Participants at a 2008 workshop of the IOM Forum on Medical and Public Health Preparedness for Catastrophic Events raised several potential workforce issues associated with the POD dispensing approach, including large numbers of staff required to operate the PODs, the need for training of volunteer staff pre-event and supervision during an event, and protection of volunteers’ health while working at the PODs (IOM, 2008). Some jurisdictions have opted to redirect government employees to staff the PODs, reducing the reliance on volunteers. Use of community health centers and hospitals as dispensing sites could disrupt the provision of both routine and critical medical services and draw medical staff away from caring for patients (although hospitals and other health care facilities could serve as closed PODs for staff and existing patients; see Chapter 4). While many jurisdictions developed more sophisticated staffing plans during the response to the 2009 H1N1 influenza pandemic, concerns may remain (particularly in jurisdictions with fewer resources) about staffing during a more sudden response, such as would be required for an anthrax attack.
In the event of a public health emergency, effective communication is critical to ensure that the public knows when and where to go to obtain MCM, regardless of which dispensing mechanisms are employed. Communications are likely to be one of the major challenges following an anthrax attack because of uncertainties and because of how quickly the attack and response are likely to unfold. Although official direction and information can influence individual decision making, the main determinants of behavior include risk perceptions and appraisals, trust and concerns about the safety and effectiveness of MCM, and the ease of implementing the recommended behavior (Vaughan, 2011).
State and local officials could use existing knowledge from both emergency and nonemergency public health messaging campaigns to develop a plan tailored to their population and response strategies. Tailored plans are needed because responses to a public health emergency are inconsistent across vulnerable populations and are not related exclusively to health literacy (Vaughan, 2011). Effective risk communication to a sociodemographically diverse audience will need to involve the use of multiple communication strategies (e.g., traditional media, unofficial Internet sites, social media, social interactions). Social media, with their ability to inform millions of people instantly, can be a viable source of communication in disasters, but they are unlikely to reach the entire population.
Public engagement also can inform communication plans. During a