Summary

The anthrax incidents during the fall of 2001 raised concerns about the nation's ability to respond to bioterrorist events and other public health threats. The incidents strained the public health system, including surveillance and laboratory workforce capacities, at the state and local levels. Several months after the incidents, the Congress appropriated funds to strengthen state and local bioterrorism preparedness. The Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) distributed the funds in 2002 through two cooperative agreement programs with state, municipal, and territorial governments. To strengthen preparedness, the two cooperative agreement programs--CDC's Public Health Preparedness and Response for Bioterrorism Program and HRSA's National Bioterrorism Hospital Preparedness Program--require participants to complete specific activities designed to build public health and health care capacities. The 2002 cooperative agreements for both programs ended on August 30, 2003. For the 2002 cooperative agreements, CDC's and HRSA's programs distributed approximately $918 million and approximately $125 million, respectively. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 directs us to report on federal programs that support preparedness efforts at the state and local levels. We have previously reported on state and local efforts and hospital preparedness. As agreed with the committees of jurisdiction, for this report, we examined the extent to which states completed 2002 cooperative agreement requirements and whether states identified any factors that hindered implementation of CDC's program and HRSA's program.

States reported progress toward the CDC program's goal of strengthening public health preparedness, but identified factors that hindered them from meeting all of CDC's 2002 cooperative agreement requirements. All states reported progress in developing the capacities CDC considers critical for public health preparedness, but no state completed all program requirements. Some of the 14 requirements that CDC considers critical benchmarks of preparedness were more likely to be completed than others. Four critical benchmarks were met by most of the states. These benchmarks included the establishment of a bioterrorism advisory committee and coverage of 90 percent of the state's population by the Health Alert Network--a nationwide program designed to ensure communication capacity at all state and local health departments. Two critical benchmarks were met by few of the states: development of a statewide response plan and development of a regional response plan. The remaining eight critical benchmarks were met by around half the states. These benchmarks included assessment of emergency preparedness and response capabilities, development of a system that can receive and evaluate urgent disease reports at all times, and development of an interim Strategic National Stockpile plan. In addition, state and local officials reported three main factors that hindered their ability to complete all of CDC's requirements: (1) redirection of resources to the National Smallpox Vaccination Program, (2) difficulties in increasing personnel as a result of state and local budget deficits, and (3) delays caused by state and local management practices, such as contracting and hiring procedures. Similarly, states reported progress toward the HRSA program's goal of strengthening hospital preparedness but identified factors that have hindered their efforts to complete all of HRSA's 2002 program requirements. While no state has completed all of HRSA's requirements--to conduct needs assessments, to meet three critical benchmarks of hospital preparedness, and to address priority issues--states have until March 31, 2004, to complete most of them. No state reported completing all components of its needs assessment. Almost all states reported that they had met two of the three critical benchmarks: designation of a coordinator for hospital preparedness planning and establishment of a hospital preparedness planning committee. No state reported meeting the third benchmark--development of a plan for the hospitals in the state to respond to an epidemic involving at least 500 patients. States reported varying degrees of progress in addressing the priority issues that HRSA required them to address, such as receipt and distribution of medications and vaccines, personal protection of health care workers, quarantine capacity, and communications. State officials expressed concern that HRSA funding was insufficient for states to meet the requirements of the 2002 program. Similarly, hospital representatives reported that redirection of resources to the National Smallpox Vaccination Program and delays caused by lengthy contracting processes for distributing funds from the state to the hospitals hindered efforts to implement the program.