Bioterror Preparedness Still Lacking, Health Group Concludes

By Ceci Connolly
Washington Post Staff Writer
Friday, December 12, 2003; Page A02

One year after President Bush sought to energize the nation's bioterrorism preparations with an unprecedented smallpox vaccination campaign, the program has all but ground to a halt. A report released yesterday, meanwhile, finds that only two states -- Florida and Illinois -- are prepared to distribute and administer vaccines or medicines that would be needed in the event of a major outbreak or attack.

Fewer than a dozen states have written plans for dealing with other public health threats such as pandemic flu, the report added, and most remain ill-prepared for any large-scale emergency.

After two years of work and $2 billion in federal aid, "states are only modestly better prepared to respond to public health emergencies than they were prior to Sept. 11, 2001," the Trust for America's Health, a nonpartisan, nonprofit health advocacy group, concluded.

Despite Bush's high-profile call on Dec. 13, 2002, for the immunization of millions of health care workers and emergency responders, the number vaccinated has been stuck at 38,700 for months.

"We are still underprepared to respond to even two cases of smallpox anywhere in the world," Michael T. Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, said in a telephone interview. Just as health care workers and the public "panicked" in the spring over a few cases of monkeypox, Osterholm predicted that a report of smallpox would send thousands rushing to hospitals in search of vaccine and find few people there ready to deliver it.

"You need a core group of vaccinated workers able to go out to the front lines, and we don't have that," he said.

Other experts voiced fears that not enough attention has been given to lethal chemical agents, hospital surge capacity and sophisticated staff training.

"Are we ready or not? The answer is not," said Trust executive director Shelley A. Hearne. "Now is the time to get serious about developing an all-hazards approach to public health to ensure we are ready for the range of possible threats we face."

White House spokesman Trent Duffy said Bush is pleased with the progress made on smallpox defenses but "would like more front-line workers to be vaccinated."

Joseph Henderson, associate director for terrorism preparedness and emergency response at the Centers for Disease Control and Prevention, said the report "tells us things we've already known. We know we have a lot of work to do."

But, he added, the swift response to naturally occurring outbreaks such as severe acute respiratory syndrome last year and influenza now "demonstrate we are definitely more prepared." CDC expects to have more precise measures for evaluating the nation's preparedness next fall, but there will always be a reluctance to publicize that information, he said.

If, for instance, the president asked for a state-by-state assessment, Henderson said he is prepared to give it. "We don't tell the public because we're afraid it might reveal too many vulnerabilities."

State budget cuts, personnel shortages and red tape were the chief reasons identified by the Trust for the spotty progress. Although the report found significant improvement in communications capability and general terrorism response planning, researchers at the Trust and other experts identified several areas that are lagging.

Georges Benjamin, executive director of the American Public Health Association, said public health departments are able to respond more quickly, are better trained and are better equipped. He remains concerned, however, about staffing shortages, labs that are unable to identify chemical agents and the shortage of state influenza plans.

"I'm not sure this flu will be a pandemic flu, but we're going through a widespread flu epidemic now, and it worries me that states were not up to speed with those plans," he said.

In addition to tracking flu plans, the report scored states in nine other areas, such as lab capacity, availability of information on the SARS virus and appropriate distribution of federal dollars. States received one point for each category in which they met basic thresholds, with a 10 the highest possible score. More than 70 percent of the states received scores of 5 or lower.

Locally, the picture is mixed. Maryland was one of four states to receive a 7, the highest score given. Virginia received a 5, and the District, a 3.

"While states have achieved piecemeal progress, the full-scale effort to comprehensively fix the nation's public health system is falling short," the report noted.

Randall Larsen, a retired military officer and chief executive of the consulting firm Homeland Security Associates, endorsed the overall conclusions but counseled patience. "People need to understand that although this is frustrating, we're not much better prepared. An enormous change is required to prepare us for homeland security in the 21st century," he said.

Jerome M. Hauer, the former Bush administration bioterrorism preparedness chief who now runs a terrorism response center at George Washington University, said he is concerned that hospitals have not done enough to prepare to handle mass casualties and that states are having trouble hiring specialists such as epidemiologists and laboratory technicians.

He and Larsen criticized CDC Director Julie L. Gerberding for recently denying that the administration had pursued a nationwide smallpox immunization program, calling her comments "a very clever political move to distance herself from a failing program."

When Bush announced the program -- he was among the first people to be inoculated -- the administration said it intended to immunize nearly 500,000 public health and hospital workers by the end of February this year. The plan called for vaccinating millions of police officers and firefighters by spring, and by summer, Bush promised, any American who insisted would be able to receive the vaccine. That has not happened.

Gerberding's spokesman, Tom Skinner , said, "She fully supports the plan the president outlined last December. We're much better prepared even with only 40,000 vaccinated, but obviously we still have more work to do."