The H1N1 flu outbreak has exposed serious gaps in the nation's ability to respond to public health emergencies and the economic crisis is straining an already fragile public health system, according to a report released Tuesday by the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation.
The report, "Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism," found that 20 states scored six or less out of 10 key indicators of public health emergency preparedness, and nearly two thirds of states scored seven or less. Eight states tied for the highest score of nine out of 10: Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma, Texas, and Vermont. Montana had the lowest score at three out of 10.
The preparedness indicators were developed in consultation with leading public health experts based on data from publicly available sources or information provided by public officials.
The report showed "that a Band Aid approach to public health is inadequate," said Richard Hamburg, deputy director of TFAH. "As the second wave of H1N1 starts to dissipate, it doesn't mean we can let down our defenses. In fact, it's time to double down and provide a sustained investment in the underlying infrastructure, so we will be prepared for the next emergency and the one after that."
Overall, the report did find that the investments made in pandemic and public health preparedness over the past several years improved U.S. readiness for the H1N1 outbreak. However, it also found that decades of chronic underfunding meant that many core systems were not ready for the effects of the flu.
Some key infrastructure concerns were a lack of real time coordinated disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity, and a shrinking public health workforce. Also, the report found that half of the states experienced cuts to their public health funding and federal preparedness funds, which puts improvements made since Sept. 11 at risk.
Other key findings from the report include:
- Twenty-seven states cut funding for public health from fiscal 2007 08 to 2008 09.
- Thirteen states have purchased less than 50% of their share of federally subsidized antiviral drugs to stockpile for use during an influenza pandemic.
- Fourteen states do not have the capacity in place to assure the timely pick up and delivery of laboratory samples on a 24/7 basis to the Laboratory Response Network.
- Eleven states and Washington , DC, report not having enough laboratory staffing capacity to work five 12 hour days for six to eight weeks in response to an infectious disease outbreak, such as H1N1.