Funding cuts said to threaten states' preparedness progress

Dec 18, 2007 (CIDRAP News) – Several states have made progress preparing for a major public health emergency such as a pandemic or bioterror attack, but funding shortfalls at the federal level threaten to stall or even reverse recent gains, according to a report today from the nonprofit organization Trust for America's Health (TFAH).

Jeff Levi, PhD, director of TFAH, a health advocacy group based in Washington, DC, said today that despite the progress, his group still has a number of concerns, including some states' ability to distribute vaccines, antidotes, and medical supplies from the national stockpile and the lack of participation by others in the federal government's subsidy program for boosting antiviral stockpiles for use during an influenza pandemic.

"Differences in state-by-state capacity put the whole country at risk," Levi said at a press teleconference.

The 120-page report, released each year since 2003, gauges the preparedness of each state and the District of Columbia, assesses federal support for state efforts, and recommends measures for boosting the country's ability to handle an emergency requiring a broad public health response.

State preparedness ratings
The TFAH assessed how states performed on 10 preparedness indicators. Levi said some of the indicators stay the same each year, such as use of a disease surveillance system that is compatible with the national system. However, he said some indicators change to reflect evolving expectations and the availability of new data. This year's benchmarks include:

  • An adequate plan to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile
  • Participation in the federal subsidy for purchase of antiviral drugs for use during a flu pandemic
  • Sufficient public health laboratory capabilities to test for biological threats
  • Capability of laboratories to provide round-the-clock coverage to analyze samples
  • Use of a disease surveillance system that is compatible with the Centers for Disease Control and Prevention's (CDC's) integrated, Web-compatible national system
  • State laws that limit liability exposure for healthcare volunteers who serve during public health emergencies
  • Engagement in public health emergency preparedness drills or training exercises
  • A minimum threshold of Medical Reserve Corps volunteers per 100,000 people
  • Increased rates of seasonal flu immunization for adults aged 65 and older
  • Steady or increased funding for public health programs from 2005-06 to 2006-07

Thirty-five states and the District of Columbia met eight or more of the TFAH benchmarks. Illinois, Kentucky, Nebraska, New Jersey, Pennsylvania, Tennessee, and Virginia scored the highest with 10 out of 10. The states scoring lowest, with 6 out of 10, were Arkansas, Iowa, Mississippi, Nevada, Wisconsin, and Wyoming.

Only seven states and the District of Columbia lack sufficient capability to test for biological threats, which is down from 11 in last year's report. However, flu vaccination rates for seniors decreased in 11 states, the report notes.

The states that haven't participated in the federal antiviral subsidy are Colorado, Connecticut, Florida, Massachusetts, Mississippi, North Dakota, and Rhode Island. Levi said some state officials have voiced concerns over the shelf life of antivirals. He said current laws allow states to assume a 7-year shelf life, but federal stockpiles can be extended beyond that, depending on the advice of the US Food and Drug Administration.

The two indicators that address healthcare volunteers are designed to draw attention to surge-capacity issues, Levi said. Because officials expect hospitals will be overwhelmed during the next public health emergency, it will be important for healthcare volunteers to fill the gap outside hospitals and clinics, he said. Twenty-one states don't have laws that protect medical volunteers during an emergency, and 13 do not have at least 14 Medical Reserve Corps Members per 100.000 people, the report says.

Exposing funding gaps
Though federal officials have advanced disaster preparedness planning with passage of the Pandemic and All-Hazards Preparedness Act last year and the president's issuance of Homeland Security Presidential Directive 21, the report says federal funding for public health and pandemic preparedness has been "inconsistent and unpredictable."

The report says the Bush administration's fiscal year 2008 budget includes $146 million in cuts to bioterrorism and public health preparedness capacities, and programs intended to upgrade local preparedness programs and hospital readiness are taking the brunt of the reductions. The cuts represent a 25% drop from 2005 funding levels, TFAH asserts.

"And just when we are beginning to see a return on the federal investment in preparedness programs, the President and Congress have continued to cut these funds," Levi said in a press release that accompanied the report. "These efforts may seem penny wise now, but could prove to be pound foolish later."

See also:

Dec 18 TFAH press release, with links to complete report

CIDRAP News story on 2006 TFAH report

Oct 22 CIDRAP News story "White House aims to transform public health preparedness"

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