While the threat of biological terrorism remains a hot topic, many government groups are focused on the need for public education.Earlier this month, President Bush announced that the government has reason to believe that Saddam Hussein is in possession of deadly biological weapons. Should Iraq come under attack, it has been hypothesized that the country would counter by unleashing its biological agents on the US. Among other potentially disastrous consequences in the event of such an attack, the possibility of an outbreak of smallpox has been a primary concern of several government and health officials. As the government continues to debate its plan for who should receive smallpox immunizations (the most recent recommendation is that 500,000 hospital workers get vaccinated first), much media attention has been paid to the background of the disease. Routine smallpox vaccinations ended in the US in 1972, and the disease was eradicated completely in 1980. Reportedly, the only remaining strands of the disease exist in secure laboratories (one in the US and another in Russia), though this is based on the optimistic premise that Hussein has none. The vaccination message Debates over when and to whom vaccinations should be offered exist because of the dangerous nature of the antidote. Based on released studies from the 1960s, 15 of every 1 million recipients will have life-threatening reactions, and one or two of those will die. That risk is even higher among recipients who already have a weakened immune system - those infected with HIV, for example. There is also concern that newly vaccinated people might infect others with whom they come into close contact. There are theories that those who received a smallpox vaccination prior to 1972 are in less danger of having an adverse reaction to being immunized again, but that is not certain. Last year's anthrax attacks left the American public with a heightened sense of awareness when it comes to protecting themselves against acts of terrorism. Upon learning about the possibility of a smallpox outbreak, a common initial reaction is to run out and get vaccinated - an action that could have potentially serious side effects because of the risky nature of the disease's existing vaccination options. Michael Durand, EVP of Porter Novelli's global healthcare practice, warns, "You are fundamentally condemning people to death if you start vaccinating before there's an outbreak. It is incredibly difficult to effectively communicate that message to the public." Relaying background information about smallpox is necessary for putting a story into context, and unproblematic in its own right. However, the issue becomes challenging as soon as facts start to be interpreted. The public needs guidance on understanding what the delivered data means and what actions need to be taken should a biological attack become a reality. This month, a Wall Street Journal columnist reported, "Fear and panic will feed conspiracy theories. Good information will be mistrusted; bad information will be seized upon." He quoted Stephen Prior, a research director for the National Security Health Policy Center, as saying, "You need an effective communications strategy now." Following the events of September 11, the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) released approximately $1 billion for all bioterrorism preparedness. That money was divided among seven functional areas, one of which was communications. "We started providing communications assistance back in November," explains Glen Nowak, associate director of communications for the national immunization program for the CDC. "We've been paying equal attention to pre-event preparations and to what we would do if there was an actual outbreak." The CDC has been using its website to communicate with the masses, and it has driven traffic to the site through media relations. The site (www.cdc.gov) has a section dedicated entirely to smallpox, which is constantly updated with developments. The CDC Smallpox Response Plan and Guidelines document, which details considerations and planning efforts in the event of an outbreak, is also posted. An FAQ section appears as well. "We've spent a lot of time talking to the public and to healthcare workers to find out their concerns," says Nowak. "We're also reviewing incoming phone calls, and then posting the questions people are asking online." The CDC has made a concerted effort to engage the media by making its experts as available as possible. "The media is a very important educational tool," reports Nowak. "We've been participating in a lot of press conferences, media briefings, and phone conferences." Searching for an agency Of the $23 million received by New York City from the CDC and HHS, $1 million was dedicated to the city's Department of Health and Mental Hygiene (DOHMH) for public outreach - separate funds were allocated for outreach to healthcare professionals. Some of those funds were set aside for risk-communications training, for which the group will hire a PR firm. The DOHMH put out an RFP in August for a firm to develop educational materials, public events, and media opportunities to prepare for potential biological, chemical, or radiological attacks in New York. "We are seeking help with developing a thoughtful communications plan that goes beyond media stories," explains Sandra Mullin, associate director and director of communications for the DOHMH. "Media outreach is just one vehicle when dealing with a matter of high concern like this. In order to be effective communicators in a crisis, you have to go beyond that." Like the CDC, the communications efforts of the DOHMH are focused on what happens before, during, and after an attack. The RFP reads, "While this is a 'pre-event' scope of services, should an event occur during the term of this contract, the applicant must be prepared to switch into crisis-communications mode immediately." The RFP cites eight specific deliverables. It requires the firm to develop a media communications plan, conduct pre- and post-test surveys, plan information-exchange sessions, plan a media symposium, develop education materials, produce two educational videos, coordinate a speakers bureau, and generate media placement. Mullin says an agency will be chosen soon. The sooner the better, according to the Critical Incident Analysis Group (CIAG), which is dedicated to improving the public's ability to understand and cope with critical incidents. The organization's recently released report, What Is to Be Done? Emerging Perspectives on Public Responses to Bioterrorism, states, "Public understanding and trust must be built prior to a bioterrorism attack. Establishing credibility with the public and with the news media before an event is the best way to avoid inaccurate, panicky, and even irresponsible reporting when the crisis comes." Matthew Doering, SVP and senior crisis comms expert at Fleishman-Hillard (which pitched for the DOHMH account), agrees. "It's impossible to manage a crisis by instinct. You have to have all your resources in place beforehand," he says. "That's done by having effective communications channels, which are created through public education efforts before anything actually happens." The DOHMH sent out another RFP for a risk-communications expert. The selected individual will focus on training internal employees, city officials, and local healthcare workers who could serve as spokespeople in the event of an outbreak. "Risk-communications training is critical when dealing with a crisis situation," explains Mullin. "You need to know things like the importance of not minimizing an issue in an attempt to reassure your audience. Similarly, it is better to say you don't know when you don't know something, rather than dispense information you are not completely confident in."