The H1N1 flu out-break exposed serious gaps in the nation's ability to respond to public health emergencies and showed that the economic crisis is straining an already fragile public health system, according to a recent report on public health preparedness.

The seventh annual Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism report, from the Trust for America's Health and the Robert Wood Johnson Foundation, found that 20 states scored six or less out of 10 key indicators of public health emergency preparedness. These indicators, developed in consultation with public health experts, include public health lab capacities, vaccine purchases, funding levels and other readiness criteria.

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.

Study authors highlighted two key indicators: 13 states have purchased less than 50 percent of their share of federally subsidized antiviral drugs to stockpile for use during an influenza pandemic; and 11 states and the District of Columbia 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 like H1N1.

Overall, the report found that the investments made in pandemic and public health preparedness during the past several years dramatically improved U.S. readiness for the H1N1 outbreak. But it also found that decades of underfunding meant that many core systems were not ready.

Key infrastructure concerns included a lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity and a shrinking public health workforce. In addition, the report found that more than half of states experienced cuts to their public health funding, and federal preparedness funds have been cut by 27 percent since fiscal year 2005.

Ready or Not? also offers a series of recommendations for improving preparedness, including:

  • Ensure stable, sufficient funding: The cuts to federal support for public health preparedness since 2005 must be restored, and funding must be stabilized at a sufficient level to support core activities and emergency planning; modernize flu vaccine production; improve vaccine and antiviral research and development; and support the Department of Health & Human Services' Hospital Preparedness Program.
  • Conduct an H1N1 after-action report and update preparedness plans with lessons learned: Strengths and weaknesses of the H1N1 response should be evaluated and used to revise federal, state and local preparedness planning. Identified gaps in core systems, including communications, surveillance and laboratories must be addressed. Continued surge capacity concerns, including establishing crisis standards of care, must be addressed.
  • Increase accountability and transparency: Health departments should regularly make updates on progress made on benchmarks and deliverables identified in the Pandemic and All Hazards Preparedness Act available to the public.
  • Improve community preparedness: Additional measures must be taken to reach out quickly and effectively to high-risk populations, including strengthening culturally competent communications around vaccine safety. Health disparities among low-income and racial or ethnic minorities must also be addressed.

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