TCS Daily

State of Unpreparedness

By Sydney Smith - October 8, 2002 12:00 AM

Lately, Congress has been busy beating its collective chest in righteous indignation at the lost opportunities to prevent 9/11. Nothing is so perfect as hindsight. Yet, one year after someone deliberately disseminated anthrax through the postal system, killing five people and sickening seventeen others, our public health authorities practically flaunt their lack of foresight in preventing and responding to future attacks - to the indignation of no one.

Some state health departments have clearly learned the lessons of last fall, and have re-organized themselves accordingly. The Arkansas Department of Health, for example, has set up a bioterrorism command center, complete with twenty-four hour telephone access. One county in Maryland has even gone so far as to hold mock bioterror attack drills to fine tune their plans.

But, these are the exceptions rather than the rule. There are many states that have yet to designate a site in each community to be used for quarantine. There are many states that have yet to consider suitable places for mass vaccination sites. There are local health departments with outmoded computer systems, and those with no access to the Internet. There are local health departments that lack the means to refrigerate vaccine once it reaches them, or to break down antibiotic shipments into the individual doses needed to deliver them to the public. Most public health authorities admit they have no idea where they'll get the manpower to administer mass vaccinations if needed. There are even local health departments that have no ability to communicate quickly and effectively with their community's physicians. And there are many public health departments who have made no effort to educate those physicians, the first responders in a biological attack, about bioterrorism and the appropriate public health response to it.

Public health authorities certainly can't plead poverty as an excuse. When the anthrax outbreaks in Florida and New York were recognized as deliberate attacks, Congress quickly passed the Bioterrorism Preparedness Act, which set aside money for state health departments to prepare themselves for future threats. By January of this year, long before the act became law, the Department of Health and Human Services allocated $220 million to the health departments of all fifty states and three major cities to put their preparedness plans into motion. The funds, representing roughly twenty percent of the eventual 1.1 billion dollars to be designated for that purpose, were dispersed proportionately to each state based on population.

In turn, the states were told to submit plans that provided for seventeen key preparedness benchmarks by last March. When their plans were approved by the HHS, the states would receive the remainder of their money. In June, after President Bush signed the act into law, the rest of the funds were released, but only twenty four states and two cities had submitted plans adequate enough to receive their full share. Four months later, those numbers have improved, but only slightly. (For a breakdown of how each state stands, click here.)

Such a state of unpreparedness can only come from a lack of will and imagination. One year ago the deliberate use of anthrax as a terrorist weapon was unthinkable to most of us. Today, bioterrorism is no longer unthinkable - except to those in the public health sector. Smallpox? It exists only in the realm of possibilities. Its risk can't be measured and translated into the language of epidemiology - the native tongue of the majority of public health physicians, so they can't bring themselves to take it seriously. Obesity and tobacco abuse, on the other hand, are familiar and well-measured health risks, and for many of our public health officials, more worthy of attention than bioterrorism preparedness.

Dr. Julie Gerberding, the newly appointed head of the CDC, has been quoted as saying that the changes she's made to address bioterrorism have "thrown some CDC staff members off balance, fretting that the focus on bioterrorism is overwhelming the agency's responsibility for all aspects of public health." The same reaction is occurring in public health departments all over the country, not just in staff members, but in the leadership as well.

Which explains why so many states have yet to formulate workable preparedness plans. And which explains the presence of two very different documents I have on my desk from my own public health department. The first is a letter-sized sheet that was faxed to my office a year ago, just after the first anthrax case was recognized as a bioterrorist act. It has the phone numbers of every department in our public health system, and the names and numbers of each public health physician. The numbers are barely legible, and thereĀ¹s no mention of anyone being available twenty-four hours, seven days a week. The other document just arrived a couple of weeks ago. It's a handsome, professionally printed collection of materials to educate both physicians and patients on preventing falls in the elderly. It may be just be a coincidence, but the pretty pamphlets say the initiative was funded by money from the CDC and the state health department. Meanwhile, my faxed list of names and phone numbers remains the last word I ever heard from them on

The author is a family physician who has been in private practice since 1991. She is board certified by the American Board of Family Practice, and is a Fellow of the American Academy of Family Practice. She is the publisher of MedPundit.



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