whatever government services are available.

4. Leadership and clear lines of authority are necessary

The influenza virus cannot be seen, 

tasted or smelled. In the fall of 1918, 

seemingly healthy people dropped dead. 

At the height of the epidemic, many 

stores refused patrons entry, but rather 

asked them to yell their orders from the 

storefront, wait for their parcels to be 

prepared, and avoid any personal contact. 

It is difficult to imagine patrons doing 

that in today‟s society. It is also unclear 

to what extent the public would adhere to 

government edicts, especially those as 

extreme as quarantine. Would families 

agree to separation for the good of the 

public? With the current trends in individualism it is hard to imagine this would 

be the case. Any wavering or confliction 

in official statements would be taken as 

an opening for individual action.

Even in 1918 quarantine was not 

advised as it was considered “impractical.” Public places were closed, but only 

fear kept people at home. Hospitals attempted to separate the ill by hanging 

bed sheets between beds. True quarantines were successful only in isolated 

areas with the ability to sustain their own 

community. Few areas of the world 

could manage that in the modern interconnected world.

In 1918 authority was more evenly 

dispersed among federal, state, and local 

officials. In addition, there was virtually 

no experience with a nationwide crisis. 

The federal government only had the authority to recommend actions to the local 

authorities. Many localities had different 

ordinances on managing the outbreak, 

which confused the public. In some areas 

public officials offered seemingly crazy 

remedies and outlandish recommendations. Today infrastructure and plans are 

in place to manage a pandemic. Whether 

the measures prescribed can be effectively put into action is a question no one 

can answer until required.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

78

Conclusion

The 1918 pandemic is not measured 

in the great economic losses it caused. 

The war ended and life returned to “normal.” Because of the limited duration the 

pandemic is “characterized as a hit-andrun disease that only produced brief 

slowdowns” in economic and human 

terms.160 The economic impact would be 

much more severe today, given the justin-time nature of the world economy.

Scientists do not discuss the next influenza pandemic in terms of whether, 

but rather when and how severe. The experience of the 1918 epidemic, as well as 

the strain itself, remain primary areas of 

scientific and anthropological study 

 

160 Ibid., p. 13.

today. The unknowns in this case strike

fear in experts‟ minds when considering 

what the future holds. In December 

2006, one study estimated that an influenza virus as deadly as the one that 

caused the 1918 Spanish flu could kill as 

many as 81 million worldwide. The tidal 

wave of chaos leaves planners challenged to find solutions to incalculable 

problems in healthcare, manpower and 

economic stability. The United States has 

a national strategy for managing pandemic influenza. Today, influenza is a 

reportable disease monitored across the 

globe. While scientists search for clues 

from the past, decision makers try to plan 

and hope the next pandemic does not rival 1918.
No Need to Panic: Public Resilience in CBRN Events

79

7. TYLENOL TAMPERING CASE

“This was an outbreak of chemical terrorism.”

–Cook County Medical Examiner Edmund Donoghue

Salient Points

 Quick response led to effective crisis 

management.

 Company (Johnson & Johnson/McNeil) took full responsibility.

 Public trust in product before and after the event was buffered by J&J actions.

A final case that can shed light on resilience in CBRN attacks is the Tylenol 

poisoning case. In this case, contamination of a trusted product created anxiety 

and changes in purchasing behavior for 

millions. The company‟s management of 

the crisis demonstrates communication 

principles key in restoring public confidence. In the fall of 1982, the mysterious 

deaths of Chicago residents stunned 

America. Seven people – two men, four 

women, and one 12-year-old girl died. 

Authorities quickly discovered the one 

thing they had in common: all had ingested Tylenol capsules shortly before 

their death. Extra Strength Tylenol capsules had been laced with potassium cyanide. This case study will focus on the 

actions of the maker of Tylenol, McNeil 

Consumer Products Company, and its 

parent company Johnson and Johnson 

(J&J) and their role in public resilience 

following the cyanide poisoning.161

Johnson and Johnson

On Sept. 30, 1982, Tylenol held 35 

percent of the $1 billion analgesic market 

in the United States, representing almost 

20 percent of its manufacturer‟s earnings 

and outselling Tylenol‟s next four competitors combined.162 The Tylenol product line was a household name and considered a trustworthy product for pain relief. Neither the manufacturer of Tylenol 

McNeil Consumer Products Company, 

nor its parent company, Johnson and 

Johnson, had a crisis management plan in 

place; nor were they prepared to manage 

the outcome of Tylenol‟s use in a multiple murder case. However, the response 

to the events during the fall of 1982 is 

considered the “gold standard in crisis 

control” by many educators in crisis management.

Johnson and Johnson had a very simple corporate credo stating in order of im-

 

161 For the purposes of this study, Johnson and 

Johnson will be referred to as “the company” with 

no distinction being made between the parent and 

its subsidiary.

162 Steven Fink, Crisis Management: Planning for 

the Inevitable, (New York: AMACOM, 1986), pp. 

203-218.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

80

portance the company had a responsibility 

to consumers, followed by employees, the 

communities served, and finally stockholders. Trust was the mantra of the company, something it hoped to convey to the 

public throughout the crisis.

The Timeline

On Sept. 29, 1982, a 12-year-old girl 

died in a Chicago suburb after taking a 

single capsule of Extra-Strength Tylenol. 

Her death was followed by three other 

Chicago area residents. By Oct. 1, seven 

people had died of cyanide poisoning and 

Tylenol capsules were pulled from the 

shelves throughout Chicago.

On Oct. 2, law enforcement officials 

determined the poison capsules had come 

from lots at two different manufacturing 

locations. By Oct. 5, 31 million bottles of 

Tylenol capsules were recalled nationwide. All advertising for the entire product line was cancelled, and production of 

capsules halted costing Johnson and Johnson over $100 million.

Hospitals in Chicago and around the 

country were flooded with telephone 

calls. Many admitted numerous patients 

under the suspicion of cyanide poisoning 

from Tylenol, although no additional cases were discovered.163 Some state health 

departments asked stores to remove all 

Tylenol products from the shelves as a 

precaution, although the Food and Drug 

Administration (FDA) required removal 

 

163 Rachael Bell, The Tylenol Terrorist, 

http://www.crimelibrary.com/terrorists_spies/terrori

sts/tylenol_murders/, (Nov. 8, 2007).

only of lots specifically linked to the 

deaths. The FBI requested J&J not end 

production of Tylenol until further information could be discerned, fearing the 

company would be seen as acquiescing to 

terrorist demands.164

Shortly following the murders, J&J received a handwritten extortion letter demanding $1 million to end the poisonings. 

Authorities traced the letter to a man named 

James W. Lewis, a tax accountant from 

New York City. Lewis was found guilty of 

extortion and sentenced to 20 years in prison. No link was ever found between him 

and the actual murders. The case has never 

been solved.

The Corporate Response

Product tampering was not part of the 

industrial lexicon in the early 1980s. 

When Johnson and Johnson initially 

learned that authorities investigated the 

role of Tylenol in the deaths of three 

people in Chicago, J&J management assumed there was a problem with the manufacturing. The CEO, James Burke, 

snapped into action within 90 minutes of 

hearing of the possibility of Tylenol‟s involvement in deaths. He began by: 

1. Appointing a senior executive to take 

charge of Johnson and Johnson‟s crisis management with the primary task 

of discovering what happened.

 

164 Fink, p. 215.
No Need to Panic: Public Resilience in CBRN Events

81

2. Sending a crisis manager to “the 

scene.”165

3. Sending a public relations manager 

with the crisis manager.

4. Opening direct communications between J&J management and crisis 

management team.166

Since no playbook existed for managing a company-wide crisis, managers 

and senior executives scrambled to contact relevant employees within the company. The vice president for public relations pushed a singular concept – to find 

out what happened and to get the truth to 

the public through the media. One critique 

of the J&J management team was they did 

not talk directly to the public through 

press conferences, but rather primarily 

used media outlets to disseminate information. However, numerous interviews 

were conducted with J&J management; 

the most notable being appearances by the 

CEO on the daily talk show “Donahue” 

and the news show “60 Minutes.”

Johnson and Johnson had an aggressive market research strategy from the 

beginning. The first poll was taken during 

the second day of the crisis. Predictably, 

as the death toll rose, consumer confidence fell. However, the company believed that given its research results that 

Tylenol could regain market share. J&J 

set up a toll-free hotline that received over 

30,000 calls in less than 60 days.

 

165 At this point, no one has considered product 

tampering, thus, it was assumed the problem was 

at the manufacturing site.

166 Fink, p. 206.

Following inspections, the company 

determined the cyanide was not introduced 

into the bottles at the factory, which left 

only one other possibility. Authorities determined the capsules had been taken from 

stores, filled with cyanide and returned to 

the shelves for sale. As soon as J&J officials realized product tampering had been 

the cause, the company began developing 

methods to protect their product. On Nov.

11, 1982, triple tamper-resistant packaging 

was released in a press conference broadcast across the country. On Oct. 12, J&J 

took out full-page ads in several major 

newspapers offering to exchange Tylenol 

capsules for tablets and soon offered significant coupons which could be obtained in 

newspapers or by calling the company.

The Tylenol crisis was the most covered story since the Vietnam War with 

more than 80,000 newspaper articles, hundreds of hours of national and local television and radio coverage. Studies by Johnson and Johnson estimate 90 percent of the 

American population was aware of the 

murders within one week.167

Tylenol‟s market share plummeted to 

7 percent by mid-October 1982. However, 

the quick response by Johnson and Johnson restored consumer confidence in a 

product they had used before. The tripletamper resistant packaging, the discount 

and the advertising campaign paid off. In 

only a few short years, Tylenol regained 

market share, and the analgesic market 

grew to over $2 billion by 1990.

 

167 Fink, p. 216.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

82

Lessons Learned

There are some limitations in comparing government and private-entity actions; 

however, several key lessons can be drawn 

from this case. While many layers protecting consumers against product tampering 

exist, concerns are high about biological 

terrorism. In the event of an attack, whether through a particular product or other 

means, the following are lessons exemplified by the events of 1982.

1. Trust in a product. It is difficult to 

imagine a more challenging threat to 

the existence of a product than to go 

from being a pain reliever to an instrument of murder. However, Tylenol had several strengths in its favor. 

It had a strong market share and a 

stellar reputation. It seems the public 

was able to forgive Johnson and Johnson given events were beyond its control. It is possible this might not have 

happened had the poisoning taken 

place inside the company. This kind 

of public trust is less likely to be as 

widespread today. However, it is clear 

J&J did an excellent job of standing 

behind its product.

2. Honesty. Johnson and Johnson‟s motto of honesty could be seen in their 

actions throughout the crisis. While 

honesty amidst a crisis is a challenge 

for governments and private entities 

alike, rest assured it will be much 

worse when the public discovers the 

lack of truthfulness, especially when 

public safety is concerned. Living in 

an era of Enron and public scandals, 

the public is likely to respond well to 

truthfulness – even if the product is at 

risk.

3. Responsibility. Johnson and Johnson 

quickly took responsibility for the crisis, recalling the product at great expense, even though the FDA required 

only specific products be removed. 

The J&J leadership made the choice 

to standby the product because they 

believed they could get Americans to 

buy the product again. They were 

right, but clearly this is related to actions throughout the crisis.

4. Use a “reservoir of good will” wisely. 

Americans trusted Tylenol, understood 

the harm had come outside of J&J‟s 

reach, and responded to the company‟s 

rapid response to secure the welfare of 

the public. As a crisis unfolds it would 

be wise to take stock of where good 

will lies and how that can be maximized without draining the “reservoir” of public trust.

5. Listen to the public. While polls are 

notoriously wrong, listening to the 

public is vital in maintaining and restoring public confidence. Johnson and 

Johnson had an aggressive market 

strategy based on consumer wants. 

Following that strategy, listening to 

their customers, and acting in good 

faith allowed J&J to restore Tylenol‟s 

market share.
83

DEFENSE THREAT REDUCTION AGENCY AND

USAF COUNTERPROLIFERATION CENTER

PUBLIC RESILIENCE WORKSHOP

While a review of previous CBRN 

incidents provides useful information 

regarding the potential public response to 

an attack or incident, such a study by its 

nature is purely retrospective. A single 

author can examine the findings of case 

studies and attempt to find insight into 

public behavior. The value of this effort 

provides only the limited perspective an 

individual can bring to such an endeavor. 

Public resilience as a concept is impacted 

by a vast range of individual, community 

and government characteristics as well as 

agencies at the local, state and federal 

levels. In order to provide a forum to 

represent the wide range of actors the 

USAF Counterproliferation Center held a 

one-day workshop to discuss these findings on Jan. 22, 2008.

The goal of this workshop was to 

bring together experts from a variety of 

military and civilian agencies with roles 

in the preparation for and response to 

CBRN events. Military organizations 

tasked with responding to a CBRN event 

include NORTHCOM whose “civil support mission includes domestic disaster 

relief operations during fires, hurricanes, 

floods, and earthquakes. Support also 

includes counter-drug operations and 

managing the consequences of a terrorist 

event employing a weapon of mass destruction.”168 Subordinate to NORTHCOM and with specific responsibility for 

these activities is Joint Task Force-Civil 

Support (JTF-CS). The mission of JTFCS is to plan and deliver DoD support 

“to the designated Lead Agency for domestic chemical, biological, radiological, 

nuclear, or high-yield explosive consequence management operations.”169

Another organization with a primary 

supporting role in catastrophic events is 

the National Guard. The National Guard, 

functioning in a Title 32 role, provides 

each state with forces prepared to respond rapidly to disasters.

In addition to military organizations, 

a number of civilian components have 

key roles in both preparing for disasters 

and helping individuals and communities 

recover from a CBRN attack. The Department of Homeland Security is the 

lead agency, with several subordinate 

agencies playing crucial roles. FEMA is 

tasked “to reduce the loss of life and 

property and protect the nation from all 

hazards, including natural disasters, acts 

of terrorism, and other man-made disasters, by leading and supporting the nation 

in a risk-based, comprehensive emergen-

 

168 USNORTHCOM website, http://

www.northcom.mil/About/ index.html.

169 Ibid.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

84

cy management system of preparedness, 

protection, response, recovery and mitigation.”170 The Citizen Corps, subordinated to FEMA, was created to help 

build communities better prepared to respond to any type of disaster, and improve the safety during and following an 

event also provides essential support. 

Given this mission, the Citizen Corps is 

the only agency with a clear mission to 

build resilience in the U.S. population.

In addition, significant academic research has been conducted into building 

public resilience and thus, representatives from academia were invited to participate in this workshop. 

The workshop began with introductions and a briefing on the concept of resilience relative to CBRN attacks. The 

goal of this briefing was to establish a 

common frame of reference for the diverse group of workshop participants. 

Prior to the workshop, a determination 

was made to break the concept of CBRN 

resilience into more manageable pieces 

for analysis. Smaller working groups enhanced the capability of the experts to 

delve more deeply into the issues. Resilience cannot be broken easily into distinct phases; therefore some substantive 

overlap existed between the chosen areas 

of preparation, response, and recovery. 

The first group focused on actions relevant to resilience accomplished prior to an 

attack or imminent threat of attack, known 

as the preparation phase. This group focused on issues of education, preparation 

 

170 FEMA website, http://www.fema.gov/

about/index.shtm.

and community coordination that taken 

before an incident would likely improve 

the public‟s resiliency during and after 

an attack. The second group focused on 

issues related to resilience in the response phase immediately following a 

CBRN incident. For the purposes of this 

workshop, response was defined as beginning at the point when an attack occurred or an imminent threat was discovered through the time the incident had 

subsided. The final group focused on actions to enhance reliance during recovery

from a CBRN event. Individuals were 

assigned to these subgroups based on a 

combination of the level of responsibility 

their organization had in each phase and 

their personal experience. Also an effort 

was made to ensure no single organization dominated any group ensuring an 

interagency perspective to the discussion 

and resulting recommendations.

Each group was tasked to conduct a 

two-hour session in both morning and 

afternoon. In the first session, the focus 

was on barriers or obstacles that could 

interfere with the ability of the population to respond resiliently in the respective phase of an event. Following this 

discussion each group reported back to 

the plenary with its most significant findings. In the second session, the groups 

were asked to return to their list of barriers and to suggest ideas, actions and 

plans to overcome these barriers. 

Again, each group presented their findings to the overall group. The notes from 

these groups are presented in this section.
85

GROUP 1: PREPARATION

Lt Col Kindt opened the plenary session with a presentation that laid the 

foundation for further discussion, and as 

the facilitator for Group 1, his thoughts 

carried into the group discussion. Group 

1 analyzed preparation as a factor in the 

resilience required to either withstand a 

CBRN event or to live under the threat of 

such an event.

Resilience Defined

Resilience is the ability to cope with 

a negative or traumatic event and return 

quickly to a healthy level of functioning. 

Inherent in resilience is the ability to 

comfortably live under the stress caused 

by the threat of an event that would necessitate resilience for survival. Clearly, 

preparation, the focus of Group 1‟s task,

has a bearing on the latter. Lt Col Kindt 

further stated that individual resilience 

factors of optimism, self-efficacy, mastery and coherence are crucial for effective coping and should offer an outline 

for group discussion. Familiarity based 

on experience, particularly successful 

experience, goes a long way toward 

causing people to believe in themselves –

to be convinced they can perform and 

persevere when required. Such a belief is 

the essence of optimistic self-efficacy –

and resilience.

Weapons of Mass Destruction Events

CBRN events, however, introduce 

factors that significantly complicate, and 

to some extent, work against self-efficacy. 

Most people have never experienced a 

CBRN event, have little or no training for 

such an event, and may have only the vaguest notion of the different types of weapons and attacks that fall into this category. Add to the unknown factor that any 

such attack would be unexpected, indiscriminate, and quite possibly grotesque; 

the prospects for resilience decrease further. Also, a radiological or biological 

attack might not be recognized immediately and likely would be invisible 

could add significant uncertainty if one 

were not properly prepared.

Behavior in Crisis

Knowing how people are likely to 

behave in crisis has a huge bearing on determining methods for preparation. The 

most common assumption is people will 

panic and flee, and strong discipline will 

be required to hold the population together. In fact, experience has shown panic 

occurs only when physical danger is imminent or present, there are limited escape 

options, and there is a lack of social connectedness. In most situations people are 

much more likely to render assistance 

than to panic. Further, if people are motivated to flee for one reason or another, 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

86

flight is often not toward safety, but toward family and friends. The desire for 

social cohesion, therefore, becomes the 

key to understanding and predicting behavior.

Public behavior in a crisis, while 

perhaps more positive than one might 

intend also is not apt to be perfect, with 

several factors contributing to less than 

desirable reactions to threats or events. 

First, there are those who will deny any 

such event is likely to happen or has 

happened. In some ways coupled to 

denial is fatalism, the idea the individual 

has no control over events and future 

events are either unavoidable or preordained – and leads some individuals to 

conclude that further activity on their 

part would be fruitless. 

Further contributing negative factors 

are the social amplification of risk – the 

either well-meaning, overblown warnings, or the demagogic warnings of those 

that have something to gain. 

Also, once an event occurs, we can 

expect some behavioral casualties, 

another term for “worried well.” These 

individuals would request health care for 

a variety of reasons, some legitimate, 

some not. Examples of such “worried 

well” behaviors might be exhibited by 

those minimally exposed, others with

anxiety reactions mimicking exposure, 

still others following official instructions, 

or individuals seeking personal gain 

through the system.

Public Expectations

Lt Col Kindt presented a summary 

of research by Dr. Monica Schoch-Spana 

that shows during crises the public expects certain things from government. 

The public expects the government to:

 provide instructions and equipment;

 provide information as to who has 

been affected or infected by an attack;

 provide drugs and vaccines;

 provide health care to those who 

need it;

 prevent more attacks; and

 establish conditions and provide information so life can return to normal.

Focus for Discussions

In the three discussion groups concentrating on preparation, response and 

recovery, each was to seek to answer 

three questions:

 What is the public likely to do?

 What information does the public 

seek?

 What is the public likely to need?

Further, these questions were to be 

considered in the context of the aforementioned resilience factors:

 optimism

 self-efficacy
No Need to Panic: Public Resilience in CBRN Events

87

 mastery

 coherence

The Role of Government

The first group had a lively discussion on the topic of preparation, with the 

issue playing against, and in concert 

with, the concepts of community engagement and personal preparedness. 

Three central points emerged from the 

discussions. First, governments do have a 

role to play. There are some tasks only 

governments can accomplish. 

Second, there may be unreasonable 

expectations about the capabilities of 

governments. Frequently, citizens look 

for someone or some organization to 

blame when a crisis occurs. Such feelings have led to expectations of perfect 

warning, instantaneous response, and the 

appearance of the President on scene to 

prove he cares about the situation. Further, we may have oversold the capability of the military to react in emergencies, 

particularly when significantly committed overseas. 

Third (and conversely), while there 

are expectations, there is also distrust of 

the government. This is reinforced when 

the government has information individuals or communities do not, and a failure 

to communicate the information.

This mistrust leads to such counterproductive activities on the part of the citizenry as refusing to be vaccinated or 

hoarding medicine against a vague threat. 

This concept led, later in the day, to a discussion on the merits of the federal government preparation, which has been extensive, but of which the public may have 

too great an expectation. One participant 

said the world is an untidy place, and 

sometimes there are bad results from 

events that governments can neither prevent nor instantly recover from. 

The counter argument was the citizens of this country, even while we diligently prepare, should be demanding 

more of government, not expecting less. 

Recovery from a CBRN event for citizens 

in a highly developed, complex and interrelated society found in the United States 

probably is significantly more difficult –

requiring more government help, for example, with rebuilding infrastructure –

than it might be in a less complex society 

in a remote region of Africa. But that is 

no reason to let governments off the hook. 

In fact, as an important engine of the 

world‟s economy, we have a certain responsibility not only to ourselves, but to 

the rest of the world, to fully recover.

It is important for citizens to realize 

what government can and cannot do, and 

prepare accordingly. This is where the 

concept of the Civil Preparedness Continuum is useful:

Individual planning

Group action

Community-level action
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

88

Individuals and local groups must 

take responsibility for themselves and 

supplement that which the government 

can provide. And since, as we have seen, 

there is a probable information gap between federal and local governments and 

between government and individuals in 

the community, frequently policy decisions at the federal and state government 

level are not consistent with individual 

and local planning. Therefore, some 

questions should be opened up to a public dialogue, involving individuals and 

communities in governmental decisions 

and allowing a better understanding of 

possible gaps in preparation for crises.

Why Individual Preparations Often Fail

The group agreed individual preparation for disaster events of all types, 

much less CBRN events, is spotty at 

best. There are a variety of reasons for 

this shortfall:

 Some lack time while others fail to 

make the time.

o Sometimes those retired or inactive in the workforce for other reasons, but are established and retain 

a good bit of community involvement, have more time to plan than 

do the rest of society.

o While it is possible to accomplish 

risk mitigation individually, rarely 

do people take the time to do so, 

as there is little incentive – particularly if there is a financial incentive to do otherwise.

 Other risks may be more compelling 

when compared to WMD risks.

o Preparing for a natural disaster 

based on past experience may 

seem prudent, but trying to think 

about WMD attacks in addition 

may be just a bridge too far (and 

cause great anxiety).

 Individuals either may not be aware 

of the threat, or may not know what 

to do about it.

 Less affluent individuals probably 

have less access to information, 

money to prepare, or time to plan.

o Many middle-class people, while 

more able, still fail to make a plan.

 When there are too many threats, 

people often become overwhelmed –

and simply do nothing in response.

 Others may fail to prepare when 

there is a significant financial cost 

involved in crisis preparation; this is 

especially daunting to those facing 

the prospect of evacuating their 

homes when they live paycheck to 

paycheck.

 When this type of event has never 

happened before, it is hard for most 

people to plan for something either 

they think very unlikely and/or probably will never occur.

 People are likely to be slow to prepare for the type of events they have 

not previously experienced.
No Need to Panic: Public Resilience in CBRN Events

89

Even when citizens do prepare, they 

may not do it well, or may have incomplete equipment or supplies. People living in hurricane zones are, in general, 

only 50 percent adequately equipped. 

And on a national scale, preparedness is 

estimated at around 2.7 on a scale of 10. 

An interesting observation confirmed by 

the group was people are much better 

prepared at home than at the workplace. 

Frequently, workplaces intend to supply 

its shelter locally using the just-in-time 

concept – which can prove deadly when 

there is no more time to respond. Experts 

in the group indicated large businesses 

tend to prepare better than small ones, 

which is unfortunate, because the small 

businesses are in contact with more 

people.

When people are prepared, however, 

they themselves become first responders 

– a wonderful result.

Social Networks as a Solution

The group agreed social reinforcement is necessary to encourage personal 

preparedness. The good news is people 

tend to self-organize in groups that already exist, and these groups offer a constant in times of crisis. Working through 

churches, schools and work places has 

proven to be effective in the past, but 

there are few incentives to do so absent a 

clear and present danger. As an example, 

the military offers very clear incentives 

to conform, plan, fight and many other 

necessary activities. A more loosely 

formed community or social organization 

does not have those incentives – unless 

the desired activity takes on the vestiges 

of a moral crusade such as the move to 

wear seat belts or stop smoking. Therefore, at least part of the solution is to 

provide incentives of some sort with existing, effective groups to encourage 

emergency preparedness. Possible 

groups to provide incentives are businesses, insurance companies and governments.

The group had a brief discussion on 

the efficacy of communities. One member suggested some research (Putnam, 

Bowling Alone) has said social networks 

decline and distrust in government grows

as we retreat to our electronic devices 

and computers. Others in the group said 

those findings are in dispute, and community groups are numerous and healthy.

One clear incentive for individuals 

and communities to coalesce around preparedness is that state and federal government assets, as well as the bulk of 

emergency responders, may need as 

much as 72 hours to respond to a disaster. Each state also has National Guard 

WMD Civil Support Teams positioned to 

arrive on scene within 12 hours of the 

incident. Local first responders like police, firemen and doctors would cope

with the event earlier. Community response capabilities, developed over time,

can be a bulwark against the shortfalls of 

government disaster responses.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

90

Experience as a Basis for Preparation

In one sense, experience works 

against preparation for CBRN events 

given so little such experience exists. 

Most individuals either cannot picture 

what such a CBRN event would look like 

or even that one would occur at all. On 

the other hand, many Americans have 

had experience with natural disasters, 

including hurricanes, tornadoes, earthquakes, and floods, and can easily picture 

the consequences of those. Most people 

understand natural disasters are likely to 

occur somewhere. So it is easier to encourage individuals to prepare for a natural disaster than it is to spur special preparations for a CBRN event. Another 

challenge is once a natural disaster occurs, it is usually over, and then it is just 

a matter of the clean-up or rebuilding. 

With a CBRN event, areas are likely contaminated or unusable for a considerable 

amount of time. Asking people to be prepared to leave, and maybe never to return, is more than many are willing to 

consider.

Using an “all hazards” approach for

preparedness is a double-edged sword. 

While one-size-fits-all planning may 

simplify preparation, most people understand some events require sheltering in 

place with stocks of supplies, while others require a capability to evacuate. A 

CBRN event could cause contamination 

to require supplies and preparation far 

beyond those required for a flood or hurricane. Finally, if all hazards take on 

equal threat value, then planners run the 

real danger the WMD hazards may seem 

unimportant and relevant specific measures may seem unnecessary.

One possible solution when addressing hazards is to focus community efforts 

on the hazard which is most likely occur 

in the local area and base preparations on 

that particular scenario. The result should 

be less overwhelming for the population. 

For instance, a town in western Nebraska 

is probably not going to be the target of 

nuclear terrorism, but it could face tornadoes. Conversely, the District of Columbia does not have to contend with 

tornadoes and hurricanes regularly, but it 

is very concerned about terrorism.

Creating a Preparation Campaign

The group conducted a discussion 

on how to create a campaign to encourage people to prepare for a CBRN event. 

Most agreed such a campaign would require participation across the civic preparedness continuum, and should include 

all levels of government. The campaign 

should be at the local level involving 

well-respected community leaders. Information may in fact flow from the 

government in many cases, but the reliance on web-based information or public service announcements may not be 

effective. A different messenger at the 

local level, a champion of the cause, in 

most cases would be more effective.

This campaign should focus on the 

most significant threat to that community 

and plan in detail for the event. As the 

planning gains community acceptance, 

plans should be expanded to include rea-
No Need to Panic: Public Resilience in CBRN Events

91

sonable local CBRN events. This might 

include an incident involving a local 

chemical or industrial plant that uses hazardous materials. One of the worst 

chemical incidents on record was the 

1984 Union Carbide incident in Bhopal, 

India that killed as many as 2,000 people. 

While this type of incident is frightening 

it provides an excellent example of the 

type of varying responses required to a 

CBRN event. It also provides a plausible 

example of a localized CBRN event 

caused by a terrorist attack or accident. 

Community plans should include 

venues for sharing information with the 

public. Several examples included sporting organizations and events, adult and 

teen certification programs, business involvement and even patriotic approaches 

such as, “I support our National Guard 

troops so they don‟t need to support me.”
92

GROUP 2: RESPONSE

Group 2 consisted of a mix of mental 

health, government, and disaster response 

professionals. Lt Col Fred Stone started 

the session by having each member of the 

group introduce himself, and then he described the goals for the group. The morning session objective for Group 2 was to 

identify potential problems during the response phase. The afternoon session objective was to identify possible solutions 

to the problems, and possibly to identify 

metrics with which to measure progress. 

The following is a summary of the discussions from both the morning and afternoon sessions.

Communication

In response to a CBRN event, communication would be a primary concern. 

One problem that could arise is the loss of 

electronic equipment, specifically communication systems. Government officials 

at all levels would need to disseminate 

information to the public. Chaos related to 

the loss of communication equipment or 

general technical failure is likely to increase or result in miscommunication or 

the release of conflicting information. 

Another issue regarding communication 

is the credibility of the source. It would 

be necessary for the public to follow directions from the government, however; 

citizens may doubt the credibility of the 

information if the source is not believed 

to be an authority.

During the afternoon session, the 

group developed several possible solutions to the aforementioned communication problems during the response to a 

CBRN event. Getting information to the 

public in a timely fashion is important. If 

there is a loss of electronic equipment, 

one solution may be the use of military 

aircraft to relay communications. The development of one-touch communication 

abilities such as OnStar would allow instant communication or information dissemination to a large section of the public. 

Developing scripts for government officials to follow in the event of a WMD incident could enhance coherent communications early in a response.

The development of a group of 

people, both internal and external to the 

government, known to the media and 

public as “trusted agents,” may facilitate 

communication and give messages more 

weight. Fewer issues of miscommunication or misunderstanding may result. The 

allocation of bandwidths for emergency 

messages may also relieve communication problems. Communication among

federal, state and local officials would be 

more effective if relevant local officials 

are identified prior to an event to allow 

for more efficient communication. 

Another aspect is the use of clear terminology when relaying information to the 

public. For example, in the event of a radiological attack when the public is told 

to take off contaminated clothes and 

shower, this suggestion needs to be accompanied with how fast the clothes 
No Need to Panic: Public Resilience in CBRN Events

93

should be taken off and how the contaminated clothes should be handled. Explanation of new concepts related to CBRN 

exposure effects and solutions would also 

make communication more effective.

Federalism

The reality of the government‟s role 

during a disaster is misunderstood by the 

public. Politicians do not generally understand their roles in a CBRN crisis either 

and fear the legal ramifications of a federal abuse of power in a response to an incident. The limits of the federal government‟s power and role are not well defined in most people‟s minds. There is 

also a fear the federal government will 

highlight the inadequacies of local government officials. The group discussed 

some solutions to these problems. Instead 

of having major regional or national exercises in which the government entities are 

judged in black-and-white terms, training 

scenarios should be created that emphasize suggestions for improvement. This 

information would need to be released so 

evaluations can be accessed. Another 

suggestion is the creation of a Center of 

Excellence to provide a repository of information and facilitate inter-agency cooperation. Further, providing education, 

training and exercises for political leaders 

to prepare them for the event of a CBRN 

attack or situation may give them some 

valuable experience in handling such a 

disaster.

People and Expectations

During the response to a CBRN 

event people will come to the area from 

unaffected areas for a number of reasons. 

Inexperienced or untrained personnel 

coming to the scene may cause confusion 

and harm to themselves or others. Another issue is concrete versus abstract problems. If the danger posed by the event is 

not considered probable and more abstract the public may be less compliant in 

preparation for it. People confronted with 

a CBRN disaster may be motivated primarily by family security concerns. It 

may be hard to keep inexperienced responders at the scene of an event if they 

are motivated by social ties, and the danger is perceived as somewhat abstract. 

The public‟s expectations of a systemwide government crisis response may be 

unrealistic. These unrealistic expectations 

may also extend to the military. Unrealistic expectations, in addition to a lack of 

personal accountability, may make the 

response more difficult to accomplish. 

The speed of the response also may not 

meet the public‟s expectations.

Some solutions developed by the 

group for changing public expectations 

likely will include Community Emergency Response Training (CERT) to increase 

community awareness of an individual‟s 

responsibility during an emergency. This 

would create a baseline knowledge within 

the community and generate a feeling of 

common interest with the members of the 

local community. Some type of incentives 

may be required to get people to prepare, 

such as offering a discount on insurance if 

the policy holder takes certain steps to-
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

94

ward preparedness. The steps toward preparedness could take the form of classes 

or training exercises.

Liability issues must be addressed as 

well. The revision of Good Samaritan 

laws applicable across state lines is required, as well as provisions in legislation 

to provide subsequent aid for casualties 

who may not receive immediate treatment. Another solution could be more 

public participation in emergency training 

and greater transparency in crisis decision-making processes. This may increase the public‟s willingness to cooperate with the government during a crisis. 

The training could also include more 

positive reinforcement of the behaviors 

needed. In addition to training, a long 

term change in perspectives and public 

education is needed. This could include 

civil defense education in schools and inclusion of community organizations in the 

training.

A number of solutions were discussions that address the issue of mass care 

following a CBRN event. The first is the 

need for a large area for people to be 

medically observed, probably outside of 

medical facilities so hospitals are not 

overwhelmed by “worried well.” Some 

alternate facilities must be found in order 

to observe those who may have been exposed. Another way to reduce “worried 

well” patients is to offer a website or call 

center to inform people who may be concerned, but may not need to visit the hospital. To reduce the possible stigma associated with being contaminated by CBRN 

agents, it would be smart to certify those 

not exposed to the event. Public education 

also should be undertaken to dispel myths 

about the dangers of associating with 

CBRN victims, once no longer contagious. It is also necessary to encourage 

doctors and officials to feel free to say “I 

don‟t know” when it is appropriate. Finally, the government must be more responsive to the public‟s needs. It should 

not be necessary to make the public come 

to government facilities, but instead government programs ought to reach out to 

them if necessary.

Resources

During the response phase the basic 

needs of the public such as food, shelter 

and safety must be addressed. A further 

problem is the lack of public transportation, a problem that can not only hinder 

evacuation out of a dangerous area, but 

also be a problem preventing supplies and 

first responders from returning to the disaster area after the event. Providing quick 

and effective medical support and adequate logistics also are important requirements. The group identified the 

present dearth of integrated public and 

private sector disaster planning and the 

ineffectiveness in resulting the sharing of 

resources. This lack of preparation limits 

or prevents the efficient use of resources 

during and following a crisis event.

One of the group‟s solutions was the 

expansion or identification of potential 

reserve resources for a surge capacity. On 

the personnel side these reserves could 

include retired professionals from military, firefighting, police and nursing sec-
No Need to Panic: Public Resilience in CBRN Events

95

tors. The group also saw the restoration of 

critical infrastructure such as transportation, communications, power and hospitals as a strategic necessity, not a discretionary one. Improved public health infrastructure was deemed as a primary immediate concern.

Summary

In summary, the top concerns identified by the response group included the 

understanding by the population of the 

concept of federalism and multiple levels 

of government response; the requirement 

to change the expectations of the general 

public regarding what government can 

and cannot do; the need to improve personal responsibility for advance preparation and self help on the part of the citizen, and the need to work with the media 

to address public perceptions of an event 

and the individual, organizational and 

government response to it.

In terms of solutions, the group came 

up with several inventive ideas to increase 

the resilience of the general public by 

helping people to respond reasonably well 

to better-understood risks. The primary 

issue is information – how and when to 

get the correct information to the public 

so individuals and communities can make 

informed decisions. Including people early in the planning and exercises during 

the preparation phase was noted as a 

priority. Following this inclusion, the creation of a Center of Excellence for CBRN 

crisis management was suggested to act 

as an information repository to be used by 

government officials, politicians, local 

leaders, as well as the general public. The 

Center could conduct training and provide 

written statements for political leaders to 

mitigate crisis effects and public expectations. The U.S. Government could use the 

Center to establish a fundamental level of 

knowledge in the population thereby 

creating a “knowledge baseline” that 

would steel a community against CBRN 

use or CBRN threats of use. This local 

involvement could include civil defense 

education in schools and community involvement by local organizations such as 

churches. The group discussed the need to 

change the culture of expectations as well 

as to provide education about likely 

CBRN effects and “best practices” in 

coping with CBRN events.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

96
No Need to Panic: Public Resilience in CBRN Events

97

GROUP 3: RECOVERY

Group 3 consisted of mental health 

and disaster response professionals from 

government, business, NGOs and academia. Michelle Spencer facilitated the introduction of each group member, and 

then outlined the group‟s goals. During 

the morning session potential problems 

associated with recovery from a CBRN 

event were discussed. In the afternoon, 

the group discussed the possible ways 

forward. The following is a summary of 

the discussions from both the morning 

and afternoon sessions.

One of the challenges of determining 

issues specific to recovery is there are no 

clear lines to separate immediate response 

options from recovery actions or recovery 

from preparation for next event.

Recovery is the true test of resilience; 

response is weathering the storm. In the 

recovery phase we are looking for people 

to return to normal, pre-event functioning. 

Within those parameters the primary 

question is, “What does the public need?” 

In addition, several topics were highlighted for the group to consider including overall wellbeing, issues specific to a 

CBRN incident, employment and those 

surrounding the community, family and 

home.

Overall Wellbeing Issues to be Managed

 Anxiety over future attacks is likely to 

be prevalent including questions such 

as: 

o Is it really over?

o Who is in charge of recovery?

o How can we make it better/make it 

right?

 Impact on those not immediately affected:

o Anxiety about additional attacks.

o Discerning if, when and how to assist others.

 Deciding how best to augment 

official responders is a significant issue.

 Challenge: How to help without 

getting in the way of legal responders.

 Managing expectations for assistance:

o Need to reinforce realistic expectations and change unrealistic ones.

o Identifying levels of need – deciding who to help first, second and 

third.

o Teaching the public how to access 

response aid without individuals 

taking unfair shares of resources.

CBRN Issues to be Addressed

 Identify first the source of the problem – a CBRN attack or a natural outbreak or accident.

 Deciding the type of attack and identifying the appropriate response to ei-
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

98

ther a chemical, biological, radiological or nuclear event.

 Provide education and communications to the public to avoid unnecessary stigmatization of 

people/products/locations.

 Providing access to medical care.

o Need to maximize medical resources 

and care in potential mass casualty 

situations with appropriate measures 

(e.g., What about triage? quarantine? 

relocation? decontamination? mass 

vaccination?).

o Separating behavioral casualties 

from physical casualties to relieve 

pressure on hospitals and clinics.

o Providing equitability of care.

 Mental health issues:

o Identifying and treating posttraumatic stress disorder.

o Making available counseling services on a large scale.

o

Community/Family/Home Issues to be 

Tackled

How long a family must wait to return home will likely depend on the attack 

type. Thus, the level of public anxiety and 

psychological stress may include:

 Burial/disposal of contaminated human remains.

 Decisions about whether bodies of 

family and friends will be recovered 

in radiation zones.

 Identifying when families can return 

home.

 Identifying if it is safe to return.

 The perception of whether the individual and group have been treated 

fairly.

 The degree to which long-term evacuation or abandonment of homes, 

communities and businesses might be 

required.

 The amount of trust and confidence 

victims have in the government authorities.

Employment Issues to be Resolved

 When will I be able to return to work?

 Will businesses/jobs return to the 

community?

 Will insurance payments offset my 

losses?

 Will government aid help in the economic recovery effort?

Communication

Following a disaster, recovery efforts 

require effective, continuous communication between the government and the public. Communication from a trusted person 

or organization may increase the credi-
No Need to Panic: Public Resilience in CBRN Events

99

bility of the message to some sectors of 

the population. Ideally, the public should 

receive a coherent message through the 

media from that trusted source with government credentials, even if he or she is 

not technically part of the government.

Citizens need to feel secure, and the 

government can provide some layer of 

security by quickly and uniformly explaining the situation including details on 

which local areas are believed to be safe, 

an explanation of why the event happened, whether another event could be 

expected in the future and anything the 

population can do to help ensure its own 

safety. Specific information on water, 

food and environmental safety may be 

needed also. Further details, especially in 

the case of a chemical, biological, radiological or nuclear (CBRN) event, would 

include how the public can access medical care or other government support services without overwhelming the public 

health sector. The government should foster the expectation that, as a situation develops, the information will change. This 

will keep the general public from feeling 

misled as facts and information change 

with situation progress. Messages to the 

public should be adaptable and flexible as 

needed. To build the public‟s trust, responsibility must be taken for any failures 

on the government‟s part.

Information also should be given to 

those not directly affected by the event. 

In crisis situation people outside of the 

disaster area will want to provide financial or other assistance. Following disasters the desire to help others is often cathartic for those geographically or otherwise disconnected from the actual event. 

Without vectoring this desire results in 

multitudes of resources being wasted on 

accepting items such as clothing, toys and 

foods that cannot be distributed, as has 

been the case after almost every major 

event in the United States in the last two

decades. There should be a point of contact where people who have the desire to 

contribute can find information on what is 

needed and how to help.

Another suggestion was to utilize 

feedback mechanisms and direct contact 

between the government and public to 

avoid a breakdown in communication. To 

shrink the gap a website or other online 

forum could be established to allow the 

public to post information or questions 

and government officials could post responses and other information. This type 

of feedback is currently being attempted 

by the Transportation Security Administration. This type of forum is not a singlesource solution as it would not reach 

some members of the population without

computer access. In addition, the site 

would be challenging to maintain during 

crisis when events are occurring quickly 

and both government and the public 

struggle to keep up with events. However, 

providing the public with a trusted information source where federal, state and 

local updates could be seen might reduce 

confusion and anxiety.

To further help with public resilience 

to a CBRN event the government‟s message should include optimism. In the face 

of a terrible event the public would benefit from a message of hope the event is 

survivable and life will and can return to 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

100

normal. Many of the group members 

pointed out the U.K. and Israel focused on 

the ability of the population to withstand 

attacks and return to a normal level of 

functioning instead of preventing such 

attacks. The knowledge that events happen seems to help the population cope 

with a problem. This same message 

should be disseminated within the United 

States. Another aspect would be clarifying what the population can do in the 

event of another attack or incident. How 

can the public adjust its actions or activities to mitigate the effects of another incident?

Macro/Micro Economic Issues

Businesses are as vulnerable as the 

public to the effects of a CBRN event. 

Many local business owners may question 

whether it is viable to reopen a business 

after a CBRN incident in a given area. 

The economic questions for commercial 

entities: Will an area be rebuilt? Is it safe 

for humans? What about the environmental effects? What is the time frame for return to an affected area? The answers to 

these questions will determine whether a 

business reopens or decides to leave the 

area. Quick and standardized decision 

making by the government is key. If an 

area will not be re-inhabited or it will take 

a long period of time to re-establish the 

population, a business may need to find a 

different location. This information is vital to a swift recovery. This issue was 

recognized as a “chicken and the egg equation” for a community because businesses require customers to be in business, 

while the public requires basic businesses 

in the local area– grocery stores, gas stations, banks – to conduct daily lives. In 

addition to businesses an affected population needs basic elements of the community to return to a normal functioning life, 

like churches and community organizations.

Infrastructure and Basic Needs

To identify where recovery should 

start the infrastructure must be restored as 

quickly as possible to return a community 

to a baseline- level of functioning. An 

important aspect of community infrastructure is not one at the forefront of 

most planning; it is the recreational areas. 

After Hurricane Katrina most of the public recreation space such as parks and 

playgrounds were destroyed and have not 

been rebuilt. A community needs rest and 

recreation places for children and adults 

to restore themselves and re-engage in 

“normal” life. The stress relief provided 

by sports, outdoor activities and community activities is elemental to resilience.

In the event of a CBRN incident, 

healthcare availability may be limited due 

to the nature of the incident. The group 

discussed the lack of health care workers 

in New Orleans after Hurricane Katrina. 

A population may be reluctant to return 

after a disaster if basic services are not 

available. In the case of pandemic illness, 

healthcare workers may be the first segment of the population affected. Additionally, mental health treatment will like-
No Need to Panic: Public Resilience in CBRN Events

101

ly be required for survivors of a CBRN 

event. Without the restoration of these 

basic necessities, people evacuated from a 

community may not come back.

As was the case with the preparation 

and response groups, the recovery group 

determined the public holds many misconceptions about the capabilities of the 

federal government. Group members felt

the public perceived the government had 

far greater capability to move resources 

and people than is currently possible. In 

addition to promoting public optimism, a 

“can do” attitude, the group suggested self 

reliance should also be fostered. Any culture of victimization will need to be 

changed to help individuals realize that, in 

the event of a CBRN incident, he or she 

may need to tend to his/her own safety 

and care for a period of time during the 

recovery process. Further, nongovernmental organizations must be included in recovery planning allowing integration and phasing of existing resources instead of trying to use commercial assets only after the government‟s 

resources have been exhausted.

Liability

After a disaster or crisis, commercial 

and private entities often supplement U.S. 

Government efforts. The private sector 

often has surge capacity the government 

does not, and can effectively collect and 

distribute materiel through existing 

supply systems. The group discussed 

Wal-Mart as an example of a large retail 

entity with enormous potential for assistance given existing shipping and transportation network, location in small 

communities across the nation, and desire 

to help in times of need. During the recovery phase of a disaster Wal-Mart 

trucks and shipping system could be utilized to move supplies and resources to 

and from the affected region. After Hurricane Katrina, the unofficial use of established commercial networks augments 

many commercial establishments in New 

Orleans. The major hurdle for the private 

sector is the issue of later compensation 

and liability. Who will be legally accountable if persons are injured in the recovery 

effort? What if trucking capacity is 

needed for removal of human remains? Is 

Wal-Mart or another commercial entity 

required to assist? If they assist, can they 

later be compensated? Integrating commercial industries into the recovery effort 

would utilize more resources closer to an 

incident site much like the Wal-Mart example, however, the government must 

provide the necessary compensation and 

liability coverage, and require the participation of the insurance industry in the 

United States. It is likely this issue would 

have to be resolved through legislation.

Summary

The recovery group determined many 

of the public‟s needs are the same in recovery as in the previous two phases. The 

greatest challenge is it is impossible to 

determine in advance how long the recovery period will last or how many resources will be required to assist a popu-
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

102

lation in efforts to recover from a WMD 

attack. As during any phase of a CBRN 

event communication between layers of 

government and between government and 

the public is elemental in effectively addressing the crisis and speeding the recovery process. An informed public will 

more likely understand some mistakes by 

the government if the local institutions are 

involved in the planning and decisionmaking process. Local authorities that 

have trained and exercised using the National Response Plan as a guide are more 

likely to show a positive attitude and 

achieve progress at the individual and 

community level.

The key to recovery and even renewal of a community after a CBRN event is 

the interdependent role among the citizens, government and the business organization sectors. Each needs the other 

working at his own level in the community to survive a CBRN disaster event. Federal and state authorities need to determine how they can best support local officials, both in preparing communities 

through education and in restoring local 

areas after an event has occurred. If this 

mutually supportive relationship can be 

established and fostered, communities 

and individuals are more likely to be resilient. A single individual or community 

cannot recover alone with the just-in-time 

nature of business today. Planning is essential to recovery, and lessons learned in 

recovery need to be fed back into the 

planning process for the next crisis to 

come.
103

RECOMMENDATIONS AND CONCLUSION

This study has defined resilience as 

the combination of a positive individual 

perspective, strong social connectedness, 

and effective problem-solving skills, all 

of which form an individual‟s ability to 

cope with traumatic events such as a 

CBRN attack. Several characteristics have 

been identified as common in resilient 

people, specifically an individual needs 

optimism, self-efficacy, mastery and coherence to achieve resiliency. In addition 

to the individual characteristics of resilience, two other factors help a person to 

be more resilient: having social ties and 

the capability to implement effective coping strategies. The ability to ask for and 

receive support from social groups such 

as family, friends, church or community 

contributes to resiliency against stress. 

In addition, supporting others is one 

way of seeing the efficacy of your action 

and beginning to take at least a small step 

toward control over what may appear to 

be an overwhelming situation. The final 

factor, coping strategies, form around the 

ability to breaking large and potentially 

overwhelming problems into more doable 

tasks so progress can be made, and taking 

breaks from the crisis to rest or refocus 

energy.

Given the findings of the case studies 

and the outcome of the workshop, certain 

conclusions can be drawn about public 

resilience, specifically the more prepared 

a population is to manage a crisis, the 

more stress resilient it will be. This finding has been proven in studies following 

disasters. A second assumption is regardless of how hard the government tries to 

convince people of the necessity of preparedness, there will be some who are unwilling or unable to do so. This fact 

should not deter the government from encouraging preparation, as the more citizens who are prepared, the better the response of the whole can be.

The most critical finding uncovered 

from the case studies and workshop is 

contrary to common perception, there is 

no significant evidence to suggest individuals or communities are prone to panic 

in a CBRN or CBRN-related event. In the 

incidents examined for this study, and in 

the opinions of most workshop participants, people have typically responded to 

such events by trying to care for themselves and loved ones and by following 

the advice of authorities as they understood it. This positive, responsive behavior 

can at times still create challenges in response and recovery, such as when people 

were quick to report anything looking like 

suspicious white powder during and after 

the 2001 anthrax attacks. Or, when people 

immediately seek medical help when they 

have been, or believe they may have been 

exposed to a chemical as was the case in 

Tokyo following the 1995 sarin attacks. 

Despite these challenges, there is no evidence of large-scale irrational or counter-
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

104

productive behavior in any of the cases 

reviewed for this report.171 This strongly 

suggests that, rather than being looked at 

as a threat or problem to be managed in a 

crisis, the public should be seen as a potential partner in meeting the challenges 

of a community or of the nation following 

CBRN event.

The recommendations of this report 

will focus on two aspects of improving 

this potential partnership between the 

government and the people to improve 

resilience to a CBRN incident. The first 

way to improve this partnership is to encourage individuals and communities to 

better prepare to serve as a partner in 

times of crisis. This includes supporting 

efforts to increase personal, family and 

community preparedness for the most 

likely threats in their area. The second 

method to enhance this partnership is to 

build the capacity of relevant military and 

government organizations to see the public as a partner and better meet the need 

for information and appropriate services 

following an attack.

Perhaps the largest barrier to greater 

resilience in the response to a CBRN 

event is the gap between government response capabilities and the expectations 

the public has for government action during and following a crisis. Broadly speaking, the American public expects their 

 

171 One could argue that 70,000 citizens of New 

Orleans chose not to listen to their government 

and evacuate prior to landfall of Hurricane Katrina. However, the reasons included unclear government direction prior to the “mandatory” call, as 

well as the delay that left people without immediate resources at the mercy of government action.

government to provide instructions and 

any equipment that might be necessary 

during an event, provide information as to 

who has been affected by an attack, and 

to provide medications and healthcare to 

those in need. Also, citizens expect the 

government to prevent future attacks and 

establish conditions so life can return to 

normal.

This study highlighted several cases 

where the United States and other governments failed in one or more of those 

expectations. While the ability to meet 

every public expectation is too lofty a 

goal, changing perceptions of the government‟s role as well as that of each citizen and community is likely to result in 

better harmony between public expectations and government capability. The goal 

instead should be to create an informed 

public that understands its role in preparation for, response to, and recovery from a 

CBRN event or other serious crisis. This 

basic knowledge can create an understanding of issues likely to raise and encourage proper action at the local level.

A 1994 University of Michigan poll 

found only 21 percent of people polled 

agreed they could trust the federal government to do the right thing most of the 

time. Fourteen years later that number is 

not likely to increase given the unpopularity of the Iraq war, the Hurricane Katrina debacle and the economic decline. 

Ironically, however, most citizens believe 

the onus is on the government to prepare 

for and respond to a major disaster or crisis. In light of these assumptions and the 

agreed requirements for public resilience, 
No Need to Panic: Public Resilience in CBRN Events

105

this report recommends the U.S. Government take the following actions:

1. Lead with authority, responsibility 

and honesty.

2. Improve communication between and 

within government entities.

3. Prepare and inform the public.

4. Improve public health infrastructure 

and resources.

5. Capitalize on existing local resources.

Lead with Authority, Responsibility and 

Honesty

While it sounds like common sense 

the federal government needs to lead the 

nation during times of crisis, there has 

often been confusion as to which agency 

has the lead to do what during and after 

an event. Lack of a coherent communication plan and clear lines of authority were 

painfully apparent during both the anthrax 

attacks and the response to Hurricane Katrina. In addition to overlapping authorities at the national level, Hurricane Katrina proved the U.S. Government could not 

effectively coordinate federal, state and 

local efforts as quickly and efficiently as 

the crisis required.

If one key to resilience is a sense of 

efficacy during a crisis, it is critical the 

authorities know which agency and personnel will be communicating vital information to the public and the public 

knows to whom it should listen. Although 

the National Response Framework provides guidelines for public communication in the External Affairs Emergency 

Support Function, it does not ensure 

clear, honest and consistent communication with the public from one source. 

Unclear communication between the 

government and the people during a 

CBRN event will likely amplify negative 

characteristics including distrust of the 

government, miscommunication and disruptive behavior. People often assume 

the government must know what to do in 

a crisis. If clear answers are not provided, 

or if the authorities are unable to honestly 

communicate the limits of their knowledge, people will have a much more difficult time responding to and recovering 

from a disaster. The public needs to feel 

the government has an effective to help

resolve the crisis.

The reason for the inclusion of the 

Tylenol poisoning case was the astounding ability of Johnson and Johnson to regain public trust and thereby increase 

market share following the tragic events 

of 1982. Important lessons can be 

learned from J&J‟s experience, including 

the fact J&J took responsibility for the 

crisis and the company responded to the 

public with honesty and clarity. No 

excuses were made, even though it was 

first thought the problem had occurred 

during manufacturing. Even after the 

company discovered it was not to blame, 

it did not slow its actions to prevent a repeat occurrence. Instead J&J acted swiftly, costing the company millions, but in 

the end, that loss was easily overcome 

within a few years. The last lesson of the 

Tylenol case was to use a “reservoir of 

good will” wisely. Americans trusted a 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

106

product and were reassured by the rapid 

response of a well-known entity. As a crisis unfolds it would be wise to take stock 

of where good will lies and how that can 

be maximized without draining the “reservoir” of public trust.

The aftermath of Hurricane Katrina 

provides the starkest example of how the 

failure of the government to lead can 

cause misery and hardship for its citizens. 

While the onus of decision-making was at 

the local level for evacuation and planning, the federal government must assume 

the task of communicating effectively 

with the public, providing trusted agents 

to share information and to direct the 

people to take proper action. 

Improve Communication Between and 

Within Government Entities (Between 

Agencies & Federal/State/Local)

Many government agencies and organizations rely on others for accurate 

and timely information, especially in a 

situation involving public health. During 

the anthrax attacks in 2001, agencies were 

challenged to manage information being

released to the public. Localities such as 

Washington, D.C. were under pressure 

from postal workers to make a decision 

about the closing of the Brentwood Postal 

Facility, as well as to determine who 

should receive treatment. The public 

health statements from CDC and HHS 

were sometimes confusing or vague, raising concerns over fairness and increasing 

confusion regarding treatment options.

While communication with the public will remain one of the greatest challenges for the government, the President 

should encourage all government entities 

(legislative, executive, and judicial) to 

have one message, and if possible, one 

messenger. This will likely require substantial cooperation preceding a crisis. A 

CBRN event is so novel a concept for 

most people that anxiety is expected to 

peak, requiring clear instructions to the 

public in a timely fashion. In one study, 

five years after the September 11th attacks 

it was reported that over 65 percent of the 

respondents did not believe the U.S. Government had adequately explained what 

was expected of citizens following a 

WMD event.172

Given the likely magnitude of a 

CBRN event, public trust in government 

statements and actions is essential. Mistrust leads to counterproductive activities 

such as refusing to be vaccinated, or 

hoarding medicine against a vague threat. 

During Hurricane Katrina the government‟s failure to communicate clear authoritative instructions to its citizens led 

to mass confusion and caused many to 

make their own decisions about evacuation and shelter. As previously stated, no 

individual or government agency has 

claimed responsibility for directing 

 

172 James N. Breckenridge and Zimbardo, Philip, 

“The Political Psychology of Terrorism Five 

Years after September 11,” Paper presented at the 

annual meeting of the International Society of 

Political Psychology, Classical Chinese Garden, 

Portland, Oregon USA, (July 4, 2007), 

http://www.allacademic.com/meta/p204617_index

.html. 
No Need to Panic: Public Resilience in CBRN Events

107

people to the Convention Center – a location that had no supplies, authorities or 

plan for evacuation. 

Not all citizens will conform, but 

clarity and uniformity will go a long way 

in easing confusion and chaos. In order to 

encourage public willingness to listen and 

follow government instructions, the use of 

trusted agents is recommended. As with 

the anthrax case, the situation following 

an event is likely to be unpredictable, requiring different actions for varying situations. Without clarity and trust, this fluidity will increase confusion and misdirection.

Prepare and Inform the Public

(Before, During, and After)

Creating the environment needed for 

self-efficacy and mastery of events during 

a crisis requires education before the 

event. General awareness must be raised 

regarding the risks and proper response to 

protect personal health and welfare because the government may not be able to 

respond as quickly as the public might 

expect. The average response time for the 

federal government to a disaster is 72 

hours. Those first three days may be vital 

to community or individual survival and 

recovery. Thus, it is incumbent on citizens and local communities act prior to an 

attack to be able to respond quickly when 

an attack does occur. Interestingly, one 

recent study suggested people were aware 

they were unprepared. When asked 

whether they thought their fellow citizens 

were prepared for a major terrorist event, 

over 72 percent did not believe they 

were.173

Even though lacking, generally 

people tend to be better prepared at home 

than in the workplace. Frequently, 

workplaces intend to supply their shelters 

locally using the just-in-time concept, 

which can prove deadly for preparations. 

Large businesses tend to prepare better 

than do small ones, which is problematic, 

because the small businesses are in direct 

contact with more people in the local 

community. 

To make the most of their own resources, citizens need to know what is 

happening and what they can to do to 

help themselves and their families. One 

suggestion for encouraging individual 

preparedness is to create a public awareness campaign. One of the most successful public service campaigns in U.S. history began in 1944 when Smokey Bear 

first said, “Only You Can Prevent Forest 

Fires.” In a recent study by the Ad Council who created Smokey, 95 percent of the 

people surveyed could finish the sentence 

when given the first words. The campaign was developed to educate the public on forest fire prevention. At the time, 

lumber was considered a strategic resource for the war effort – a resource 

threatened by accidental fires that accounted for nine out of 10 forest fires, 

which were destroying millions of acres 

every year.174 Today Smokey has his 

 

173 James N. Breckenridge and Philip Zimbardo, 

(July 4, 2007).

174 The Ad Council, Forest Fire Prevention - Smokey Bear (1944-Present), 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

108

own website with information and resources for educators, parents and children.

The involvement of America‟s youth 

was seen by many workshop participants 

as crucial to increasing knowledge and 

improving overall resilience. Children 

will force the issue at home when their 

interest in a topic has been piqued. By 

providing steps easily understood and implemented, children can be one of the 

most significant forces for change in attitude surrounding personal and family responsibility to be prepared for a natural 

disaster or WMD event. The Department 

of Homeland Security and FEMA have 

recognized this fact, including “Ready 

Kids” as one of three primary focus 

groups for preparedness information.

In addition, the use of sporting organizations and events, adult and teen certification programs, business involvement, 

and even patriotic approaches such as “I 

support our National Guard troops so they 

don‟t need to support me,” should be considered as viable approaches to improving 

citizen preparedness.

A campaign should focus on the most 

significant threat to that community and 

plan in detail for the event that all the

community can imagine. Thus, each 

community is threatened by some natural 

disaster whether it is flood, fire, earthquake, tornado or hurricane. Increasing 

citizen preparedness for a natural disaster 

can easily transform into preparedness for 

a CBRN event, if the public knowledge 

 

http://www.adcouncil.org/default.aspx?id=129, 

(April 1, 2008).

base exists. Citizens need to distinguish 

between types of WMD events and have 

an understanding that each requires a different response. This information is provided by the U.S. Government on a preparedness website called Ready.gov. 

However, it is lost in a myriad of information that is likely, when taken as a 

whole, to overwhelm citizens.175 The results of the preparedness campaign have 

been lack-luster, perhaps owing to the 

lack of a catastrophe that forms a relation 

in citizens‟ minds between their own 

well-being and preparedness for an event 

that could affect their lives directly. 

At the local level communities are 

reaching out to citizens to encourage preparedness for natural disasters through 

localized versions of the federal program. 

The “Ready Houston” Campaign is an 

excellent example of a focused effort for 

hurricane preparedness, as are numerous 

community and faith-based initiatives to 

increase collaboration among people and 

organizations at the local level.

As previously mentioned, even with 

an effective preparedness campaign, not 

all citizens will be aware and prepared. 

While preparedness is a vital aspect of 

public resilience, it does not address all 

phases of a crisis. The concept of preparedness needs to be expanded to encourage longer-term views should citizens 

have to endure a lengthy crisis, whether 

CBRN-related or a natural disaster on the 

 

175 One source titled, “Are You Ready: An Indepth Guide to Citizen Preparedness,” is helpful. 

However, it is 204 pages in length and not prominently displayed, http://www.fema.gov/

areyouready/recovering_from_disaster.shtm
No Need to Panic: Public Resilience in CBRN Events

109

scale of Hurricane Katrina. The Government must be ready and able to quickly give instructions to the public. This 

information must be clear and concise and 

indicate the desired action. One of the 

criticisms of government announcements 

regarding Hurricane Katrina is that localities in Louisiana used different terms such 

as “precautionary” evacuation, “voluntary” evacuation, “recommended” evacuation, “highly recommended” evacuation, 

and “highly suggested” evacuation.176 

While there has been criticism of the national threat level system, it can be used 

as an example of a general tool to help the 

public understand the situation. The challenge is to tie actions to the threat, increasing the clarity of desired action.177

In the United Kingdom, preparedness 

is viewed amid a broader spectrum of resilience. But resilience is not simply what 

occurs following an event or crisis, but 

rather a constant state. By integrating 

elements of preparedness into daily life, 

resilience is normalized. Residents have 

access to several helpful websites to di-

 

176 Select Bipartisan Committee to Investigate the 

Preparation for and Response to Hurricane Katrina, U.S. House of Representatives, (2006), p. 108.

177 Many of the recommendations in this paper are 

consistent with a large body of research on risk 

perception and risk communication. Although a 

full review of this field is not within the scope of 

this work, for an overview of these topics see Fischoff, Baruch, “Risk perception and communication.” In R. Detels, R. Beaglehole, M.A. Lansang, 

and M. Gulliford (Eds.), Oxford Textbook of Public Health, Fifth Edition Chapter 8.9, (Oxford: 

Oxford University Press, 2009). Other researchers 

in this field that are relevant to resilience include 

Paul Slovic and Peter Sandman.

rect information that can be used daily or 

during an event. Information includes 

organizational contacts, both public and 

private (from Red Cross to government 

agencies), as well as pertinent information such as weather and traffic. There is 

a general national-level website, regional 

websites with information specific to 

threats and responses of the local area, 

and local resilience forums, led by local 

representatives.178 The goal of the local 

forums is to provide community risk assessments and help formulate locationspecific responses. 

Technology is one important tool to 

accomplish this task. The spread of the 

SARS virus in China provides an illustrative example. As the outbreak worsened, 

public anxiety grew as did rumors of infections and quarantines. While official 

information was sparse, citizens took it 

upon themselves to share information by 

sending text messages on their mobile 

 

178 London has six local forums. According to the 

London website, “The Local Resilience Forums are 

chaired by local authority chief executives. Membership includes representatives from the emergency 

services, local authorities, government agencies, 

health, utilities, voluntary organizations, businesses 

and the military. One key area of work undertaken 

by LRFs is the identification and assessment of local 

risks that could cause an emergency. A wide variety 

of risks are assessed including flooding, pandemic 

flu and utility failures. Once identified, the chance 

of a risk occurring and the possible consequences are 

assessed, and the risk is given a score. All of this 

information is collated to produce a Community 

Risk Register (CRR). The CRR is then used as a 

tool to effectively monitor and manage risks, and to 

inform work priorities for emergency planning teams 

in your area,” http://www.londonfire.gov.uk/LocalResilienceForums. asp.
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

110

phones, quickly spreading the news of 

disease outbreaks. In response, telecommunication companies began to offer innovative tools to assist their clients in 

preventing contagion. One Hong Kong 

telecommunication carrier introduced an 

SMS tool that showed areas where infections had been confirmed to help citizens 

avoid those areas. The government quickly saw the capability as an asset and sent 

out an estimated 6 million SMS messages 

to quell a rumor Hong Kong would be 

quarantined. Use of push technologies 

such as SMS, smart phone applications, 

email and On-Star capabilities is vital to 

sharing time-sensitive information with 

the public. Technology will not provide 

the information silver bullet. However, 

those without access to electronic communications are likely to have links to 

people who do, thus, bringing the focus 

back to community involvement.

Yet another challenge during an ongoing crisis is what is not known. Political leaders hesitate to admit a lack of 

knowledge, but studies have shown 

people are capable of handling uncertain 

and unsettling news provided it is given 

candidly. Thus, it is best to share priorities and the risks of government actions. 

Admit mistakes and elucidate options, 

including associated risks. More information, not less, is likely to illicit the desired 

outcome. One expert explained, “Don‟t 

withhold information, because people will 

think you know more. Tell the truth –

don‟t manage the truth. The key is 

trust.”179

 

179 John Barry, “Pandemic Influenza: Past, Present 

and Future,” CDC Workshop, (Oct. 7, 2006), p. 8.

The ability of the government to 

manage the expectations of its public is 

vital to recovery from any type of crisis. 

When people expect the government to 

take care of them, they are less likely to 

take steps to care for themselves. During 

the workshop, participants discussed methods for changing – not decreasing expectations. Therein lies the role of the 

media.

In the 24/7 news cycle it is easy for 

the vital information to be lost when 

competing for the public attention with 

engaging stories of triumph and loss – or 

any ratings-winning story. The government must work with the media to highlight essential information during and following a crisis. The current trend toward 

sensationalism could greatly hamper a 

government‟s ability to lead its population through a crisis. The government has 

the opportunity to frame how the public 

perceives the situation, but it must work 

together with the media to do it. This includes discouraging sound-bites and armchair quarterbacks following an event. 

The government needs to develop 

scripts in advance of a CBRN event for 

acknowledged experts to follow. These 

universally accepted spokesmen should 

be known to the media. The creation of a 

speaker‟s bureau or list will greatly reduce public anxiety when people known 

to the community provide clear, concise

information and directions. There are precedents for this concept – former U.S. 

Surgeon General C. Everett Koop‟s messages related to healthcare, George H.W. 

Bush and Bill Clinton‟s joint appeal following Hurricane Katrina, as well as the 
No Need to Panic: Public Resilience in CBRN Events

111

numerous celebrities who have spurred 

the public into action for various causes.

In order to get communities involved, 

businesses need to be engaged in preparedness efforts. The government could 

provide incentives through tax credits or 

create a certification process that provides 

preparedness compliance awards. An example of this process is the Energy Star

program the government uses to promote 

the manufacturing and use of energy efficient consumer products. Through this 

program the government offered consumers, home and commercial builders, and 

appliance manufacturers tax credits for 

energy efficient products. Consumers win 

both through the tax credit and lower 

energy costs.

An alternative method for increasing 

public preparedness is to encourage states 

and localities to hold tax-free shopping 

for preparedness items. Preparedness kits 

could be offered to provide basic medical 

necessities, food and water purifiers, and 

clear instructions of what to do in case of 

a natural disaster or CBRN event. Much 

like weather radios, preparedness kits 

could be offered through a variety of 

businesses.

Improve Public Health

Infrastructure and Resources

Medical resources are perhaps the 

most crucial resource following a CBRN 

event. Given the dearth of knowledge surrounding WMD, overcoming ignorance is 

likely to be a major challenge in managing an event. During the 1918 influenza 

pandemic, the war and ignorance of the 

medical facts were the two primary factors in determining government actions at 

the federal, state and local levels. Many 

leaders denied an epidemic. Only a few 

brave public health officials took preventative measures, while most stood by until 

illness brought their constituency to its 

knees. The lack of leadership, the censorship of the media, and the dearth of understanding severely tested the public‟s 

ability to trust its elected leaders. It left 

the population almost to its own devices 

in determining the most effective preventative measures. Following a WMD 

event, the public will need clear and decisive directions on what to do and who 

needs to seek medical care.

There are likely to be many behavioral casualties or those who are uncertain of their contamination or infection. 

That fact denotes the need for large areas 

for people who want or need to be observed to congregate. Sporting or convention venues should be considered, as well 

as the need for family visitation and 

transport of the sick to medical facilities. 

Given the possibility of a stigma being 

attached to those tested for contamination, a documentation process would be 

advantageous. Persons not exposed could 

receive a certificate of health, thereby reducing the stigma.

The need for medical and support 

personnel could be overwhelming, as it 

was in 1918. The United States needs to 

identify and create a database of reserves 

should the need arise. These could include retired military, firefighters, policemen, as well as medical personnel. 
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

112

Also, non-clinical nurses should be accessible. Texas was an example of a state 

with a database listing 40,000 such nurses 

available when surge capacity is required. 

This need is not discretionary. It is a strategic necessity that should receive priority 

as it has value in responding to almost 

any crisis situation.

In order to plan for a crisis, some assumptions have to be made. However, in 

a CBRN incident, predicting outcomes 

with little empirical evidence will challenge the public‟s attention and patience.

During the anthrax attacks, medical assumptions led to misdiagnoses and improper directions to the public. Public 

health authorities learned that much of the 

contagion assumptions made from available historical data did not hold up in the 

2001 cases. Thus, when assumptions are 

made, they need to be made transparent to 

the public. Let the public know guidance 

will change depending on the situation, 

and they should not assume the initial 

guidance will still be correct and timely at 

the end of the crisis.

Capitalize on Existing Local Resources

Two specific social issues during the 

1918 influenza epidemic are relevant today. First, unlike the early 1900s, families 

are now more dispersed and the lack of 

local familial and immediate social support may have an adverse affect on personal resilience. In the early 1900s, generations of families lived together under 

one roof (or at least nearby). Demographics have changed. Today families are 

smaller and often geographically dispersed which will challenge the ability of 

a person‟s social network to come to their 

aid, and could force many to rely on 

whatever government services are available. Secondly, in 1918, private philanthropic groups literally saved society 

through their organizing efforts. However, these local groups do not exist in the 

same form they did in 1918 and the 

neighborhood sense of community is likely to be less in many areas. 

That is not necessarily true of 

churches and religious organizations, 

which often play a significant role in the 

local community, especially after a disaster. Following landfall of Hurricane Katrina, local non-profit organizations 

housed and cared for as many evacuees as 

the Red Cross, although many did not receive re-imbursement or government 

support after the crisis had ended. The 

government needs to engage these nontraditional sources of community support. 

They have connectivity to the population 

and can communicate to them prior to and 

even during an event. For this reason, 

these private organizations should also be 

involved in local planning. Their adaptability and responsiveness demonstrate the 

strength of their local expertise, relationships and capability to reach and serve 

vulnerable populations and communities.180 Local community organizations 

may be best positioned and capable of 

bridging the gap between federal and 

state governments and their citizens.

 

180 The Aspen Institute, 2006, 9.
No Need to Panic: Public Resilience in CBRN Events

113

Unfortunately the federal government 

does not always have the foresight to include local entities in planning. One example is the 2005 National Strategy for 

Pandemic Influenza, in which local and 

states have the lead in controlling the 

spread of contamination and disease, but 

had little to no role in creating the national response plan. This lack of coordination means the plan is based on assumptions regarding local and state capabilities 

that may not hold up during an event.

Conclusion

In the United Kingdom, demonstration of public resilience is part of British 

history. British citizens survived the London Blitz during the 1940s and repeated 

IRA bombings in the decades that followed. After the 2005 subway attacks, 

Londoners rode “the tube” again the next 

day. In Israel years of bombings, terrorism and war have forced Israeli citizens to 

prepare for and recover from the worst 

circumstances.181 It is uncertain whether 

American citizens will ever be as resilient 

without similar crisis experiences. However, given our history of successful public campaigns and community service, it 

 

181 Further information on the focus on resilience 

in the UK can be found at the official government 

site: http://www.ukresilience.gov.uk/. The USAF 

Counterproliferation Center has conducted a comparison of Israeli and American homeland security 

efforts which begins to address this resilience issue. See Larsen and Pravacek, Comparative USIsraeli Homeland Security, (2006), 

http://www.au.af.mil/au/awc/awcgate/cpcpubs/larsen3.pdf

is clear we can improve upon American 

public preparedness and resilience.182 In 

order to accomplish this goal, the government needs to change its role from 

primary care provider to a more broadbased supporter of local and community 

resilience efforts. Focusing on personal 

preparedness at an early age, beginning at 

school, would go a long way in preparing 

citizens to cope successfully with future 

crises and disasters. 

Honesty and clarity in government 

communication creates public trust. Public trust is a requirement for reasonable, 

orderly response to a traumatic incident 

such as a CBRN event. Leadership by the 

government will increase understanding 

of the situation and feelings of manageability of crisis, all of which are requirements for personal resilience. 

In looking back at major catastrophic incidents around the world, experts have 

noted the closer a person was to the crisis, 

the more realistic and reasonable the individual‟s behavior. Preparation for disasters, education, training and exercises, 

both physical and mental, can promote 

confidence in the public they can cope 

with what comes. Advance preparation 

can also educate citizens to a variety of 

possible CBRN or other crises and, thus, 

lessen the number of unexpected surprises 

encountered. During a crisis, clear, consis-

 

182 One study indicated that when asked a majority 

of respondents stated (22% agreed and 17.5% 

strongly agreed) they were “personally resilient,” 

while 28% agreed and 18% strongly agreed they 

“belonged to a resilient community.” See James 

N. Breckenridge and Philip Zimbardo, (July 4,

2007).
Michelle L. Spencer, Michael T. Kindt, and Megan P. Stans

114

tent information from a reliable source is

enormously helpful to those coping with a 

crisis or disaster. A prepared, informed 

and involved public is a resilient one.