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9/11, A Decade Later -- Managing fear
9/11 unleashed ripples of uncertainty and fear of further attacks in the following months. While this was expected, given the enormity of the event, did the federal and state response fuel the terror of terrorism?
I would argue that it did, and that effective risk communication strategies are still lacking 10 years later. Furthermore, failure to implement a comprehensive risk communication strategy that covers natural and man-made disasters will continue to undermine preparedness, response and recovery efforts.
It’s clear now that the U.S. Government had particular difficulty in communicating the risk of terrorism immediately after 9/11. Extensive concern prevailed that 9/11 attacks were the first in a wave of attacks on the U.S. The anthrax attacks that started in October 2001, helped to reinforce that perception.
The color-coded Homeland Security Alert System (HSAS) that was implemented in 2002 sought to inform the public of the current terrorist threat level. However, the HSAS failed to adequately contextualize the warnings by informing the public what actions they should embark on, based on the perceived threat level. Furthermore, the HSAS remained principally at yellow or orange, leading to “alert fatigue” among the public, further reducing its effectiveness. Attempts were made to improve the system with specific alert levels given to transport sectors and regions.
Years later, in April 2011, the HSAS was replaced by the two-tiered National Terrorism Advisory System (NTAS) that comprises “elevated” and “imminent” threat levels. But, moving from a five-tiered to a two-tiered system constrains the ability to vary the risk warnings, again risking alert fatigue. This is true despite the fact that the new NTAS provides a framework to better contextualize warnings.
As is amply demonstrated by ongoing tinkering with the alert system, DHS’s ability to effectively communicate the risk of terrorism remains a considerable challenge 10 years after 9/11. In 2010, the National Academies’ National Research Council released a report mandated by Congress which examined DHS risk analysis processes and was critical of the agency’s risk communication capabilities. That report strongly recommended that DHS formulate a “well-developed risk communication strategy” to “address the deficiencies to adequately understand the social and economic impacts of terrorist attacks.”
I couldn’t agree more, because the key challenge for society after a terrorist attack is to ensure that it manages and mitigates the ripple effects that cause people to undertake adverse avoidance behavior, which can cause further economic and social harm.
These avoidance behaviors can fall into two categories. The first comprises responses with mostly economic consequences, but limited effect on the well-being of individuals. These effects include a reduction in the use of a recently-targeted transport system, or less frequent attendance at locations previously attacked (e.g., shopping districts or restaurants).
At the other end of the spectrum are responses that potentially have adverse consequences for the safety and health of individuals and communities, as well as economic impacts. These are activities that pose a greater risk to an individual’s well-being, at the same time that the individual believes they are reducing the risk of being subjected to a terrorist attack (e.g., choosing a mode of transport or behavioral change that poses a greater risk to them.)
Examples of first-category responses after 9/11 included reduction in travel or attending specific events. An assessment of the longer-term behavioral effects of 9/11 in the five years after the attack reveals a significant proportion of individuals who continued to alter their lives. Gallup surveys revealed that approximately one-in-five Americans said they had permanently changed the way they lived as a result of 9/11, and a little more than half (53 percent) believed most Americans had changed their lifestyles.
To ascertain the nature of these behavioral changes, Gallup asked respondents over five years about their travel patterns and whether they go into skyscrapers or attend events with large crowds. Americans were less willing to travel overseas (48 percent in 2001 to 47 percent in 2006), and less willing to fly (43 percent in 2001 and 30 percent in 2006). Somewhat fewer said they were less willing to go into skyscrapers (35 percent in 2001 and 22 percent in 2006) or go to events attended by thousands of people (30 percent in 2001 and 23 percent in 2006).
The second category, responses by the public that cause harm to individuals on top of economic effects, included a noted increase in the use of drugs and alcohol in the northeastern U.S. in the months after 9/11, to reduce the perceived fear and anxiety resulting from the attacks. These behaviors impacted the safety of drivers on the roads, causing an increase in traffic fatalities.
During the 2001 anthrax attacks, ineffective risk communications employed by public health professionals and the federal government also exacerbated the adverse reactions by the public. This included putting pressure on essential supplies of ciprofloxacin by those who unnecessarily took the antibiotic drug, an estimated 20 percent of whom experienced the drug’s side effects, and possibly risked changing the bacteriological environment from the widespread use of the antibiotics, rendering some organisms resistant to the antibiotics employed.
Analyses of prescription levels reveals a large number of Americans who unnecessarily acquired ciprofloxacin and doxycycline (the two drugs recommended by CDC to treat anthrax). A comparison of the national prescription levels of ciprofloxacin and doxycycline in October AND November 2001 with the same period in 2000 showed an increase of 160,000 prescriptions for ciprofloxacin in October, and 216,000 for doxycycline during October - November. These figures do not include the 10,000 prescriptions prescribed by CDC, which came from the National Pharmaceutical Stockpile.
Although it was not a terrorist attack, the 2011 Fukushima nuclear reactor disaster which followed an earthquake saw a similar response, when a number of pharmacies on the West Coast of the U.S. reported that they had sold out their supply of iodine tablets. Residents believed there was a credible radiation risk from Japan that required undertaking these actions, despite reassurances by the public health community that there was no such risk.
The perceived risk and uncertainty that characterizes terrorist attacks, particularly those involving chemical, biological, radiological and nuclear materials, makes it imperative to understand what messages will elicit desired behavioral responses among the public. After a severe attack, such as could occur with a chemical, biological, radiological or nuclear device, medical facilities may not be able to cope with the demand for treatment (either because of partial or complete closure due to contamination or because they are overwhelmed with patients).
The recovery phase will be undermined further by public perceptions of “how safe is safe,” regarding the areas that people can remain in, and return to, in the weeks and months that follow.
So, although headway has been made by DHS, there still must be a coordinated risk communication strategy similar to those that other agencies, such as the Food and Drug Administration (FDA), have undertaken.
Countries facing terrorism face the challenge of responding domestically and internationally in a proportionate way. Critically, governments must ensure that their response does not inadvertently do part of the terrorists’ job for them -- amplifying the terrorists’ terror and implementing policies that unnecessarily constrain society’s ability to function freely. Effective risk communication can mitigate adverse avoidance and adaptive behaviors, and significantly strengthen the resiliency of the U.S.
Ben Sheppard, PhD., is an Adjunct Fellow of the Potomac Institute for Policy Studies, and the author of “Psychology of Strategic Terrorism: Government and Public Responses to Attack” (Routledge, 2009). He can be reached at: