Complacency, underfunding fuel state readiness gaps

In its annual snapshot of how prepared the nation is to prevent and battle infectious disease outbreaks, Trust for America's Health (TFAH) said today there are still major gaps, with more investments needed to battle new threats such as MERS-CoV, antibiotic-resistant organisms, and spikes in diseases such as pertussis.

The Washington, DC–based health advocacy group said more than half (28) of states met 5 or fewer of the 10 indicators that the group uses to gauge the capacity to detect, diagnose, and respond to outbreaks.

At a media telebriefing today, TFAH Executive Director Jeffrey Levi, PhD, said overall preparedness has improved since the 2001 terror and anthrax attacks, but the nation is in a pattern of ebbs and flows driven by newly emerging threats, with a fall back to complacency in the wake of the Ebola outbreak.

Though the report isn't designed to show a comprehensive overview of preparedness, it is an important bellwether, he said.

"The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country's ability to prepare for infectious disease threats," he said in a statement. "We cannot afford to continue to be complacent. Infectious diseases—which are largely preventable—disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary healthcare costs each year."

Gaps in all areas

The 116-page report, now in its 13th year, showed that five states tied for the top ranking, meeting 8 of 10 indicators: Delaware, Kentucky, Maine, New York, and Virginia. Seven states were tied at the bottom of the list, meeting only 3 of TFAH's indicators: Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon, and Utah.

In its breakdown of some of the report's highlights, an indicator designed to assess healthcare-associated infection (HAI) control capacity showed that only nine states reduced the standardized infection ratio for central line-associated bloodstream infections between 2012 and 2013.

Levi said the findings highlight a troubling 150% increase in new hepatitis C infections in young adults from 2010 to 2013, related to a rise in heroin and injection drug use. So far only 16 states and Washington, DC, explicitly authorize syringe exchange programs.

For HIV, 43 states require reporting of all detectable and undetectable CD4-cell-count and viral-load data to state surveillance programs, an important tool for measuring the impact of treatment programs.

The report also found that gaps remain in preparedness for emerging threats, such as a bioterror attack. For example, TFAH found that 36 states have a biosafety professional in their state labs and that only 15 have completed their climate change adaptation plans.

Eroding resources

At the media briefing, Dan Hanfling, MD, contributing scholar at the UPMC Center for Health Security in Baltimore, said that, during last year's Ebola outbreak, health departments were able to backfill their capacities with emergency supplemental funding. "But this year, it seems like a distant memory to many," he said. "I've seen it over and over again, the failure to sustain funding."

Hanfling said another gap is a lack of a strong plan to care for patients in outbreak settings. "Surge planning needs to go to the next level. We aren't quite there yet."

He added, however, that the Ebola outbreak raised awareness, and that some progress is being made, such as the creation of the National Ebola Training and Education Center, which is poised to prepare hospitals for not only Ebola but other emerging diseases.

Levi said a bright spot is the development of a Centers for Disease Control and Prevention strategy for modernizing the nation's surveillance system. "But there's a long way to having the resources to build it," he said, noting that an ongoing overarching concern is the need to create a solid public health infrastructure that can provide a reliable response to infectious diseases.

Hanfling warned that flat public health funding has come to be seen as an increase in support. "What it really represents is an erosion."

Recommendations for next steps

TFAH's report came with a list of recommendations across a range of preparedness issues. For example, it pushes for updates in surveillance systems so that they can track diseases in real time and be operable across communities and health systems.

The report also urges incentives for the development of new medicines and vaccines and an improved ability to handle a wide range of threats—from a widespread outbreak to a novel pathogen that requires specialty care.

TFAH called for every state and city to adopt modernized strategies to stamp out AIDS. Its other recommendations include stepped-up measures to decrease antibiotic use, HAIs, and infections in young adults such as hepatitis C and sexually transmitted diseases.

See also:

Dec 17 TFAH report page

Dec 17 TFAH press release

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