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The US as a whole had a score of 7.1 out of 10 for 2017, nearly a 3% improvement.
Even an epidemic in a far-off country could do major damage to the US economy, experts say.
"It seems we've lost an understanding of the difference between a pandemic and an epidemic."
One recommendations is for all nations to assess preparedness and animal health capacities by 2019.
The plan includes a $2.8 billion boost to HHS but cuts to global health.
The annual index found worrying discrepancies among states that create widening gaps, especially in low-income areas and those vulnerable to public health emergencies.
TFAH rated 26 states and Washington, D.C., as 6 or lower on a 10-point scale.
The non-profit highlights policies that could save billions in avoidable healthcare costs, it says.
The report showed some weak spots, including a persistent and varied gap in readiness among states.
An exhaustive 2-year effort gives the US an overall score of 7.2 out of 10.
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CIDRAP - Center for Infectious Disease Research and PolicyOffice of the Vice President for Research, University of Minnesota, Minneapolis, MN
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