Think prepared!

Feb. 1, 2004

Think prepared!

In 1953, President Dwight D. Eisenhower professed, History does not long entrust the care of freedom to the weak or the timid. We must acquire proficiency in defense and display stamina in purpose. Where I grew up, ordinary folk having survived a World War and confronting the Korean War figured out escape routes, practiced fire drills, knew who lived in their community, got polio vaccinations for their children, donated blood, stored food and supplies, trained the Scouts in first aid and resuscitation, tested the civil defense sirens regularly, and generally had a handle on defending themselves as best they could against various threats. My part as a third-grader meant diving under my desk when the teacher yelled, Drop! Everyone played a role in being prepared. 

So, when MLO received news of the Trust for Americas Health (TFAH) report, Ready or Not? Protecting the Publics Health in the Age of Bioterrorism,
( at the end of 2003, I was astonished to find that only nine states met more than half of 10 preparedness targets drawn up by its advisory panel of seasoned health experts. Our nations capital met only three. 

Twenty-six states did not spend or obligate 90% or more of the FY 2002 federal bioterror preparedness funding. Thirty-three states did not provide at least 50% of federal capacity-building funds directly to local health departments. Thirty-two states and D.C. decreased funding for public health services. Only Florida and Illinois have assembled appropriate staff to receive/distribute medication/supplies from the Strategic National Stockpile. Seven states and D.C. do not have at least one lab equipped to handle critical biological agents with a biosafety level 3 (BSL-3) designation, while 44 states and D.C. do not have sufficient BSL-3 lab facilities. More than three counties in each of 21 states are without continuous high-speed connections to the national Health Alert Network. Thirty-seven states and D.C. have no completed or draft plan for confronting the emergence of a new, lethal strain of influenza and this health threat alone, says TFAHs report, should loom as large as bioterrorism or

Last years APHL analysis asserted that 30 states had cut lab funds, directly diminishing the states abilities to manage a wide range of health threats. In 2001, the CDC warned that the U.S. public health infrastructure is still structurally weak in nearly every area. In 2003, the IOM noted that, among others, problems like an inadequately trained public health workforce and antiquated laboratory capacity leave the nations health vulnerable and not only to exotic germs and bioterrorism. The U.S. GAO concurred in 2003, finding deficiencies in capacity, communication, and coordination elements essential to preparedness and response.

State officials surveyed for the TFAH study agreed that public health was neglected for 20 years before the 9/11 tragedy, which was followed by the anthrax attacks, the SARS threat, and the spread of West Nile virus. While all 50 states and the District now have a CDC-approved plan for developing and initiating a bioterrorist attack or other public health emergency response plan, coordination and planning progress leave much to be desired. Where did the urgency for national preparedness go that was born on that bleak September day?

Forty years ago, a carpool caravan shuttled us schoolchildren to the country outside Atlanta in practice evacuation exercises, and rickety old wooden desks were our protection should a surprise attack occur. These sometimes feeble arrangements to spare us should an atom bomb hit the city did not make sense then, and still do not. But that unity of local and national preparedness was still alive and well when the 1963 Cuban missile crisis surfaced.

What makes sense now is that we acquire and retain that proficiency in defense and continue to display stamina in purpose. February
2004: Vol. 36, No. 2