Mapping Perceptions Related to Acceptance of Smallpox Vaccination by Hospital Emergency Room Personnel

Emergency room workers would likely be on the frontlines in the event of a bioterrorism attack using smallpox, yet in the past these workers were reluctant to be vaccinated against smallpox. The authors use perceptual mapping methods to determine how ER workers’ attitudes about vaccination change in various scenarios with increasing levels of threat.

Emergency department personnel would be first responders in the event of a bioterror smallpox outbreak, yet few were willing to be vaccinated during the 2002 federal campaign. To better understand vaccination concerns, perceptual mapping methods were used to create multidimensional models of how emergency department personnel (N = 73) in the Philadelphia area perceive the risks and benefits of smallpox vaccination under 4 levels of threat: (1) today; (2) if another terrorist attack happened anywhere in the U.S.; (3) if a smallpox attack happened somewhere in the U.S.; (4) if a smallpox attack happened locally. The perceptual maps show significant shifts in factors that are important for motivating respondents to accept vaccination under increasingly higher levels of threat. In the “today” scenario, endorsement of vaccination from a credible source, such as a major hospital in the area, was a very important factor (mean = 7.10 on a 0–10 scale). However, endorsement was not as important under the 2 higher levels of threat. Under these conditions, respondents’ sense of wanting to help in a disaster emerged as an important element the closer the hypothetical attack was to the respondent, ranging in importance from 3.87 under the least threat to 7.35 under the greatest threat scenario. The perceptual maps yield information that would assist planners in designing more effective risk communication strategies tailored to particular audiences and levels of threat. Such communications are important to prepare for a smallpox event or other uncertain outbreak, where it is essential to rapidly vaccinate a critical mass of healthcare workers.