At the end of 2011, the Trust for America’s Health (TFAH) in conjunction with the Robert Wood Johnson Foundation (RWJF) released their ninth annual report — Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism. The authors found key programs to detect and respond to public health emergencies are at risk due to federal and state budget cuts.

“Public health officials were at the lead of the anthrax response — diagnosing and treating victims and running more than a million tests on 125,000 potentially life-threatening samples around the country in a short period of time,” recalled Jeff Levi, PhD, executive director of TFAH. “These officials were often working without adequate resources or training to respond to these types of attacks and had limited knowledge of the science involved in weaponized anthrax and how widely it was dispersed through the U.S. mail system.”

It was the first time, Levi continued, that public health really came to be viewed as a central component of national security and emergency response. The gaps in resources and knowledge that became apparent during the anthrax attacks have been systematically addressed in the ensuing years.

“Over the past decade, we made a lot of strategic, smart investments to improve preparedness in the United States,” Levi noted.

Since 2001, the country has seen improved preparedness planning and coordination; significant increases in public health laboratories, vaccine manufacturing, and distribution of pharmaceutical and medical equipment; improved surveillance and communications; institution of legal and liability protections; and increased surge capacity at hospitals.

A lack of funding in the wake of the economic crisis, however, now poses a real threat. “We’re seeing a decade’s worth of progress eroding in front of our eyes,” said Levi. “Preparedness had been on an upward trajectory, but now some of the most elementary capabilities — including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies and treat people during mass traumas — are experiencing cuts in every state across the country.”

Of particular concern:

• 51 of the 72 cities in the Cities Readiness Initiative, which supports the ability to rapidly distribute and administer vaccines and medications during emergencies, are at risk for elimination. In the Medical News coverage area, the list includes Baton Rouge and New Orleans, La.; Birmingham, Ala.; Charlotte, NC; Louisville Ky.; Jackson, Miss.; Little Rock, Ark.; Memphis and Nashville, Tenn.; and Orlando and Tampa, Fla. Of the 21 cities not at risk for elimination from the initiative, the only three safe in this region are Atlanta, Miami and St. Louis.
• All 10 state labs with “Level 1” chemical testing status are at risk for losing top level capabilities, which could potentially leave only the U.S. Centers for Disease Control and Prevention (CDC) with a lab that has full ability to test for chemical terrorism and accidents. The 10 states at risk are California, Florida, Massachusetts, Michigan, Minnesota, New Mexico, New York, South Carolina, Virginia and Wisconsin.
• Additionally, 24 states are at risk of losing the support of Career Epidemiology Field Officers, which are CDC experts who supplement state and local resources to rapidly respond to disasters or disease outbreaks. The list of states in jeopardy includes Alabama, Florida, Mississippi, North Carolina and Tennessee.
• The University of Alabama School of Public Health, University of North Carolina Gillings School of Global Public Health and University of South Florida College of Public Health are among the 14 universities at risk of losing Preparedness and Emergency Response Learning Center funds.
• Of additional concern, the CDC faces a threat to its ability to mount a comprehensive response nationally due to potential cuts to the National Center for Environmental Health.

After adjusting for inflation, federal funds for state and local preparedness declined more than 25 percent between FY 2005 and FY 2011. Furthermore, President Obama’s proposed budget for FY 2012 represents another $72 million in cuts for Public Health Emergency Preparedness Funding (PHEP).

All 50 states also had cuts in the Hospital Preparedness Program (HPP) from FY 2010 to FY 2011. Providing some relief, the U.S. Department of Health and Human Services awarded more than $352 million in HPP grants in July. The money was distributed among all states and three large metropolitan areas.

Throughout the country, 40 states plus Washington, D.C. cut state public health funds … and 29 of those (including Missouri) were making cuts for the second consecutive year. Mississippi and North Carolina were among the 15 states that have decreased funding for three years in a row. Ten states, however, maintained or increased funding over the past year, including Arkansas, Florida, Indiana, Louisiana and Tennessee.

To stop the backslide and continue improving the nation’s preparedness, the report recommends assuring dedicated public funding, improving biosurveillance to rapidly detect and track outbreaks or attacks, improving research and development of vaccines and medications, ensuring hospitals have the surge capability to deal with a mass influx of patients, providing support to communities in the aftermath of disaster, and coordinating with the Food and Drug Administration to ensure the safety of the food supply.

“The most important way we can honor the past is to make sure we sustain enough resources to support the field of public health so they have the tools and expertise they need to so their jobs … so we can prevent what we can and respond when we have to,” Levi stated.

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