Summary
Much of the response to a bioterrorist attack would occur at the local level. Many local areas and their supporting state agencies, however, may not be adequately prepared to respond to such an attack. In the Public Health Improvement Act that was passed in 2000, Congress directed GAO to examine state and local preparedness for a bioterrorist attack. In this report GAO provides information on state and local preparedness and state and local concerns regarding the federal role in funding and improving preparedness. To gather this information, GAO visited seven cities and their respective state governments, reviewed documents, and interviewed officials. Cities are not identified because of the sensitive nature of this issue.
State and local officials reported varying levels of preparedness to respond to a bioterrorist attack. Officials reported deficiencies in capacity, communication, and coordination elements essential to preparedness and response, such as workforce shortages, inadequacies in disease surveillance and laboratory systems, and a lack of regional coordination and compatible communications systems. Some elements, such as those involving coordination efforts and communication systems, were being addressed more readily, whereas others, such as infrastructure and workforce issues, were more resource-intensive and therefore more difficult to address. Cities with more experience in dealing with public health emergencies were generally better prepared for a bioterrorist attack than other cities, although deficiencies remain in every city. State and local officials reported a lack of adequate guidance from the federal government on what it means to be prepared for bioterrorism. They said they needed specific standards (such as how large an area a response team should be responsible for) to indicate what they should be doing to be adequately prepared. The need for federal guidance has continued to be an issue as states have proceeded in their planning and preparedness activities with funding from HHS. For example, in their progress reports to HHS in late 2002 two states reported that they were seeking guidance from HHS on assessing vulnerabilities for foodborne or waterborne diseases and preparedness steps they should take for these hazards. One of these states has declared that it could not make further efforts on testing for these types of diseases until it receives more guidance. State officials also expressed a desire for more sharing of best practices. Officials stated that, while each jurisdiction might need to adapt procedures to its own circumstances, time could be saved and needless duplication of effort avoided if there were better mechanisms for sharing strategies across jurisdictions. They stated that HHS was better positioned to know about different strategies that states were pursuing and they want information on the best practices.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
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Recommendations for Executive Action
Recommendation: To help state and local jurisdictions better prepare for a bioterrorist attack, the Secretary of Health and Human Services should, in consultation with the Secretary of Homeland Security, develop specific benchmarks that define adequate preparedness for a bioterrorist attack and can be used by state and local jurisdictions to assess and guide their preparedness efforts.
Agency Affected: Department of Health and Human Services
Status: Implemented
Comments: GAO found that officials from response organizations in seven states reported a lack of guidance from the federal government on what it means to be prepared for bioterrorism. Consistent with one of GAO's recommendations, the Centers for Disease Control and Prevention developed interim evidence-based performance goals for public health disaster preparedness and distributed them to state and local public health departments for their current use. In addition, the Department of Homeland Security is incorporating the public health performance goals into a federal effort to standardize state and local public health departments' bioterrorism preparedness exercises and training.
Recommendation: To help state and local jurisdictions better prepare for a bioterrorist attack, the Secretary of Health and Human Services should, in consultation with the Secretary of Homeland Security, develop a mechanism by which solutions to problems that have been used in one jurisdiction can be evaluated by HHS and, if appropriate, shared with other jurisdictions.
Agency Affected: Department of Health and Human Services
Status: Implemented
Comments: GAO found that officials from response organizations in seven states expressed a desire for increased information sharing among state and local jurisdictions of best practices on various types of bioterrorism preparedness activities. Consistent with one of GAO's recommendations, the Centers for Disease Control and Prevention, in coordination with the American Medical Association, held its First National Congress on Public Health Readiness in July 2004, with the purpose to provide a forum of discussion, information sharing, resource development, networking, and collaboration with key partners.
