of preparedness. A closely related theme is communication—among levels of government and the various partners in preparedness, with communities and the general public, and with the media—also an area panelists found missing or severely underrepresented among the indicators, despite the vital importance of effective communication channels and methods in most preparedness activities.

The committee found that, despite the fact that the pre-event guidance emphasized the need for intersectoral relationships among the public health system and the first responder communities (i.e., fire, emergency medical services, law enforcement), the indicators do not reflect this emphasis on collaboration and communication. They contain almost no mention of these important partners in preparedness and little mention of the cross-linkages with health care providers and professional organizations, health care institutions (including, but not limited to, hospitals), and health care insurers. With the exception of a few representatives of the public health community, other partners were not involved in the development of the readiness indicators, although their critical roles in responding to smallpox attack (and other public health crises) were acknowledged and described in earlier planning materials developed by CDC. To remedy these gaps, formal measures of the strength and effectiveness of collaboration could be added to the readiness indicators to assess jurisdictions’ capacity in these important areas.

In recent years, the role of communities in the public health system has been increasingly recognized and supported. With their ethnically and culturally diverse populations, service and social organizations, opinion leaders, and faith groups, communities can contribute knowledge and other resources to the work of keeping the population healthy. Bioterrorism is just one of the threats to the public’s health, and developing purposeful community engagement in preparedness should be part of the range of activities conducted by the public health agencies and their partners. Involving the community in planning and evaluation requires good communication, building partnerships with organizations and community leaders, and including community representatives in decision-making. This investment in counting communities among partners in preparedness also could lead to a better informed citizenry, which may help to decrease the potential for fear and panic in the course of a bioterror event or other emergency.

Risk communication is largely absent from the activities measured by the smallpox readiness indicators. As the committee has emphasized in previous reports, in particular its second report (IOM, 2003a), effective communication is key to preparedness and should include building relationships with the media, designating trained, trusted, knowledgeable spokesperson(s), developing uniform messages, relaying timely and accurate information to the public, and planning communication strategies and

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