Past Low Flu Vaccination Rates and Gaps in Flu Policies Contribute to Vaccine Shortages and Other Problems in Preparedness

Ready or Not?

«state» Scored «number» out of Ten on Key Indicators in Report on Health Emergency Preparedness

Majority of States Score 6 or Lower Out of 10 Indicators in Ready or Not?

Washington, D.C., December 19, 2012 – In the 10th annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report, «state» scored «total» out of 10 on key indicators of public health preparedness — 35 states and Washington, D.C. scored a six or lower.

The report, issued by the Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF), found that while there has been significant progress toward improving public health preparedness over the past 10 years, particularly in core capabilities, there continue to be persistent gaps in the country’s ability to respond to health emergencies, ranging from bioterrorist threats to serious disease outbreaks to extreme weather events.

In the report, Kansas and Montana scored the lowest – three out of 10 – and Maryland, Mississippi, North Carolina, Vermont and Wisconsin scored highest – eight out of 10.

“In the past decade, there have been a series of significant health emergencies, including extreme weather events, a flu pandemic and foodborne outbreaks,” said Jeffrey Levi, PhD, executive director of TFAH. “But, for some reason, as a country, we haven’t learned that we need to bolster and maintain a consistent level of health emergency preparedness. Investments made after September 11th, the anthrax attacks and Hurricane Katrina led to dramatic improvements, but now budget cuts and complacency are the biggest threats we face.”

The Ready or Not? report provides a snapshot of our nation’s public health emergency preparedness. Its indicators are developed in consultation with leading public health experts based on data from publicly available sources, or information provided by public officials. Some key findings from the report include:

No.	Indicator	«state»	Number of States Receiving Points
A “Y” means the state received a point for that indicator
1	Funding Commitment – Did the state maintain or increase funding for public health programs from FY 2010-2011 to FY 2011-12.	«q1»	21 + D.C.
2	Response Readiness – Was the state able to notify and immediately assemble (within the goal time of 60 minutes) public health staff to ensure a quick response to an incident in 2011.	«q2»	47 + D.C.
3	Infectious Disease Control and Vaccinations – Did the state meet the HHS goal of vaccinating 90 percent of 19- to 35-month-olds against whooping cough.	«q3»	2
4	Infectious Disease Control – Does the state require Medicaid to cover flu shots with no co-pays for beneficiaries under the age of 65.	«q4»	38
5	Extreme Weather Event Preparedness – Does the state currently have a complete climate change adaptation plan.	«q5»	15
6	Community Resiliency – Does the state mandate all licensed child-care facilities to have a multi-hazard written evacuation and relocation plan.	«q6»	30 + D.C.
7	Emergency Management – Has the state been accredited by the Emergency Management Accreditation Program (EMAP).	«q7»	29 + D.C.
8	Health System Preparedness – Does the state participate in a Nurse Licensure Compact.	«q8»	24
9	Public Health Laboratories Staffing and Surge Capacity – Does the state public health laboratory report having enough staffing capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as a novel influenza A H1N1, from August 10, 2011 to August 9, 2012.	«q9»	37 + D.C.
10	Public Health Laboratories – Chemical Threat Preparedness – Did the state public health laboratory report having increased or maintained their Laboratory Response Network for Chemical Threats (LRN-C) chemical capability from August 10, 2011 to August 9, 2012.	«q10»	49
Total		«total»

“Public health preparedness has improved leaps and bounds from where we were 10 years ago,” said Paul Kuehnert, MS RN Director of the Public Health Team at the Robert Wood Johnson Foundation. “But severe budget cuts at the federal, state and local levels threaten to undermine that progress. We must establish a baseline of ‘better safe than sorry’ preparedness that should not be crossed.”

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

Reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA);
Assure sufficient, dedicated funds for public health preparedness to ensure basic capabilities to respond to threats public health departments face every day and also to have the trained experts and systems in place to act quickly in the face of major, unexpected emergencies;
Provide ongoing support to communities so they better cope and recover from emergencies;
Modernize biosurveillance to a real-time, interoperable system to better detect and respond to problems;
Seriously address antibiotic resistance;
Improve research, development and manufacturing of medical countermeasures;
Increase readiness for extreme weather events; and
Update the nation’s food safety system.

The report was supported by a grant from RWJF and is available on TFAH’s website at www.healthyamericans.org and RWJF’s website at www.rwjf.org.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website and RWJF’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

8 out of 10: Maryland, Mississippi, North Carolina, Vermont and Wisconsin
7 out of 10: Alabama, Arkansas, California, Delaware, Nebraska, New Hampshire, New Mexico, New York, North Dakota and Virginia
6 out of 10: Connecticut, Idaho, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, Utah, Washington and Wyoming
5 out of 10: Alaska, Arizona, Washington, D.C., Florida, Hawaii, Illinois, Indiana, Michigan, Minnesota, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas and West Virginia
4 out of 10: Colorado, Georgia, Nevada and New Jersey
3 out of 10: Kansas and Montana

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter or Facebook.

Issue Brief: Ending the HIV Epidemic Among Gay Men in the United States

The Facts Hurt

Ready or Not? 2011

Report Finds Preparedness for Bioterror and Health Emergencies Eroding in «state»

Cuts to Key Programs Could Hurt Ability to Detect and Respond to Crises

Washington, DC, December 20, 2011 – The Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF) released the ninth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism today, which finds key «state» programs that detect and respond to bioterrorism, new disease outbreaks and natural or accidental disasters are at risk due to federal and state budget cuts.

Some key programs at risk due to continued cuts to federal public health emergency preparedness funds include:

51 of the 72 cities«cities_at_risk» in the Cities Readiness Initiative are at risk for elimination; the Initiative supports the ability to rapidly distribute and administer vaccines and medications during emergencies;
«chemical_testing» This would leave the U.S. Centers for Disease Control and Prevention (CDC) with the only public health lab in the country with full ability to test for chemical terrorism and accidents;
24 states, «epidemiology» «state», are at risk for losing the support of Career Epidemiology Field Officers – CDC experts who supplement state and local gaps to rapidly prevent and respond to outbreaks and disasters, such as during the H1N1 flu pandemic and responding to the health impact of the Gulf Oil Spill in 2010;
Support for all of the nation’s preparedness research and training centers is at risk for elimination«university_research»; and
The ability for CDC to mount a comprehensive response to nuclear, radiologic and chemical threats as well as natural disasters is at risk due to potential cuts to the National Center for Environmental Health. All 50 states and Washington, D.C. would lose the support CDC provides during these emergencies.

«funding»

“We’re seeing a decade’s worth of progress eroding in front of our eyes,” said Jeff Levi, PhD, Executive Director of TFAH. “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.”

Combined federal, state and local budget cuts mean public health departments can no longer sustain a number of basic elements of preparedness. In the past year, 40 states and Washington, D.C. cut state public health funds – with 29 of those states and D.C. cutting their budgets for a second year in a row and 15 states for three years in a row. Federal funds for state and local preparedness declined by 38 percent from fiscal year (FY) 2005 to 2012 (adjusted for inflation) – and additional cuts are expected under budget sequestration.

“Americans expect the public health system to have the capability to competently protect their health during emergencies. This is not an optional service,” said Mel Kohn, MD, MPH, State Health Officer and Public Health Director of the Oregon Health Authority. “We will be unable to absorb reductions of this magnitude simply by finding efficiencies. We have reached the point where our ability to do this work will be seriously compromised, with life and death consequences.”

“During the anthrax attacks and Hurricane Katrina, we witnessed what happens when public health doesn’t have the technology, resources, workforce or training needed to respond to emergencies,” said James S. Marks, Senior Vice President and Director of the Health Group of RWJF. “The old adage is that it’s better to be safe than sorry. Unfortunately if we ignore preparedness now, we’ll be sorry later when the next emergency strikes.”

The report includes a series of recommendations that will be important for improving America’s preparedness, including:

Assuring dedicated funding and strengthening the public health preparedness core capabilities;
Improving biosurveillance to rapidly detect and track outbreaks or attacks;
Improving research, development and manufacturing of vaccines and medications;
Enhancing the ability to provide care for a mass influx of patients during emergencies;
Providing better support to help communities cope with and recover from disasters; and
Coordinating food safety with other preparedness efforts through the strategic implementation of the FDA Food Safety Modernization Act of 2011.

Detailed Findings Summary

The 51 cities at risk for elimination from the Cities Readiness Initiative include: Albany and Buffalo, NY; Albuquerque, NM; Anchorage, AK, Baltimore, MD; Baton Rouge and New Orleans, LA; Billings, MT; Birmingham, AL; Boise, ID; Burlington, VT; Charleston, WV; Charlotte, NC; Cheyenne, WY; Cincinnati and Columbus, OH; Columbia SC; Des Moines, IA: Dover, DE; Fargo, ND; Fresno, Riverside, Sacramento and San Jose, CA; Hartford and New Haven, CT; Honolulu, HI; Indianapolis, IN; Jackson, MS; Kansas City, MO: Little Rock, AR; Louisville, KY; Manchester, NH; Memphis and Nashville, TN; Milwaukee, WI; Oklahoma City, OK; Omaha, NE: Orlando and Tampa, FL; Peoria, IL; Portland, ME; Portland, OR; Providence, RI; Richmond and Virginia Beach, VA; Salt Lake City, UT; San Antonio, TX; Sioux Falls, SD; Trenton, NJ; Wichita, KS.

The 21 cities NOT at risk for elimination from the Cities Readiness Initiative include: Atlanta, GA; Boston, MA; Chicago, IL; Cleveland, OH; Dallas, TX; Denver, CO; Detroit, MI; District of Columbia; Houston, TX; Las Vegas, NV; Los Angeles, San Diego and San Francisco, CA; Miami, FL; Minneapolis, MN; New York City, NY; Philadelphia and Pittsburgh, PA; Phoenix, AZ; Seattle, WA; St. Louis, MO.

The 10 state labs at risk for losing “Level 1” chemical testing abilities: California, Florida, Massachusetts, Michigan, Minnesota, New Mexico, New York, South Carolina, Virginia, Wisconsin.

The 24 states at risk to lose Career Epidemiology Field Officers: Alabama, Arizona, California, Florida, Idaho, Kentucky, Maine, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New York, North Carolina, North Dakota, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia, Wyoming.

The 14 universities at risk to lose Preparedness and Emergency Response Learning Center funds: Columbia University Mailman School of Public Health; Harvard University School of Public Health; Johns Hopkins University Bloomberg School of Public Health; Texas A&M School of Rural Public Health; University of Alabama at Birmingham School of Public Health; University of Albany SUNY School of Public Health; University of Arizona College of Public Health; University of Illinois at Chicago School of Public Health; University of Iowa College of Public Health; University of Minnesota School of Public Health; University of North Carolina Gillings School of Global Public Health; University of Oklahoma College of Public Health; University of South Florida College of Public Health; University of Washington School of Public Health.

The nine universities at risk to lose Preparedness and Emergency Response Research Center fund: Emory University; Harvard School of Public Health; Johns Hopkins University Bloomberg School of Public Health; University of California at Berkley and Los Angeles; University of Minnesota; University of North Carolina; university of Pittsburgh; University of Washington.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need–the Foundation expects to make a difference in our lifetime. For more information, visit rwjf.org

Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense

A New HIV Prevention Paradigm for Gay and Bisexual Men in the U.S.

The New Prevention Fund

Ready or Not 2010

«state» Scored «capspellscore» out of Ten Key Indicators for Emergency Health Preparedness in New Report

Report Finds States Achieve Highest Ever Scores for Public Health Preparedness, But Progress Threatened by Budget Cuts

Washington, D.C., December 14, 2010 – In the eighth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report, «state» achieved «spellscore» out of 10 key indicators of public health emergency preparedness. Overall, states achieved the highest scores ever for health emergency preparedness with 14 states scoring nine or higher. Three states (Arkansas, North Dakota, and Washington State) scored 10 out of 10. Another 25 states and Washington, D.C. scored in the 7 to 8 range. No state scored lower than a five

The scores reflect nearly ten years of progress to improve how the nation prevents, identifies, and contains new disease outbreaks and bioterrorism threats and responds to the aftermath of natural disasters in the wake of the September 11, 2001 and anthrax tragedies. In addition, the real-world experience responding to the H1N1 flu pandemic – supported by emergency supplemental funding – also helped bring preparedness to the next level.

However the Ready or Not? report, released today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation notes that the almost decade of gains is in real jeopardy due to severe budget cuts by federal, state, and local governments. The economic climate change has led to cuts in public health staffing and basic capabilities, which are needed to successfully respond to crises. Thirty-three states and Washington, D.C. cut public health funding from fiscal years (FY) 2008-09 to 2009-10, with 18 of these states cutting funding for the second year in a row. The report also notes that just eight states (Alabama, Arkansas, Kentucky, Nebraska, North Dakota, South Dakota, Texas, and West Virginia) have increased funding for two or more consecutive years.

«state» «increased» its public health budget from FY 2008-09 to 2009-10«wasone». The Center on Budget and Policy Priorities has found that states have experienced overall budgetary shortfalls of $425 billion since FY 2009.

In addition to state cuts, federal support for public health preparedness has been cut by 27 percent since FY 2005 (adjusted for inflation). Local public health departments report losing 23,000 jobs – totaling 15 percent of the local public health workforce – since January 2008. The impact of the recession were not as drastically felt by public health until more recently because of supplemental funds received to support the H1N1 pandemic flu response and from the American Recovery and Reinvestment Act.

“There is an emergency for emergency health preparedness in the United States,” said Jeff Levi, PhD, Executive Director of TFAH. “This year, the Great Recession is taking its toll on emergency health preparedness. Unfortunately, the recent and continued budget cuts will exacerbate the vulnerable areas in U.S. crisis response capabilities and have the potential to reverse the progress we have made over the last decade.”

No.	Indicator	«state»	Number of States Receiving Points
A checkmark means the state received a point for that indicator
1	Funding Commitment – Did the state maintain or increase funding for public health programs from FY 2008-09 to FY 2009-2010?	«Indicator1»	17
2	Health Information Technology – Does the state currently send and receive electronic health information to health care providers and community health centers?	«Indicator2»	43 and D.C.
3	Electronic Syndromic Surveillance – Does the state health department have an electronic syndromic surveillance system that can report and exchange information?	«Indicator3»	40 and D.C.
4	Incident Response Capacity – Did the state acknowledge pre-identified staff of emergency exercises or incidents within the target time of 60 minutes at least twice during 2007-08?	«Indicator4»	44 and D.C.
5	Emergency Operations Center (EOC) – Did the state public health department activate its EOC as part of a drill, exercise, or real incident a minimum of two times in 2007-08?	«Indicator5»	44 and D.C.
6	After Action Reports – Did the state develop at least two After-Action Report/Improvement Plans (AAR/IPs) after exercise or real incident in 2007-08?	«Indicator6»	48 and D.C.
7	Community Resilience – Children and Preparedness – Does the state require all licensed child care facilities to have a multi-hazard written evacuation and relocation plan?	«Indicator7»	25 and D.C.
8	Foodborne disease detection and reporting – Was the state able to rapidly identify disease-causing E.coli O157:H7 and submit results by PulseNet within four working days 90% of the time?	«Indicator8»	29
9	Public Health Laboratories – Surge Workforce – Does the state have the necessary lab workforce staffing to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1?	«Indicator9»	47
10	Public Health Laboratories – Did the state increase Laboratory Response Network for Chemical Treat (LRN-C) capability?	«Indicator10»	49 and D.C.
Total		«Score»

Note: Indicators 4, 5, 6, and 8 are based on findings from a recently released report from the U.S. Centers for Disease Control and Prevention (CDC) based on activities in 2007-08.

According to the report, while states have made progress, there are still a series of major ongoing gaps in preparedness, including in basic infrastructure and funding, biosurveillance, maintaining an adequate and expertly trained workforce, developing and manufacturing vaccines and medicines, surge capacity for providing care in major emergencies, and helping communities cope with and recover from emergencies.

Ready or Not? provides a series of recommendations that address the ongoing major gaps in emergency health preparedness, including:

Gaps in Funding and Infrastructure:The resources required to truly modernize public heath systems must be made available to bring public health into 21st century and improve preparedness;
A Surveillance Gap: The United States lacks an integrated, national approach to biosurveillance, and there are major variations in how quickly states collect and report data which hamper bioterrorism and disease outbreak response capabilities;
A Workforce Gap: The United States has 50,000 fewer public health workers than it did 20 years ago – and one-third of current workers are eligible to retire within five years. Policies must be supported that ensure there are a sufficient number of adequately trained public health experts – including epidemiologists, physicians, nurses, and other workers – to respond to all threats to the public’s health;
Gaps in Vaccine and Pharmaceutical Research, Development, and Manufacturing: The United States must improve the research and development of vaccines and medications;
A Surge Capacity Gap: In the event of a major disease outbreak or attack, the public health and health care systems would be severely overstretched. Policymakers must address the ability of the health care system to quickly expand beyond normal services during a major emergency;
Gaps in Community Resiliency Support: The United States must close the existing day-to-day gaps in public health departments which make it difficult to identify and service the most vulnerable Americans, who often need the most help during emergencies.

According to James Marks, Senior Vice President and Director of the Health Group at the Robert Wood Johnson Foundation, the gaps that remain and the risks of loss of our nation’s ability to respond during emergencies call out for an ongoing investment to rebuild and modernize our public health system. “This report makes it clear that not enough Americans are protected against health emergencies. And those whose health departments have done a good job preparing are at great risk of losing ground. The American public needs to know if their state and local health agency has the resources and expertise to respond to any health crisis. Detecting weaknesses and identifying how to fix those are why independent accreditation with specific, measurable standards of quality and performance are so critical to helping the public and their leaders know what more is needed to protect their families and communities.”

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s web site at www.healthyamericans.org and RWJF’s Web site at www.rwjf.org. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

10 out of 10: Arkansas, North Dakota, Washington state
9 out of 10: Alabama, California, Kentucky, Louisiana, Maryland, Missisippi, Ohio, Utah, Virginia, West Virginia, Wisconsin
8 out of 10: Alaska, Arizona, Colorado, Connecticut, Delaware, Florida, Indiana, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Vermont, Wyoming
7 out of 10: Washington, D.C., Georgia, Hawaii, Maine, Missouri, Oregon, Tennessee, Texas
6 out of 10: Idaho, Illinois, Kansas, Massachusetts, Nevada, New Mexico, Rhode Island, South Carolina, South Dakota
5 out of 10: Iowa, Montana