One of the best ways to combat a bioterrorism event (or any disease outbreak) is by having an involved and educated public. Surveillance by those who recognize a disease (particularly a rarely occurring one) can help reduce the effects of the disease. Furthermore, proper understanding of and response to an event can reduce public fear, minimize economic impact, and halt the paralyzing effect that some terrorists attempt to inflict. However, the public may not be educated sufficiently to serve in this capacity. The following example of the state-of-understanding of a potential health risk and bioterrorism act demonstrates the need for better education tools and strategies.
The risk of a smallpox attack is unlikely. The known declared supplies of the variola virus supposedly reside only in secure facilities at the State Research Center of Virology and Biotechnology (called VECTOR) in Koltsovo, Russia and the U.S. (at the CDC).46 However, it is possible that rogue states have isolates of the smallpox virus. Thus, the potential for a smallpox attack has led to a debate on what precautions should be taken nationally. To be effective, the public should be knowledgeable about smallpox and the risk of prophylaxis. Lack of knowledge will render the public less capable to identify a victim of smallpox (if one is ever encountered), to appreciate the degree and intensity of transmission, and to make judicious decisions on whether to receive the vaccine.
Blendon et al.47 conducted a survey of randomly selected adults (n = 1006) to evaluate their knowledge of and beliefs about smallpox virus and the vaccine and their possible reactions to an attack. The majority of respondents had misunderstandings or wrong information about smallpox and smallpox vaccination. Some beliefs were that (1) there had been a case of smallpox in the last five years (the last in the world was in 1977); (2) there is an effective treatment for smallpox once contracted (although none exists); (3) vaccination within two to three days after exposure does not provide protection (although it does, assuming the virus has not been engineered to evade the immune response of the host);48 and (4) there are not enough doses of vaccine for the public (although there are).49
While not a direct action of a microbial forensics program, the above described state of affairs of the public's understanding points to a need for better education. Smallpox has been presented substantially in the news, yet the public knows little about it. Increased preparedness and planning will enable early recognition of the disease, effective vaccination strategies, and proper isolation procedures to mitigate the spread of the disease.45 Early detection will stem the spread of disease and allow better gathering of forensic evidence. Furthermore, there is no reason to believe that the public's (including public leaders) understanding of bioterrorism risks, prevention, and recognition is any better for other potential pathogenic weapons and their impacts on society. Without education, early detection/warning of an event may not occur, and out-of-scale reactions will likely occur. No modeling can predict the thoughts and actions of terrorists or how the public and its leaders will respond during times of crises.50 However, education to some degree can place issues and actions in proper perspective.
The microbial forensics field, in collaboration with, for example, the American Society of Microbiology, must develop educational tools so that materials will be available for lectures, courses, workshops, and general dissemination to the public. The SWGMGF has deemed education an important part of its mission.
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