June 2004

Grant Results

SUMMARY

In late 2001 and 2002, researchers at the Harvard School of Public Health, working with a polling firm, International Communications Research, conducted four national and three regional telephone surveys of public opinion and knowledge about the threat of bioterrorism in the United States. The surveys were conducted in response to the anthrax infections that occurred in October 2001 and concern over the possibility of a smallpox attack.

Key Results
The project team reported their findings from the surveys, which included the following:

  • Members of households with postal workers were significantly more worried about contracting anthrax than the general population.
  • No national figure was trusted by a majority of respondents as a source of reliable information during a bioterrorism outbreak.
  • Anthrax attacks affected the lives of a large share of people in communities where they occurred.
  • Most respondents were confident that their doctor could recognize smallpox symptoms and that local hospitals and health departments could manage an outbreak.
  • A majority (61 percent) said they would get vaccinated or revaccinated if a vaccine were offered, with larger numbers saying they would if there were an outbreak in the U.S. (75 percent) or their own community (88 percent).

Funding
The Robert Wood Johnson Foundation (RWJF) provided $245,000 to support this project.

 See Grant Detail & Contact Information
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THE PROBLEM

Americans' fears about bioterrorism grew after the 9/11 attacks, and even more so after several anthrax incidents in the following month; the federal Centers for Disease Control and Prevention (CDC) reported a large increase in calls to its emergency operations center and state health labs in October 2001. Understanding public attitudes, knowledge and misinformation about bioterrorism can help public health agencies respond quickly to attacks, according to the principal investigator, but at the time the CDC could not mount surveys without time-consuming reviews.

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THE PROJECT

Using random-digit-dial telephone interviews of adults ages 18 and over, the researchers conducted a series of national and regional surveys on public attitudes toward and knowledge of bioterrorism:

  • Public Response to the Anthrax Threats (October 24–28, 2001; 1,015 adults.)
  • National and Three Metropolitan Areas Affected by Anthrax (November 29–December 3, 2001):
    • National (1009 adults)
    • Washington (516 adults)
    • Trenton/Princeton, N.J. (509 adults)
    • Boca Raton, Fla. (504 adults)
  • Public Attitudes About the Threat of a Smallpox Attack (May 8–21, 2002; 3011 adults).
  • The Public and the Smallpox Threat (October 8–December 8, 2002; 1006 adults).

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FINDINGS

The project team reported the following findings from the October 2001 survey "Public Response to the Anthrax Threats" in a press release and report:

  • Members of households with postal workers were significantly more worried about contracting anthrax than the general population. Only 14 percent of all respondents thought it likely that they or a family member would contract anthrax, but 32 percent of those with a postal worker in the household thought so.
  • No national figure was trusted by a majority of respondents as a source of reliable information during a bioterrorism outbreak. Public health officials and physicians were more trusted than officials without such backgrounds.

The project team reported the following findings from the November–December 2001 survey, "National and Three Metropolitan Areas Affected by Anthrax" in a press release and report:

  • Anthrax attacks affected the lives of a large share of people in communities where they occurred. One in five residents (20 percent) of Washington and Trenton/Princeton, N.J., reported that they, a friend, or a family member had been exposed to or tested for anthrax, or had their workplace closed in response. Some 9 percent of Boca Raton, Fla., residents said the same, as did 4 percent of the national sample.
  • Residents of Washington and Trenton/Princeton, N.J., who said they had been affected by the attacks were more likely than others to express concerns about the safety of mail, to report taking precautions in opening mail, and to get a prescription or purchase anitbiotics to protect against a future attack. (The Boca Raton, Fla., sample was too small for analysis.)
  • Nationwide, more Americans thought they or a family member would be injured by a terrorism attack in the next year (18 percent) than by anthrax (9 percent) or smallpox (8 percent). Residents of Washington and Trenton/Princeton, N.J., who reported being affected by the attacks were far more concerned about a future anthrax attack, with 26 percent and 35 percent, respectively, saying that they or a family member was likely to contract anthrax in the coming year.

The project team reported the following findings from the May 2002 survey, "Public Attitudes About the Threat of a Smallpox Attack," in a press release and report:

  • Some 59 percent of respondents said they would get vaccinated for smallpox as a precaution against a bioterrorist attack if a vaccine were made available to them — even after being told of a small danger of serious side effects from the vaccine. Another 22 percent said they would get vaccinated if a smallpox outbreak occurred in their community.
  • Some 43 percent of respondents reported being worried about a future smallpox attack, but only 8 percent believed that they or a family member would contract smallpox over the next year. Most respondents (74 percent) were at least mildly optimistic that they would survive smallpox if they got immediate medical care.
  • Most respondents were confident that their doctor could recognize smallpox symptoms and that local hospitals and health departments could manage an outbreak.
  • Americans' knowledge about smallpox is mixed. Most respondents knew that it is contagious, but only 43 percent knew that vaccination could protect someone who was already exposed to smallpox, and only 32 percent knew that once someone develops symptoms of smallpox, there is no cure.
  • Some 28 percent said their local hospital would likely refuse to treat smallpox victims for fear of infecting other people at the hospital. Smaller percentages expressed concern about discrimination against the elderly (17 percent) and African-Americans (12 percent overall, but 28 percent among African Americans).
  • There was little reported change from earlier surveys in Americans' behavior in response to bioterrorism threats, with one in 10 fearing an anthrax or smallpox attack in the near term. Fewer people reported taking mail precautions or avoiding public places, but there was a rise in the number of people reporting getting a prescription or purchasing an antibiotic to protect against an attack.

The project team reported the following findings from the October–December 2002 survey in an article, "The Public and the Smallpox Threat," in the New England Journal of Medicine, 348(3), January 2003:

  • Most respondents held one or more mistaken beliefs about smallpox and smallpox vaccination:
    • Some 30 percent believed there had been a case of smallpox in the U.S. in the last five years, and 63 percent believed there had been a case somewhere in the world in the same period.
    • Some 78 percent believed there was an effective treatment for smallpox once symptoms had developed.
    • Some 83 percent believed there is not enough smallpox vaccine to vaccinate everyone in the U.S.
    • Some 30 percent believed that a prior vaccination would protect them from the disease.
  • A majority (61 percent) said they would get vaccinated or revaccinated if a vaccine were offered, with larger numbers saying they would if there were an outbreak in the U.S. (75 percent) or their own community (88 percent). But only 21 percent said they would be vaccinated if their own and other physicians refused vaccination themselves.
  • There was a high level of support for several emergency measures to deal with a smallpox outbreak, such as:
    • Requiring hospitals and clinics to provide services to possible victims (87 percent in favor).
    • Isolating people with smallpox in special health facilities (73 percent).
    • Using National Guard troops to prevent people from leaving areas with reported cases (67 percent).
    • Quarantining people suspected of having smallpox (57 percent).

However, respondents were divided (51 percent pro, 48 percent con) on whether to require people to be examined or tested for smallpox, and only 41 percent favored requiring vaccination.

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CONCLUSIONS

The authors of the New England Journal of Medicine article offered the following conclusion:

  • There is a need for public education about smallpox, as well as a discussion within the medical community about the vaccination of physicians.

Communications

Articles on the surveys appeared in the New England Journal of Medicine, the Journal of Health Communication, and the online journal Medscape. Reports and press releases on each of the surveys are available through the Harvard School of Public Health. Findings from the surveys were made immediately available to the CDC; the Harvard School of Public Health also monitored related media polls and provided summaries to both RWJF and CDC. The project director presented the survey findings at two national conferences: the BioSecurity 2002 Summit in November 2002 and the State Health Officials Conference in September 2003. See the Bibliography for details.

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AFTER THE GRANT

The federal Bioterrorism Assistance Act now gives the CDC authority to conduct surveys without extensive prior review, and the CDC now provides direct funding to continue the survey series. Recent surveys have included "Readiness" (March 2003) and "Americans' Response to SARS" (April 2003).

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GRANT DETAILS & CONTACT INFORMATION

Project

Surveying Public Opinion on the Growing Threat of Biological Terrorism

Grantee

International Communications Research (Media,  PA)

  • Amount: $ 245,000
    Dates: December 2001 to December 2002
    ID#:  044111

Contact

Robert J. Blendon
(617) 432-4502
rblendon@hsph.harvard.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Blendon RJ, Benson JM, DesRoches CM, Pollard WE, Parvanta C and Herrmann MJ, "The Impact of Anthrax Attacks on the American Public." Medscape General Medicine, 4(17): [online], 2002. Available online.

Blendon RJ, DesRoches CM, Benson JM, Herrmann MJ, Taylor-Clark K and Weldon KJ, "The Public and the Smallpox Threat." New England Journal of Medicine, 348(5): 426–432, 2003. Abstract available online.

Blendon RJ, Benson JM, DesRoches CM and Weldon KJ, "Using Opinion Surveys to Track the Public's Response to a Bioterrorist Attack." Journal of Health Communication, 8(Suppl. 1): 83–92, 2003. Abstract available online.

Reports

Blendon RJ, Benson JM, DesRoches CM, and Herrmann MJ, Working Papers of the Project on Biological Security and the Public (1): Public Response to the Anthrax Threat. Boston: Harvard School of Public Health, 2001.

Blendon RJ, Benson JM, DesRoches CM, and Herrmann MJ, Working Papers of the Project on Biological Security and the Public (2): The Impact of Anthrax Incidents in Three Metropolitan Areas. Boston: Harvard School of Public Health, 2001.

Blendon RJ, Benson JM, DesRoches CM, and Herrmann MJ, Working Papers of the Project on Biological Security and the Public (3): Public Attitudes About the Effect of a Smallpox Attack. Boston: Harvard School of Public Health, 2002.

Blendon RJ, Benson JM, DesRoches CM, and Herrmann MJ, Working Papers of the Project on Biological Security and the Public (4): Report on "ER" Viewers Who Saw the Smallpox Episode. Boston: Harvard School of Public Health, 2002.

Blendon RJ, Benson JM, DesRoches CM, and Herrmann MJ, Working Papers of the Project on Biological Security and the Public (5): Public Attitudes, Beliefs and Knowledge about Smallpox. Boston: Harvard School of Public Health, 2002.

Presentations and Testimony

Robert J. Blendon, "The Impact of Anthrax Attacks on the American Public," at the Director's Conference, Centers for Disease Control, April 9, 2002, Atlanta. PowerPoint presentation available online.

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Report prepared by: Lauren Green
Reviewed by: Robert Narus
Reviewed by: Molly McKaughan
Program Officer: Pamela Russo