Apr 18, 2006 (CIDRAP News) – Close to half of local public health workers who responded to a survey in three Maryland counties last year said they probably would not come to work during an influenza pandemic, according to a study published today.

The reluctance to report for work was linked with a perception by most of the workers' that they would not have an important role to play in a pandemic emergency. Only 40% of the workers thought they would even be asked to work in that situation, and nearly two thirds thought going to work would be risky, according to the report published online by BMC Public Health. Clinical staff members were much more likely than technical and support workers to express a willingness to work during a pandemic.

The research was conducted by Ran D. Balicer, MD, MPH, of Ben-Gurion University in Israel and three colleagues from the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"We found that most of these workers feel they will work under significant personal risk, in a scenario they are not adequately knowledgeable about, performing a role they are not sufficiently trained for, and believing this role does not have a significant impact on the agency's overall response," their report says.

The survey was conducted among public health workers in Carroll, Dorchester, and Harford counties in Maryland between March and July of 2005. Of 531 workers who received the self-administered questionnaire, 308 (58%) completed and returned it. There were no significant differences in age and gender distributions between the survey respondents and the workers overall.

About 54% of the respondents said they would be willing to go to work in a pandemic, the report says. Compared with technical and support workers, clinical workers, such as physicians, dentists, and nurses, were more than twice as likely to be willing to work (odds ratio in multivariate analysis, 2.5; confidence ratio, 1.3 to 4.7).

Only 40% of the workers—45.1% of professional employees and 26.1% of support and technical staff—thought they would be asked to work in a pandemic emergency, the authors report.

The workers' perception of their importance in pandemic response was the single most important variable associated with a willingness to work. Only 15.1% of technical and support workers and 18.4% of environmental health workers believed they would have important roles to play.

Overall, "Less than a third of the respondents believe they will have an important role in the agency's response to local outbreaks of pandemic influenza, but within this subgroup, willingness to report to duty was as high as 86.8%," the article says.

Sixty-six percent of the respondents thought they would be at risk if they worked during a pandemic, the authors found. Regardless of job classification, workers' perception of their own safety was linked with their perceived knowledge about flu pandemics and their perceived ability to communicate about risks, among other variables. Only 33.4% described themselves as knowledgeable about the public health impact of a pandemic.

"In the face of a pandemic influenza threat, local health department employees' unwillingness to report to duty may pose a threat to the nation's emergency response infrastructure," the authors write.

The report does not present any specific information on workers' reasons for their unwillingness to report to work or their attitudes or beliefs about pandemic flu. The authors acknowledge several limitations of the study: It was limited to three nonrandomly selected health departments in one state; the sample size was relatively small; the job classifications didn't correspond neatly with functional responsibilities in a disaster; and technical and support staff were slightly overrepresented among survey respondents.

The researchers recommend several measures to improve the situation, such as training workers in their specific roles in pandemic response, providing risk-communication training, and providing personal protective equipment.

Balicer RD, Omer SB, Barnett SB, et al. Local public health workers' perceptions toward responding to an influenza pandemic. BMC Pub Health 2006 Apr 18 (early online publication) [Full text]