Public health found still not ready for bioterrorism

Washington -- A new study finds that states are only marginally better prepared for a bioterrorist attack today than they were before Sept. 11, 2001, despite the nearly $2 billion in federal funds that have since been pumped into their budgets.

No state scored a perfect 10 on indicators that were selected by the Trust for America's Health, a nonprofit health promotion group, to reflect the capabilities the organization believes every state public health system should have in a post-9/11 world.

The report, "Ready or Not? Protecting the Public's Health in the Age of Bioterrorism," assessed areas of improvement and areas of continued vulnerability in the nation's effort to prepare for bioterrorism and other large-scale health emergencies.

"Are we ready or not? The answer is not," said Shelley Hearne, PhD, Trust's executive director. "While there has been some progress made, we cannot fix overnight a system that has been neglected for over 20 years," she told a group of congressional staffers and others assembled by the Alliance for Health Reform for a Dec. 11, 2003, briefing.

California, Florida, Maryland and Tennessee scored the highest among the states, meeting seven of the trust's 10 measures. Arkansas, Kentucky, Mississippi, New Mexico and Wisconsin scored the lowest, meeting just two.

Nearly three-quarters of states received positive marks for five or fewer of the indicators.

The report measured a state's preparedness level in three general categories:

• Funding, including state budgets for public health programs.
• Public health infrastructure, including an examination of work force, laboratories and communication preparedness in the states.
• "Double duty" indicators that reflect how recent public health bioterrorism funding has affected traditional public health functions.

Among gains made by most states were those in emergency health communication. Most of the population is now covered by the Centers for Disease Control and Prevention's emergency communications network. In contrast, "Health officials around the country during the 2001 anthrax investigation said they were getting better information from CNN than [from the] CDC," said Dr. Hearne.

In addition, all 50 states have drafted bioterrorism plans, and many have begun upgrading their laboratory facilities and equipment and hiring additional staff.

However, nearly two-thirds of states have cut their public health services budgets; only half have spent 90% of their fiscal year 2002 bioterrorism funds; and one-third have passed along only half their federal funds to local health departments.

The report also found that only one-quarter of states have a plan to respond to a pandemic flu outbreak. "Public health officials are severely concerned about influenza. We are long overdue for a major event," said Dr. Hearne. However, often the bioterrorism money is put into a "silo" and states might not be able to access the funds for use during a severe flu outbreak, she noted. "But flu is just as serious a concern."

An all-hazards approach is necessary, said Dr. Hearne, as well as a long-term commitment to funding public health.

Public health on the rebound

In defense of the nation's public health system, Georges Benjamin, MD, executive director of the American Public Health Assn., said that vast changes have occurred in operating environment and infrastructure during the past two years.

The public health system has moved from being invisible to being a visible player in the nation's security as well as one that is up and running 24/7, not just from 9 to 5 Monday through Friday, he said.

A consistent and adequate funding stream is vital. "Stop the yo-yo funding," he urged. The system also faces a work force drain in which 20% to 30% of the those working in public health will be eligible for retirement in the next five years and there aren't enough people in the pipeline to fill the positions. Public health and hospitals may be forced into a competition for nurses.

North Carolina State Health Director Leah Devlin, DDS, MPH, came to the defense of her state, which the new study said met five of the 10 indictors of preparedness. Most of the states, including North Carolina, are more ready than not and more ready than they have ever been. "It's important to keep the spotlight on public health," she said. "Public health for the first time is being recognized as a critical first-responder."

Her state, for instance, spent 100% of its fiscal year 2002 bioterrorism funding, and 100% of its 2003 funding is obligated. Seventy-five percent of the bioterror funds were spent directly or in support of local health departments, and while state public health funding overall has been reduced by 11.7% over two years, no cuts were related to bioterror preparedness. "North Carolina is a five in the report, but I think we are a nine," she said.