5
Communications and Cooperation with the Public

From its own meetings with the public, as well as its review of past public hearings, the committee has identified widespread—but not universal—concern in the Frederick community about the planned expansion of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), as well as its continuing operations. A more proactive community relations strategy could not only alleviate some of those concerns, but also could provide a channel through which community members could provide commentary on the ongoing improvement of laboratory policies and practices.

ROOTS OF PUBLIC CONCERN

It is not difficult to understand why many members of the public are seriously concerned about research on biological select agents in their backyard. USAMRIID and other biocontainment facilities were created to study these pathogens because such agents represent a significant threat of deadly epidemics were they to be released into the general population. In fact, at least in the hands of foreign governments or terrorist organizations, many of the pathogens handled at USAMRIID are considered weapons of mass destruction. The entire U.S. biodefense program is predicated on low-probability, high-consequence risk of an attack, so it is easy to see why many Frederick area residents view the risk of an accidental release or intentional diversion from USAMRIID laboratories in the same manner, that is, low probability, but high consequence.

Although some members of the public are concerned about biosafety laboratories sponsored by any organization, many appear particularly wary of USAMRIID, based on Fort Detrick’s pre-1969 history as home to the U.S. offensive biological weapons program. Ironically, most are unaware of USAMRIID’s contribution to the science of biosafety which grew out of the old offensive programs. Some critics view the biodefense program as biowarfare by another name.



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5 Communications and Cooperation with the Public From its own meetings with the public, as well as its review of past public hearings, the committee has identified widespread—but not universal—concern in the Frederick community about the planned expansion of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), as well as its continuing operations. A more proactive community relations strategy could not only alleviate some of those concerns, but also could provide a channel through which community members could provide commentary on the ongoing im- provement of laboratory policies and practices. ROOTS OF PUBLIC CONCERN It is not difficult to understand why many members of the public are seri- ously concerned about research on biological select agents in their backyard. USAMRIID and other biocontainment facilities were created to study these pathogens because such agents represent a significant threat of deadly epidemics were they to be released into the general population. In fact, at least in the hands of foreign governments or terrorist organizations, many of the pathogens han- dled at USAMRIID are considered weapons of mass destruction. The entire U.S. biodefense program is predicated on low-probability, high-consequence risk of an attack, so it is easy to see why many Frederick area residents view the risk of an accidental release or intentional diversion from USAMRIID laboratories in the same manner, that is, low probability, but high consequence. Although some members of the public are concerned about biosafety labora- tories sponsored by any organization, many appear particularly wary of USAMRIID, based on Fort Detrick’s pre-1969 history as home to the U.S. offen- sive biological weapons program. Ironically, most are unaware of USAMRIID’s contribution to the science of biosafety which grew out of the old offensive pro- grams. Some critics view the biodefense program as biowarfare by another name. 55

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56 Health and Safety Risks of New USAMRIID High-Containment Facilities They believe that USAMRIID is collecting or even creating biological agents that could be developed into an offensive weapons capability, despite the defensive focus of the program. Some community members appear to have been comfortable with the level of biodefense research conducted at Fort Detrick prior to 2001, but as they have become aware of the expansion of select agent laboratories both at USAMRIID and elsewhere in the United States, they fear that the rapid growth will lead to a weakening of security and safety practices. USAMRIID is subject to federal law, but not necessarily to local laws and regulations. In displaying confidence that it is working hard to prevent incidents and accidents, USAMRIID leadership is perceived as arrogant by many of its critics. Thus, some in the community feel that the Army, in approving its own construction proposals and National Environmental Policy Act (NEPA) docu- mentation, has not been responsive to their concerns. As elsewhere, past incidents and infections have heightened public con- cern. The Federal Bureau of Investigation’s (FBI) conclusion, several years after the “anthrax letters,” that a USAMRIID insider was responsible for the inci- dents, demonstrated that a risk the Army was previously unwilling or unable to quantify was indeed real. (Note that the FBI’s public findings on the anthrax mailings came after the publication of the USAMRIID EIS.) Finally, issues not directly related to USAMRIID’s performance amplify the concerns of many in the community. Neighbors of Fort Detrick, particularly those near its Area B (recently added to the U.S. Environmental Protection Agency’s National Priorities List), mistrust the base leadership because Army pollution has contaminated private wells. They say that Fort Detrick’s slow re- sponse demonstrates that the Army does not care about their health. Neighbors also are concerned about other environmental impacts, such as traffic, that are far beyond the scope of this report. PUBLIC CONCERNS ABOUT THE RELEASE OF PATHOGENS There is concern in the greater Frederick community that USAMRIID, along with other laboratories at Fort Detrick, poses a serious threat to public health and safety. In fact, this is why Congress commissioned this review by the National Research Council (NRC). The committee recognizes that USAMRIID and its proposed expansion enjoy the support of many members of the commu- nity beyond its staff, contractors, and retirees, but, at the same time, there is vo- cal opposition. This has been expressed by elected officials, the editorial staff of the daily newspaper, and by the dozens of citizens who have appeared at a series of public hearings on the subject. It was beyond the scope of the committee’s task to poll the community. Opponents of laboratory expansion have argued that they would be safer if USAMRIID were to site all or some of its operations in an unpopulated area, but a comparison study is also beyond the committee’s charge. People are concerned

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57 Communications and Cooperation with the Public that pathogens from the laboratory will be transmitted to the local community. They relate reports of laboratory-acquired infections, laboratory accidents, in- adequate tracking of biological materials, and the deliberate removal of agents from the laboratories. The committee finds that USAMRIID has a robust, continuously improv- ing program for protecting both its workers and the public (see Chapter 2), but it recognizes that even with the best policies and practices there is no way to en- sure that no infectious organisms will ever escape to infect individuals in the local community. Though the committee finds that USAMRIID’s safety program meets or exceeds applicable standards, it also finds that USAMRIID has done an inade- quate job of communicating and cooperating with the public, particularly in de- veloping the EIS. While zero risk may be unattainable, the committee believes that USAMRIID can do more to improve community confidence that it is acting conscientiously to prevent the spread of laboratory-caused disease. For example, at the November 19, 2007, public meeting convened by the Frederick County Board of Commissioners (DVD submitted by Jan Gardner, President, Frederick County Commissioners), a member of the public compared the brief description of the 2000 glanders case in the EIS with the detailed de- scriptions of this case in journal articles (Srinivasan et al. 2001; Rusnak et al. 2004c). With USAMRIID deliberately minimizing the seriousness of the acci- dent, the speaker questioned how the public could have confidence in statements about the true health risks inherent in the proposed expansion. Ironically, the journal article cited by the commenter, as well as others produced by USAMRIID staff, demonstrates the facility’s ongoing and system- atic approach to reducing laboratory-acquired infections. The EIS and its associ- ated Hazard Assessment would have better served the Army if it had provided more detail on the history of laboratory-acquired infections at the facility as well as USAMRIID’s efforts to learn from past exposures. Similarly, USAMRIID has published lists of pathogens to be handled at the expanded laboratory. The public, however, is unaware that most of the pathogens under study have limited capacity for being transmitted from human to human. This and other concerns about the nature of organisms and the research program have not been well addressed either in the EIS or in other public documents. Nor does it appear that the public is aware that none of USAMRIID’s research is clas- sified (USAMRMC/USAG 2006). THE IMPORTANCE OF TRUST Establishing trust is key to successful public interactions in evaluating and responding to risk. Slovic, for example, suggested that more public participation in both risk assessment and risk decision making would “make the decision process more democratic, improve the relevance and quality of technical analy- sis, and increase the legitimacy and public acceptance of the resulting decisions”

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58 Health and Safety Risks of New USAMRIID High-Containment Facilities (Slovic 1999, p. 689). The NRC (1996) proposed a model in which the formal risk assessment step is preceded and accompanied by a broad interaction with stakeholders. Renn (1999) has outlined several strategies for this process, in- cluding its use in the context of facility siting decisions or other matters of envi- ronmental controversy. In retrospect, it may be that the judicious use of such approaches at the outset of the decision planning process might have reduced the degree of contentiousness associated with the decision or even led to a more widely accepted decision. Developing and sustaining public trust is essential to the effective long- term operations of USAMRIID. Reviewing the community relations program at the Canadian Science Centre for Human and Animal Health in Winnipeg, Keith and Wagener (2004, p. 194) wrote: Having a strong community relations program is important not only be- cause of what opposition may mean for a facility but also because of the potential impact on the facility’s ongoing reputation. The impact of an in- cident within an environment lacking in trust can extend far beyond the easily identified direct harm and can include long-term costs often not considered in cost-benefit analyses. Damage to the reputation of one facil- ity may even have a ripple effect than can impact other facilities of the same nature. A good reputation within the community can mean potential partnerships, more accommodating politicians, and greater interest from prospective employees. It can also minimize public alienation during difficult times. If the facility has shown itself to be trustworthy, people will be more likely to support it in times of difficulty. Trust does not necessarily mean agreement. That is, community members may still question the laboratory’s mission or the magnitude of the Nation’s bio- defense program. But they may come to recognize that given that mission, USAMRIID is committed to operating safely and to protect its employees, its neighbors, and the entire Nation. Race (2008, p. 45) summarized research findings on community trust: While accurate, detailed message content is necessary, it is likewise im- portant to recognize that trust, transparency, competence, and avoiding se- crecy are essential for effective risk communication. If the public is dis- trustful of officials because of credibility problems, past history, or social alienation, even the best-designed risk communication efforts may be un- successful, or impeded. Overall, communication must be a proactive dia- logue that addresses the needs of diverse audiences and stakeholders, starts from the earliest planning stages of a project, and continues through project operations.

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59 Communications and Cooperation with the Public There are three key elements to the development of public trust. One is to perform in a way that merits public trust. In this case, that means maintaining and continuously improving practices that protect the public from infectious disease. A second element is communicating those practices to the public in an open, transparent fashion. The third element is listening to public concerns and addressing them when appropriate. A NEW APPROACH TO COMMUNICATIONS AND COOPERATION WITH THE PUBLIC Although the committee does not believe that improved communication will eliminate all opposition to USAMRIID’s operation or expansion, a proac- tive community relations strategy can build trust, alleviate concerns about com- munity safety, and provide an opportunity for community members to partici- pate in the continuous improvement of laboratory practices. The Army should go beyond demonstrating that it is following the rules and procedures that gov- ern its operations and more directly answer the specific concerns raised by its critics. Furthermore, as Race (2008, p. 45) found, “Ongoing communications involving true public dialogue and engagement—not just press releases and an- nouncements—must be part of the lifetime of these facilities.” First, environmental studies and hazard assessments should report the type of laboratory incidents and laboratory-acquired infections described in USAMRIID’s scientific literature, as well as actions taken to prevent them. Safety and security failures, along with their countermeasures, should be reported promptly to the pub- lic. The tendency to minimize such rare accidents has created mistrust among the local population. Second, USAMRIID should consider holding an “open house,” which might include displays showcasing its approach to safety, before the new labora- tory begins operations. The December 1996 open house at the Winnipeg Cana- dian Science Centre provides a successful model (Redekop 1996). It is likely that members of the Frederick community are unaware of the engineering con- trols and security procedures designed to minimize the risk of accidental infec- tions. With careful planning, such an event could be conducted without risking the security of the facility. Such an open house also would provide concerned community members an opportunity to suggest improvements in safety and se- curity. Third, USAMRIID, perhaps in cooperation with other laboratories at the National Interagency Biodefense Campus, should consider creating a visitors’ center containing inactive—that is, without agents—models of laboratory opera- tions to provide continuing opportunities for the public to understand its opera- tions. While such a center might be located within the gate of Fort Detrick, the Army’s Chemical Demilitarization programs have found it productive to estab- lish outreach offices in the host communities.

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60 Health and Safety Risks of New USAMRIID High-Containment Facilities Fourth, USAMRIID and other laboratories handling pathogens could pro- vide fact sheets to describe the pathogens that they are researching. Public testi- mony suggests that the undifferentiated knowledge of select agents compounds people’s fears. Fifth, and most important, the committee believes that two-way communi- cations between USAMRIID and the public at large, including its critics and opponents as well as its supporters, would best be served by the creation of a community advisory board that meets regularly. At such meetings, led by USAMRIID personnel with administrative, not just public relations, responsibil- ity, the Army should report regularly on problems, successes, and improvements in policies and practices. It should take suggestions from the public and work with public representatives to prepare fact sheets and other educational materi- als. By meeting regularly, the advisory group would create a group of lay par- ticipants with above-average understanding of the laboratory’s work, establish a mutual problem-solving mentality, and if successful, build trust. While the pro- posed board would be advisory, with no formal decision-making authority, USAMRIID should obligate itself to respond to all suggestions and comments offered by members of the proposed board. Fort Detrick’s Garrison already operates a Community Liaison Council, which is said to be convened quarterly and attended by local community and political leaders. Its stated intent is to provide a platform for the Garrison Com- mander to provide information and updates about Fort Detrick programs, con- struction, and environmental issues and to get feedback from community leader- ship. Fort Detrick’s Installation Restoration (clean-up) Program also sponsors a Restoration Advisory Board. While similar in structure to the proposed USAMRIID advisory board, these two bodies fulfill different functions. Sixth, USAMRIID should work with public representatives on the pro- posed board to develop guidelines for reporting incidents, accidents, and labora- tory-acquired infections to the public—that is, who should be notified and when. Some events may merit immediate notification of public officials or the public at large, while for others periodic summaries may prove sufficient. Seventh, a non-governmental member of the advisory board, as well as a representative of local government, should be invited to serve on the Institu- tional Biosafety Committee. Finally, members of the Frederick community have expressed the need for the various laboratories that make up the National Interagency Biodefense Cam- pus to coordinate and streamline their communications with the public. This committee has not reviewed the community relations activities and plans of the other laboratories on the National Interagency Biodefense Campus. Indeed, it is beyond its scope. Nevertheless, the committee urges USAMRIID to consider whether it might strengthen and/or simplify its community relations strategy by combining or coordinating the above suggested activities with the other agencies on the campus.

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61 Communications and Cooperation with the Public FINDINGS  A segment of the local population around Fort Detrick is not satisfied that the Army is doing everything it can to protect them from infection by pathogens being studied at USAMRIID.  Communication between USAMRIID and the Frederick community has not been adequate to address community concerns. The community has not been made aware of the details of the many safeguards already in place at USAMRIID, the requirements governing the operation of biocontainment facili- ties, and the Army’s ongoing commitment to improving safety and security. RECOMMENDATIONS  USAMRIID should expand its two-way communications with the pub- lic. Examples of possible communication efforts are: o Promptly disclosing laboratory incidents to the public, o Providing fact sheets about pathogens being studied, to include in- formation on their natural reservoirs and how they are transmitted, and o Holding an open house prior to activation of the new USAMRIID facility or opening a visitors’ center.  USAMRIID should consider strategies that have been used by other containment laboratories (e.g, the laboratory in Winnipeg) to enhance commu- nity understanding and facilitate integration into the community. If possible, such communication strategies could be coordinated with the two other laborato- ries of the National Interagency Biodefense Campus.  USAMRIID should involve the Frederick community in ongoing ac- tivities related to improving safety at the laboratory. For example, it might be useful to include community members on the Institutional Biosafety Committee or other relevant committees.  USAMRIID should create a community advisory board, with a broad representation of community views. This board should meet regularly to learn about successes, problems, and improvements in policies and practices; encour- age public suggestions for improvements; and help shape the laboratory’s public communications strategy and activities—including the development of guide- lines for reporting incidents to the public. It would be helpful to create such an advisory board as soon as possible so that it can be engaged with the ongoing activities associated with the construction of the new facility.