"Ready or Not?" Report on Preparedness for Biological Threats

The Trust for America's Health has issued its fourth annual "Ready or Not?" report on the state of preparedness in protecting the public from biological threats. The report's major findings are:

1. Only 15 states and two cities are rated at the highest preparedness level required to provide emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile (SNS).
2. Eleven states and D.C. lack sufficient capabilities to test for biological threats.
3. Four states lack sufficient laboratory experts trained to test for a suspected outbreak of anthrax or the plague.
4. Four states do not test for flu on a year-round basis, which is necessary to monitor for a pandemic flu outbreak.
5. Half of states would run out of hospital beds within two weeks of a moderately severe pandemic flu outbreak.
6. Flu vaccination rates for seniors decreased in 13 states.
7. The national median for vaccinating seniors for pneumonia is 65.7 percent, the national goal is to vaccinate 90 percent by 2010.
8. Twelve states and D.C. are not fully compatible with the Center for Disease Control and Prevention’s (CDC’s) National Electronic Disease Surveillance System (NEDSS) to track disease outbreak information.
9. Forty states and D.C. have a shortage of registered nurses.
10. Six states cut their public health budgets between FY 2004-05 and FY 2005-06. As of FY 2005-06, the median state funding for public health is only $31 per person per year.

The report emphasizes that collaboration is needed among public health professionals and other responders. It argues that an effective response will require, among other things:

Pre-planned, safety-first rapid emergency response capabilities and precautions:

Tested plans and safety precautions to mitigate potential harm to communities, public health professionals, and first responders.

Immediate, streamlined communications capabilities: Coordinated, integrated communications among all parts of the public health system, all frontline responders, and with the public. Must include back-up systems in the event of power loss or overloaded wireless channels.

But because the public health system is distributed across all levels of government, some problems with coordination arise. Specifically:

Lack of clear roles for the various state, local, and federal agencies.

Limited coordination among the levels of government, including determination of how federal assets would be deployed to states and localities, and across jurisdictions, such as sharing assets and resources among states.

No minimum standards, guidelines, or recommendations for capacity levels or services required of state and local health departments. This results in major differences in services and competencies across state and local agencies.

The bulk of the report provides scores on preparedness in for each state. It's worth looking up for your state. (Oklahoma scored the highest.) It also makes some recommendations, although these are mostly at the federal level.

Overall, the report provides more weight to the argument that better coordination between public health agencies – at all levels of government – and first responders is a must.