Role of Doctors Critical in Effective Public Health

Fact Sheet
  • The goal of bioterrorism-related initiatives is to protect the public’s health by increasing the ability of the public health system to respond effectively to a bioterror attack. Current response approaches assume that most of the public will adhere to the recommendations of public health officials about what to do during and after an event.

  • The 2001 anthrax attacks provided an opportunity to understand how people respond to a mass public health campaign and to explore the factors that may affect the public’s decisions about adhering to public health recommendations.

  • The RAND Corporation interviewed a diverse sample of individuals from Capitol Hill and from the Brentwood postal facility. The group included Hill staffers who were directly exposed to the letter containing anthrax sent to Senator Daschle or who worked in surrounding offices, and workers at the Brentwood postal facility where the letter was processed. The purpose of the interviews was to understand in detail how these individuals responded to the advice of public health officials to take antibiotics for at least 60 days.

  • The figure summarizes the response of the Hill staffers and postal workers interviewed. Initially, all those interviewed looked to public health officials for guidance. But trust in the officials eroded when people thought they were not getting the right answers, or when the information changed or was insufficient. Many people turned to their private physicians for advice, and what the physicians told them had an important influence on their adherence behavior.

  • Thirty-seven people got specific advice about taking the medication.

  • When the physician said “take the medicine,” 14 out of 15 did.

  • When the physician was vague or uncertain, or said “you don’t need it” or “I wouldn’t take it,” only 4 of 22 took their medication.

  • The interviews revealed that those who took the antibiotics as directed also tended to have networks of family, friends, and coworkers who continuously encouraged them to take the medication.

  • This study highlights the need to provide clear, accurate information on an ongoing basis during a public health emergency and to integrate private physicians into the public health response.

This fact sheet is based on:

Stein, Bradley D., Terri L. Tanielian, Gery W. Ryan, Hilary J. Rhodes, Shalanda D. Young, and Janice C. Blanchard, “A Bitter Pill to Swallow: Nonadherence with Prophylactic Antibiotics During the Anthrax Attacks and the Role of Private Physicians,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Vol. 2, No. 3, 2004, pp. 175-185.

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Copyright © 2004 RAND Corporation

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RB-9094 (2004)