Testimony of the American Public Health Association Concerning Risk Communication: National Security and Public Health

Mr. Chairman and members of the Subcommittee, my name is Mohammad Akhter, and I am the Executive Director of the American Public Health Association. APHA is the oldest and largest public health association in the world, representing approximately 50,000 public health professionals in the United States and abroad. On behalf of our members, I appreciate the opportunity to express our views on the application of risk communication strategies to federal efforts to disseminate information on bioterrorism threats.

Never before has the essential role of public health infrastructure been so publicly acknowledged, and we thank you for recognizing our unique function as the only segment of the health care system that includes prevention, detection, and response to a bioterrorism event. We are pleased to work with you to enhance the ability of public health to work with all sectors, including the federal government, in addressing threats of the magnitude that we currently face. In this regard, I would like to address several aspects of risk communication that our collective efforts can improve.

The Speed and Effectiveness of Communications between Hospitals and Health Departments

There is already in place a system whereby a diagnosis of suspicious symptoms can be communicated from an emergency room to the local health department. This is generally done by phone, as electronic communication via e-mail is absent in an alarming percentage of cases. Whether or not the message is received by the health department in a timely manner is dependent on whether it is communicated during business hours, as communications are not received and acted upon on a twenty four hours a day, seven days a week basis. The advent of West Nile Virus in New York served to point out the unacceptable nature of this system, and certainly the events of September 11th have reinforced the urgent need to upgrade the speed and effectiveness of communication between hospitals and health departments. There is absolutely no reason why the communication of health emergencies should not be as important as other business communications. Let us determine now that the installation of e-mail communication from emergency rooms to health departments, with continuous monitoring and response, is no longer an option but a necessity. We can and must make this a reality.

In Washington DC, where there have been six cases of inhalation anthrax and two deaths, a mere twenty four hours from detection to diagnosis made the difference between life and death. Compare this with the fact that it has been determined that the optimal length of time for risk communication by an emergency room to a health department is four hours. At the present time, this criterion is met in only ten percent of all such communications. Clearly, we must improve this statistic, and a goal of one hundred percent compliance within two years is not impossible if we start right now.

Though you will hear the news media state that the immediate threat of significant additional anthrax cases is diminished if not over, even a single new case is one case too many. If anything, the threat increases as this last episode has pointed out to subsequent perpetrators of a bioterrorism event that the current system is substantially flawed. With regard to the response time between hospitals and health departments, there is no question that this is a problem that we can solve through funding mechanisms and assessment tools. The current appropriations process has come a long way toward understanding the need to bolster infrastructure at its front line, and the additional efforts of congressional health leaders like Senators Kennedy and Frist have greatly enhanced the likelihood that preparedness and response will vastly improve in the near future. We salute their efforts, and those of like-minded legislators.

The Ability of Local and State Health Departments to Communicate with Each Other, and with the Centers for Disease Control and Prevention (CDC) in a Timely and Effective Manner

The same problems that plague communications between hospitals and health departments are present in the emergency interaction among local, state, and federal entities. On many recent occasions we have witnessed the unacceptable fact that health departments have obtained information from CNN more rapidly than they have from each other or from CDC. Mechanisms must now be put in place to make these essential communications seamless and continuous, twenty-four hours a day, seven days a week. We must also include in this information loop at the local level all emergency personnel who are the first responders in the event of bioterrorism, such as law enforcement, firefighters, emergency medical technicians, and others. This calls for a new commitment to coordinating all communication among all interested parties in a health emergency, and an overhaul of the existing communications capability of the public health infrastructure. We must engage in a comprehensive approach that recognizes the need for continuous automatic communication among parties that may not have previously seen the need for it. This will require not only new dollars, but also a new way of looking at emergency communication in a way that includes a greater array of players.

Communication Among Health Entities, Law Enforcement, and the Intelligence Community

The advent of bioterrorism has presented a new challenge that requires new partnerships to be formed and a new network of communication to be firmly established. Specifically, there must now be a much closer relationship among the public health, law enforcement, and intelligence communities. Whereas law enforcement and intelligence may have entertained a sporadic relationship up until now, public health has never been a viable part of that interaction. This is no longer acceptable, as was seen in the manner in which the three entities appeared to stumble over each other in responding to the tragic events of September eleventh and thereafter. The culture of secrecy that is emblematic of the intelligence community must give way to a more enlightened approach to solving the unique challenges presented by a bioterrorism event. Each entity has a distinct but interrelated role in preventing, detecting, and responding to such an event, and only by sharing information in a transparent manner can the maximum effectiveness of their collective role be realized. Only a directive from the highest levels of government will bring about this unprecedented level of communication, but we have received the wake-up call and are not at liberty to ignore it.

An Appropriate Communications Role for the Private Sector

The heightened threat presented by bioterrorism calls for the participation of the private sector in the chain of players required to effectively address its effect. Radio, television, and print media can and must become effective partners in the sharing of accurate and consistent information in the event of a bioterrorism emergency. Competition for ratings must take a back seat when public safety is at stake, and the media can play a significant role in aiding the health, law enforcement, and intelligence communities. In the event of an emergency, all elements of the media must act as one to communicate a consistent message to the American people to convey whatever emergency instructions are appropriate in the particular instance. Standards would need to be developed to determine what constitutes an emergency; and a single authority, such as the Surgeon General, would be appointed as the clearinghouse and sole source for all messages to be delivered to the public, via the media, for the duration of the emergency. We all witnessed and were subject to a wide variety of changing interpretations by the media regarding the recent and ongoing anthrax crisis. Americans must be informed, in a correct and consistent manner, regarding the nature of the problem and what they can do about it. In the instance of anthrax, a media message might have indicated which groups were considered to be at the highest risk, and where to go for evaluation and drug therapy. The media must reinvent itself as the powerful partner that it needs to be in this era of escalated threats to the health and welfare of the American public.

Conclusion

In this country we are fortunate to have a public health infrastructure that is capable of preventing, detecting, and responding to public health emergencies of a conventional nature. The advent of bioterrorism has presented us with terrifying new challenges that mandate the interaction of additional partners to combat the heightened ill effects of this new threat. We must think in a new way, with new partners, to be effective in addressing this challenge. Our collective responsibility is to review our current communications structure, add new parties, and allocate assets effectively. The American Public Health Association is eager to assist in this endeavor.

Mr. Chairman, this concludes my remarks, and I appreciate the opportunity to share our views with the subcommittee. I will be happy to address your questions.