The Erosion of U.S. Emergency Preparedness

Since September 11 and anthrax, we've released the "Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism" in partnership with the Robert Wood Johnson Foundation. Over the past ten years, the report has documented how preparedness had been on an upward trajectory. While there were serious ongoing gaps, the progress in upgrading the system has been dramatic, as noted in past issues of "Ready or Not?".

Unfortunately, the economic crisis has changed the story.

Now, we're seeing a decade's worth of progress eroding in front of our eyes.

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.

This year, "Ready or Not?" has focused on projections into the future: the impact that cuts have had so far, in combination with the proposed upcoming budgets and likely funding scenarios. The analysis found that a number of programs that help detect and respond to bioterrorism and other health emergencies are at risk for major cuts or elimination. These cuts are expected to impact every state in the nation in one way or another. Notably:

  • 51 of the 72 cities that are currently part of the Cities Readiness Initiative are at risk for elimination from the program. This initiative supports the ability to rapidly distribute and administer vaccines and medications during emergencies,
  • All 10 state labs with "Level 1" chemical testing status are at risk for losing top level capabilities, which could 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 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; 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.

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 for three years in a row. In addition, federal funds for state and local preparedness declined by 38 percent from fiscal year (FY) 2005 to 2012 (adjusted for inflation). The Great Recession is clearly taking its toll on emergency health preparedness.

In addition to the above, the report identifies several major vulnerabilities in U.S. preparedness, including:

  • The ability to maintain basic emergency capabilities -- we often take a knee-jerk band-aid approach to responding to emergencies after they happen instead of being prepared for when they happen;
  • The lack of a coordinated biosurveillance system, which hampers our ability to detect and track bioterrorism attacks or disease outbreaks;
  • Gaps in researching, developing and manufacturing vaccines and antiviral medications;
  • Gaps in the ability to provide care for an influx of patients during mass trauma events; and
  • Gaps in the way we help communities cope with and recover from emergencies.

Ten years ago, during the anthrax attacks, we saw firsthand what happens when we don't invest in public health preparedness. We were graphically reminded of this again during Hurricane Katrina. The country has made major strides toward being better prepared -- many of the fruits of this investment were evident during the H1N1 flu pandemic response.

While we were still far from our goals, we were leaps and bounds beyond where we were in 2001. Sadly, the track we're on now with the budget cuts may mean history could tragically repeat itself.
When the next disaster strikes, we won't be ready.

Detailed findings:

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: Alaska, 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 School of Public Health; University of Albany SUNY School of Public Health; University of Arizona College of Public Health; University of Illinois; 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.