Nation is Unprepared for Bioterrorism Threat, Study Finds

Donna Young

More than three years after the terrorist and anthrax attacks of 2001 and $3 billion in federal funding, states are still struggling to meet basic emergency-preparedness requirements and have inadequate resources to cope with the various public health issues they face, a study released in December 2004 shows.

While progress has been made, limited resources, work force shortages, and the lack of a comprehensive information network continue to thwart improvement, according to the nonprofit Trust for America's Health (TFAH), which conducted the study.

Ready or Not: Protecting the Public's Health in the Age of Bioterrorism 2004 (PDF), funded by the Robert Wood Johnson Foundation, is a follow-up to the Trust's 2003 study.

Shelley Hearne, TFAH's executive director, said that the report rated states' emergency preparedness using 10 key performance indicators, such as existing and future public health work force, available laboratories, disease-tracking capabilities, and public health spending.

Two states, she noted, received the highest scores—Florida and North Carolina—achieving 9 out of 10 indicators.

Alaska and Massachusetts scored lowest, meeting only 3 of the indicators.

But most states fell into the middle, with over two thirds of states and the District of Columbia meeting six of the indicators.

"Which is a sign of great concern," said Hearne, speaking in Washington, D.C., at a December 16, 2004, forum hosted by the nonprofit Alliance for Health Reform.

While the scores indicate progress in some areas, their variance is evidence that the nation's bioterrorism-preparedness policy is "ill-defined and inconsistent," the report stated.

Only six states, Hearne noted, are adequately prepared to distribute and administer materials from the Strategic National Stockpile—a national cache of drugs, vaccines, and supplies established in 1999 by the Clinton administration that can be deployed to areas struck by disasters, including bioterrorism.

"That's an improvement from last year, when we had three, but it's still an indication of a long ways to go," she said.

A little more than one third of states have met national standards for disease tracking, Hearne said.

"One of the most critical elements of public health—Job 101—is to know the health of your community," she said. "It's a lesson we learned from years back when we actually solved the epidemics that were wiping out this country in the 1800s—cholera, yellow fever, typhoid—to track the health of the citizens. When you see a problem, that's where you can immediately do the rapid response, get out there, take care of those who are sick, and prevent others from getting sick. You need to know what's going on out there in the communities."

A state's readiness for a bioterrorism attack overlaps with planning for other public health threats, such as an influenza pandemic or a smallpox outbreak, said Ed Howard, executive vice president for the Alliance for Health Reform.

Before 2001, planning for an influenza pandemic was considered a model for bioterrorism preparedness. But now, according to TFAH's report, states use bioterrorism planning to prepare for an influenza pandemic.

In 2004, 30 states reported having a publicly available plan for managing an influenza pandemic—an immense improvement over the 13 states that reported having such a plan in 2003.

Yet, researchers noted, 20 states lack an influenza pandemic plan.

About three quarters of states and the District of Columbia reported that they had increased influenza vaccination rates for adults 65 years or older, researchers said.

Hearne stressed the importance of engaging the public in planning for health threats, whether those threats are man-made or "it's Mother Nature that actually throws us the next curve ball."

The 2004 influenza vaccine debacle, which resulted in long lines, confusion, and in some cases, hysteria, is evidence that states cannot have "theoretical plans" that sit on the shelf without knowledge of how to roll out those plans, she said.

Public health laboratories are central to response efforts in the event of a biological, chemical, or radiological terrorist attack, the report stated.

Yet only one third of states reported having a sufficient number of biological safety level 3 (BSL-3) laboratories.

However, that is a vast increase from the six that reported having adequate BSL-3 laboratories in 2003. But three states that reported in 2003 having ample BSL-3 laboratories—Alabama, Ohio, and Utah—reported in 2004 that due to facility and funding shortages, they no longer met the requirements for having sufficient facilities.

States also lack enough scientists to test for bioterrorism threats.

Indeed, just over 20 states reported that they had enough scientists to test for anthrax or plague.

One of the greatest challenges states face, Hearne said, is to sustain a well-trained public health work force.

"We found huge gaps in work force, and the next generation is not standing there ready to go," she said.

About half of states surveyed said that more than 25% of their public health workers will be eligible to retire in five years, the report stated.

"It certainly raises grave concerns about the stability of a work force," Hearne said.

But, she added, not only are large numbers of public health workers nearing retirement, salaries offered by state health agencies are not enough to compete with the private sector.

Counting on people to enter the public health work force because "they care is just not enough to get the job done," Hearne declared.

James S. Marks, senior vice president and health group director for the Robert Wood Johnson Foundation, noted that two thirds of state public health agencies reported in 2003 that their budgets had been cut, and in 2004 at least one third of state health agencies—some for the second year in a row—had their funds slashed.

Plus, federal bioterrorism funding decreased by over $1 million per state in 2004, according to the report.

"This is a little like pouring water to fill a bucket that has a hole in the bottom," Marks said. "Why should we be surprised that progress is not as great as we would like?"

The nation, he said, has asked the public health system, which he said is "badly in need of repair after years of neglect," to not only shoulder established diseases, such as asthma, tuberculosis, and cancer, but to also to take on the additional burden of being on the frontlines of preventing terrorist threats with limited resources and funding.

Marks noted that although the federal government has allocated $3 billion for state bioterrorism-preparedness programs, the apportioned amount per U.S. resident per year is only $3.50.

"I had coffee this morning from a name-brand coffee maker for $3.50," he said.