Although states have made substantial progress in preparing for public health emergencies, the H1N1 pandemic has revealed remaining deficiencies, according to a new report.
Of 10 key indicators of preparedness, 20 states achieved six or fewer. The worst performer, Montana, fulfilled only three, according to an assessment by the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation.
Seven states -- Arkansas, Delaware, New York, North Carolina, Oklahoma, Texas, and Vermont -- tied for the highest score of nine out of 10.
The unexpected emergence of pandemic H1N1, coupled with shrinking state budgets in a crumbling economy, exposed problems with the public health infrastructure, including a lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine production techniques, limited hospital surge capacity, and a smaller public health workforce, the report stated.
It urged increases in funding for preparedness and efforts to solidify the public health infrastructure, even in the face of waning H1N1 activity.
"As the second wave of H1N1 starts to dissipate, it doesn't mean we can let down our defenses," said Richard Hamburg, deputy director of TFAH, in a statement. "In fact, it's time to double down and provide a sustained investment in the underlying infrastructure, so we will be prepared for the next emergency and the one after that."
The 10 indicators and how states performed in 2009:
Antiviral stockpiling: 13 states purchased less than half of their share of federally subsidized antivirals to stockpile for an influenza pandemic.
Hospital preparedness/hospital bed availability reporting: 10 states and the District of Columbia report weekly data for at least 50 percent of the hospitals within their jurisdiction to the National Hospital Available Beds for Emergencies and Disasters System, which is required by the Department of Health and Human Service's Assistant Secretary for Preparedness and Response.
Lab pick-up and delivery services for public health laboratories: 13 states do not have the capacity for timely transportation of samples around the clock to an appropriate public health Laboratory Response Network reference lab.
Surge workforce capacity in public health laboratories: 12 states and the District of Columbia do not have enough staff to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak.
Biosurveillance: Six states do not have a disease surveillance system compatible with the CDC's National Electronic Disease Surveillance System.
Food safety: 14 states were not able to identify the pathogen responsible for reported foodborne disease outbreaks at a rate that met or exceeded the national average of 46 percent.
Medical Reserve Corps readiness: Nine states do not meet criteria for readiness, which include the presence of a state coordinator, compliance with the National Incident Management System guidelines, and integration with the state Emergency System for Advance Registration of Volunteer Health Professionals.
Community resiliency as it pertains to children and preparedness: 20 states and the District of Columbia require all licensed childcare facilities to have a multi-hazard written evacuation and relocation plan.
Legal preparedness: 19 states have not adopted entity emergency liability protections or have made no formal determination under existing law.
Public health funding commitment: 27 states cut funding for public health from budgets from 2007-08 to 2008-09.
The report authors recommended that funding be restored for emergency preparedness -- federal preparedness funds have dropped by 27 percent since 2005 -- to help address remaining deficiencies.
They also recommended:
Improvements in surge capacity;
Increased accountability and transparency of public health agencies, which should include a publicly available H1N1 after-action report;
Improvements in community preparedness, including additional measures to reach out quickly to high-risk populations and to address disparities based on income or race;
Development of full legal preparedness for public health emergencies at the state level, including liability protections for healthcare workers and mandates that insurance companies cover vaccines;
Establishment of sick-leave policies.