Robert Blendon

Although American political parties have no compunction about polling the public frequently, the American government historically does not perform polling. So federal public health officials who want to know what people are thinking and doing these days in the face of bioterrorism threats are turning to HSPH Professor Robert Blendon to find out for them.

A professor in the Department of Health Policy and Management, Blendon directs the Harvard Program on Public Opinion and Health and Social Policy. He also directs the HSPH/Robert Wood Johnson Foundation Survey Project on Americans’ Response to Bioterrorism, which has conducted three surveys since September 11th.

Released last week, the latest poll reveals that three in five Americans surveyed said they would get vaccinated against smallpox as a precaution against a bioterrorism attack if a vaccine were made available to them, despite the fact that respondents were told smallpox vaccination may produce serious side effects in a small number of cases.

More than three-fourths of Americans said they would get vaccinated if cases of smallpox were reported in their communities. Nearly 10 percent said they would not get vaccinated, even in the midst of an outbreak. There may be medical, religious or other reasons why people wouldn’t get vaccinated in a community with a smallpox outbreak, Blendon explained.

The top national public health agency in the US, the Centers for Disease Control and Prevention (CDC), frequently seeks advice and assistance from schools of public health. Asking for help to understand public attitudes is an extension of that relationship, said Blendon, who described the CDC’s informal cooperative agreement with his group and the Robert Wood Johnson Foundation. He and his colleagues provide the CDC with survey results quickly and monitor the nation’s media polls on the agency’s behalf. Information is shared in both directions: the CDC describes key issues they think public health officials are interested in, and Blendon offers related polling results–while keeping editorial independence from the CDC.

"This informal partnership with the CDC is to give their leadership a chance to use these sorts of technologies related to polling, even though they do not pay for it or do it themselves, because there are people at the CDC who absolutely feel the need to know this information," said Blendon.

The CDC launched a series of public forums on smallpox last week. The forums are taking place in four cities, starting with New York and San Francisco.

While news media conduct polling to inform headlines, public health surveying can provide practical information of immediate importance to policymakers. In the middle of an epidemic, public health officials need to know how people are behaving, what beliefs they currently hold and where they are getting their information, said Blendon.

"We have a system where people dealing with disasters don’t have a clue about what the public is thinking," said Blendon.

Canvassing minority groups in a crisis is particularly important, he said, because they may be convinced that "people in authority will treat them terribly, given the history," said Blendon. Indeed, in the smallpox survey, nearly three in 10 African Americans surveyed believed that discrimination in treatment would occur in an outbreak.

Speed is essential in the polls Blendon conducts. Lengthy surveys more typical in fields such as epidemiology may take too long when a disaster is unfolding.

"Days can matter," said Blendon. "In a world of crises and attacks, there can be changes in peoples’ beliefs and behaviors, and we have to think about using a collection mechanism that allows us to see the effects of these events quickly. Otherwise, we will be in the dark."

A system that allows for both short- and long-term surveys is needed, he said.

The smallpox survey showed that many Americans understand the disease is contagious, but less than half of those surveyed knew that if they were exposed, but not yet showing symptoms, getting vaccinated at that point could still prevent them from getting sick. There is no cure for smallpox once someone shows symptoms, and there is no fast way to test for smallpox infection.

If they thought they had smallpox symptoms, most Americans would seek help from their own doctor or medical clinic, followed by a hospital emergency room or outpatient department, the survey showed. Very few Americans would seek assistance from a public health department clinic. Most Americans are confident that their doctors could recognize smallpox symptoms, despite the fact that many physicians have probably never seen the disease in their practices. The World Health Organization declared smallpox eradicated as a naturally occurring disease in 1980.

The survey confirmed findings of a previous Blendon poll that showed a lack of a single spokesperson whom the public trusts on bioterrorism issues.

The survey’s revelations raise questions about public health responses to a bioterrorism attack, said Blendon. Smallpox-infected people who do not get vaccinated before they have symptoms–and those who show up at doctors’ offices and hospitals–may further spread the disease. Authorities need to figure out where they want to send smallpox-infected people for treatment, how to get them there and who to assign to treat them, said Blendon.

Government officials also must figure out who they want vaccinated against smallpox and when. Asking unvaccinated doctors and nurses to treat smallpox-infected patients is questionable, said Blendon. Vaccinating the public at large brings up other issues, and two federal government advisory committees of experts–the Advisory Committee on Immunization Practices and the National Vaccine Advisory Committee–are currently debating whether or not voluntary smallpox vaccinations should be offered to Americans.

Right now, responsibility for handling the public health aspects of bioterrorism falls to local authorities, said Blendon, but he believes that such strategies largely have not been worked out.

In light of uncertainties surrounding bioterrorism threats and other public health issues, Blendon sees polling as a way for public health officials to monitor how successfully messages reach the public and what people do with the information.

"Essentially, what we are trying to do is to show the applicability of the polling mechanism–outside of politics–to tell professionals what is going on with Americans," said Blendon. "This becomes particularly important when you are trying to help people in a crisis."