Fear of Fear Itself: The "Worried Well" Problem in Biodefense Policy

This week, U.S. Security officials released information on Osama bin Laden's journal, the contents of which are sure to be scoured over in the days ahead. Although some interesting nuggets have already surfaced, one thing noticeably absent is any mention of bioterrorism.

It is an odd omission given bin Laden’s stated desire to kill as many Americans as possible. Bioterrorism poses a unique threat to a nation. Unlike a bomb-based attack, a biological agent attack has the potential to create prolonged fear and official mistrust in a population. The inherent uncertainties that federal, state, and local governments would face in the event of a bio-attack are alarming.

The concept of the “worried well” is a particularly troubling concern. Many communities have developed their own mass public health preparedness procedures that typically contain a vaccine distribution component. Most of these plans call for infected individuals to go to a clinic in order to obtain antibiotics, requiring people to wait in lines before being screened and treated.

The “worried well” are those individuals who mistakenly believe they have been exposed to the biological agent and seek treatment based on this fear. In short, it is a population’s fear-driven rush to access a potentially limited supply of antibiotics. This dynamic is unique to a biological attack and creates two distinct response policy problems.

First, the number of “worried well” individuals is dangerously unpredictable. Depending on the amount and virulence of the attacking agent, the number of “worried well” could easily over-extend the resources of regional medical systems, depleting limited medical supplies needed for individuals who have been exposed. Richard Danzig, one of the most sophisticated national security minds in America, has noted that this fear of exposure is enough to send people to hospitals in droves: “those who fear they have been infected, but have not been, will demand treatment.”

Second, when these non-infected “worried well” individuals show up at medical distribution sites, the odds that they become infected go up exponentially since there is increased likelihood that they come into contact with other contagious individuals waiting at the site. If everyone showing up at a distribution site believes they have been exposed, there is no simple method to determine who has and who has not until after an initial screening. But by this point, the cross-exposure has already occurred.

The White House made an initial stab at this inherent policy problem a couple years ago. In 2009, Obama signed an Executive Order mandating that the U.S. Postal Service play a role in the disbursement of medical countermeasures in the aftermath of a biological attack. The idea is that, by delivering necessary medicines via established mailman routes, the threat of cross-infection is significantly mitigated.

While this logistical tactic may work in principle, it leaves many questions unanswered. How long will mail-based distribution take? Who will protect the mail personnel when carrying these high-value antibiotics? How much will the program cost? How can authorities be sure that individuals will be able to self-administer the medical treatments?

As U.S. officials continue to warn against a bioterror attack, these logistical hurdles need to be overcome. 

Photo CreditNIAID_Flickr

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Andrew Baird

Andrew is currently a law student at the University of North Carolina at Chapel Hill where he focuses on health law and policy. Prior to returning to graduate school, he worked in Washington, D.C. for the University of Pittsburgh Medical Center (UPMC) on federal biodefense and infectious disease policy, concentrating specifically on the development and procurement of medical countermeasures. Andrew graduated from Trinity College in Hartford, CT in 2006 with a degree in Classics.

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