In the event of a pandemic requiring public health workers to respond to, transport or otherwise physically have to deal with pandemic-levels of influenza victims, a new survey published last Friday found that about 1 in 6 public health workers would not report to work during a pandemic regardless of the severity of the pandemic strain of flu.

The report of the survey, “Assessment of Local Public Health Workers' Willingness to Respond to Pandemic Influenza through Application of the Extended Parallel Process Model," published in the journal PLoS ONE - an interactive open-access journal for the communication of all peer-reviewed scientific and medical research – stated that 16 percent of the workers that were surveyed said they would not report to work regardless of the severity of the pandemic.

The survey was led by researchers at the Johns Hopkins Center for Public Health Preparedness and Johns Hopkins Preparedness and Emergency Response Research Center in Baltimore, Maryland.

Throughout the debates and planning at both Federal, state and local levels for an influenza pandemic, concerns about how many public health workers would actually show up to work has been of great concern. Early on in pandemic planning, there were estimates that perhaps as much as 40 percent of the public emergency health care workforce across the board would be absent from work, a number that paralleled estimates for nearly all workforce employees.

The latest findings though are a substantive improvement over the Johns Hopkins research teams’ survey in 2005 of public health care workers that found that more than 40 percent of public health employees said they were unlikely to report to work during a pandemic.

"Employee response is a critical component of preparedness planning, yet it is often overlooked. Our study is an attempt to understand the underlying factors that determine an employee's willingness to respond in an emergency," said Dr. Daniel Barnett, the lead author of the study and assistant professor in the Department of Environmental Health Sciences at the Bloomberg School of Public Health.

“The anticipated worldwide morbidity, mortality, and social disruption from an influenza pandemic require detailed and tested approaches to staffing and resource allocation in public health systems,” the study stated. “The willingness of health responders to report to duty during an influenza pandemic is a highly salient concern given the ‘inevitable’ nature of this threat and its associated challenges. Scant margin exists in the nation's public health system for local health department workers – the backbone of public health system readiness – to ‘opt out’ of response duties, given limitations of health system surge capacity, public health personnel shortages, and continued steep learning curves associated with relatively new 24/7 response expectations for health department employees.”

The new study noted that “the unwillingness of some health workers to place themselves at risk of exposure to emerging infectious diseases was observed during the 2003 SARS epidemic and the early years of the HIV/AIDS epidemic. In the aftermath of the terror attacks of September 11, 2001 and the ensuing anthrax bioterrorism attacks, a growing body of research literature has examined willingness to respond to large-scale emergencies among a variety of health-related cohorts.”

But “despite the evidence for fundamental distinctions between ability and willingness to respond, there remains a gap in the public health preparedness literature on training approaches that explicitly address response willingness (attitude) as a discrete outcome. Based on the principle that ‘all disasters begin locally,’ these observations underscore a fundamental need to understand root causes of local public health workers' barriers to response willingness, as a basis for identifying and addressing public health response system gaps in this domain.”

The current study stated that “a variety of risk perception theories have been suggested and may help to identify barriers to health personnel adopting an emergency responder role. One prominent model conceptualizes risk perception as the sum of ‘hazard’ and ‘outrage,’ where hazard is a product of risk magnitude and probability, and outrage is a function of other peripheral influences independent of the actual risk, such as perceived authority, trust, and situational control.”

For example, the study stated that “among the public health workforce, recent applications of this ‘Risk = Hazard+Outrage’ model have uncovered a variety of potential peripheral risk perception influences on health department workers' response willingness apart from the actual hazard ... in a 2005 pilot study conducted in three local health departments in Maryland, we found that a health department employee's individual perceived level of importance in their agency's response efforts was a particularly strong peripheral influence on response willingness toward an influenza pandemic.”

“To build a public health workforce that is not only able to respond, but also willing to do so ... observations suggest the need for a unifying paradigm that can address both the threat and efficacy dimensions of willingness to respond,” the report stated, noting that, “to date, the research literature on public health emergency response willingness has lacked such a paradigm.”