Progress in public health tempered by shortfalls

Shrinking state budgets, antiquated personnel processes, outdated computer systems and a host of other factors are complicating the already enormous task of boosting the public health system's capacity to respond to terrorist attacks, federal, state and local health officials said Tuesday.

In a wide-ranging meeting of Health and Human Services Secretary Tommy Thompson's Council on Public Health Preparedness, health experts from various levels of government and the private sector said while progress has been significant, particularly in crisis planning, gains are tempered by the sheer scope of unmet needs.

Among other things, state health officials said they are overwhelmed with the requirements of the Bush administration's smallpox vaccination plan, and fear it will detract from other important public health work. In addition, they are finding it difficult to recruit and keep talented health care workers, who can usually earn more money in the private sector.

"The most important thing we can do at this point in time is to strengthen our state and local infrastructure," said Council Chairman D.A. Henderson, Thompson's principal science adviser.

Although federal officials believe there is no imminent threat from smallpox, Jerome Hauer, acting assistant secretary for public health emergency preparedness at HHS, said "We do have real concerns that smallpox is in the hands of people who don't have the same vision of the future we do." Based on federal guidance developed over the last year, states are expected to begin vaccinating health care workers against the disease in the next three weeks.

Smallpox is only one of many concerns facing health care authorities. To test the agency's ability to respond to terrorist threats, HHS officials have begun conducting table-top exercises, including two recent exercises involving smallpox, and one involving the detonation of a radiological weapon. Next month, agency officials plan to conduct an exercise involving a chemical weapons attack.

A major challenge for state and local officials will be to improve the ability of hospitals to respond to mass casualties, said Richard Niska, director of the hospital preparedness program at the Health Resources and Services Administration, which administers grants to states to increase preparedness.

The program's top priority is to ensure that regions can handle at least 500 acutely ill patients, including potential medications and vaccinations; personal protection, quarantine and decontamination; and communications with authorities and the public, Niska said. Over time the goal will be raised to ensure treatment of more patients. It is up to the states to define "regions" and demonstrate how they will meet the goals to qualify for grants through the program. The Bush administration wants to increase spending on hospital preparedness in 2003 to $518 million, a significant increase over the $135 million spent in 2002.

While it will be tough for some states to meet the goals, Niska said, others are developing innovative plans that should provide benefits beyond bioterrorism preparedness. "Getting hospitals ready to deal with communicable diseases has spin-off effects, he said. "They'll be better able to deal with an influenza pandemic for instance."