With the recent terrorist attacks on New York City and Washington, D.C., it appears as though the nation is on edge for further occurrences, including the use of biological weapons.
While it is necessary to be vigilant for future attacks, according to Carol North, M.D., professor of psychiatry at Washington University School of Medicine in St. Louis, it is also important to do so without encouraging panic in others. North, who has specialized in studying bioterrorism, stressed in an interview with Psychiatric Times that people may have various responses.
She said, "There will be different responses in different people, ranging from logical to excitable, even for psychiatrists, because we are also human. It is very important to use common sense and be a good role model for patients."
Robert J. Ursano, M.D., professor and chair of the department of psychiatry at Uniformed Services University of the Health Sciences in Bethesda, Md., agreed with North on the necessity for balancing awareness and common sense. Ursano, who has also studied the psychiatric effects of trauma and disaster, told PT, "Psychiatrists need to be able to educate their patients, colleagues and community leaders in the accurate assessment of risk, the normal anxiety and hypervigilance that accompanies serious threat that is of a low probability for any one group, and how to assist families and children in managing feelings of altered safety that may have come since the Sept. 11 event."
One key to helping people deal with anxiety is understanding how the recent anthrax cases in Florida and elsewhere differ from a real bioterrorist attack. North, who stressed that the Florida cases were all contained in a single location and not contagious, said, "Unlike smallpox, the only way to get anthrax poisoning is through contact with the contagion itself. Furthermore, anthrax poisoning is easy to diagnose and treat." She added that she is not aware of any mass hysteria outbreaks in Florida as a result of the cases.
Despite this, Ursano still feels that the threat of bioterrorism is valid. He stated, "Bioterrorism remains of significant concern and, as has been again demonstrated with recent events, [there are a] large number of people who may be worried about exposure when none has occurred. The issues of behavioral and psychiatric responses to bioterrorism are among the most important to be dealt with if our public health system is to be able to function."
Part of helping the public health system contend with the threat of bioterrorism is having reliable research available. North stressed this importance, "Right now, we don't have much good data on bioterrorism. We have to extrapolate and anticipate from what we have available." (For more information on the threat of bioterrorism, please see the cover story in the July issue of Psychiatric Times--Ed.) She added that the National Institute of Mental Health has sponsored small research projects on bioterrorism in the past, but that funding needs to be pumped up due to recent events.
In an effort to fill this need, NIMH has put out a call for grants specifically relating to events following the Sept. 11 attacks as part of its Rapid Assessment Post-Impact of Disaster (RAPID) research grant program. Research topics under consideration by NIMH include exposure and reaction to the disaster; settings of care; methods for triage and risk assessment; factors that aid or impede health care provider training; delivery of crisis intervention care; social support systems and coping mechanisms; and intervention and treatment to reduce psychopathology symptom severity and disability.
On an international level, the United States and the United Kingdom agreed to carry out mutual efforts in combating bioterrorism. On Oct. 10, U.S. Department of Health and Human Services (HHS) Secretary Tommy G. Thompson and U.K. Minister of Health, the Right Honorable Alan Milburn, M.P., signed the Joint Statement of Intent during a session of the Commonwealth Fund's Fourth International Health Policy Symposium, held in Washington D.C. The health ministries for Canada, Mexico, Australia and New Zealand were also represented at the symposium.
As part of the joint agreement, the United States and the United Kingdom will carry out efforts in emergency planning, including enhanced detection capabilities of biological incidents, prevention of mass casualties from bioterrorism and effective treatment of any deliberately inflicted disease. The two countries will also collaborate on scenario planning, early disease surveillance and diagnosis, treatment for new diseases, and appropriate vaccine capacity. Thompson and Milburn also discussed possible future multinational efforts to combat bioterrorism.
On the homefront, President Bush has requested an additional $1.5 billion to combat bioterrorism. This will be added to HHS' fiscal 2002 budget request of $345 million to fight bioterrorism.