If a health disaster were to strike, Illinois doctors and nurses could hunt down emergency vaccines, track the spread of disease using the Internet and deploy thousands of medical workers to cope with the crisis. But their neighbors in Wisconsin and Iowa wouldn't be quite as prepared.
States are getting better at preparing for health emergencies, but their efforts are uneven, according to a nationwide scorecard released Tuesday (Dec. 18).
"The improvements in state preparedness are encouraging, but the job of preparing the United States for major health emergencies is not nearly done," said Jeff Levi, executive director of the Trust for America's Health , a non-profit, non-partisan group working to make disease prevention a national priority.
Seven states were rated as best-prepared, based on their performance in 10 areas: Illinois, Kentucky, Nebraska, New Jersey, Pennsylvania, Tennessee and Virginia. At the bottom were Arkansas, Iowa, Mississippi, Nevada, Wisconsin and Wyoming.
Even the lower rung of states achieved six of the group's goals, which include having lab capacity to analyze biological and chemical samples, extending legal protections for medical volunteers in emergencies and boosting funding for public health services.
"We would argue that this does reflect some serious progress and argue further that this progress is potentially at risk if we don't sustain the same funding commitment" at the state and federal levels, Levi said.
One of the problems highlighted by the report is states' inability or unwillingness to join federal efforts to prepare for a pandemic flu outbreak.
Seven states (Colorado, Connecticut, Florida, Massachusetts, Mississippi, North Dakota and Rhode Island) didn't buy discounted antiviral medicine, such as Tamiflu and Relenza, offered at a discount until July by the federal government. Fourteen other states bought less than half their share.
Under the arrangement, the federal government paid a quarter of the cost for 31 million treatment courses, at a cost of $170 million. States shoulder the rest of the burden, for about $680 million.
The idea is to spread out resources so they can be deployed quicker in an emergency. But there are advantages to having the federal government, rather than states, stockpile the medicines. States can only hold on to the medicine for seven years, while the federal government can keep the drugs as long as inspectors verify they're still effective.
"Given the states' difficulties in meeting their commitments under the current guidelines, it is unlikely they will be able to meet future commitments. Containment of a pandemic must be a national priority. Any differences in capacity on a state-by-state basis place the entire nation at risk," the report said.
Another difficulty for states is declining federal funding for disaster preparedness. If President Bush's budget request is approved, that level will have decreased 25 percent over three years.
The report highlighted progress as well.
All states held emergency preparedness drills this year. In July, Arizona and California National Guard units simulated the aftermath of an earthquake, in which thousands of evacuees from Los Angeles and San Diego would likely head to Phoenix.
An 11-day exercise in Indiana in May was the largest disaster drill ever held. Emergency responders dealt with mock incidents such as a nuclear bomb exploding in Indianapolis, hurricanes and terrorist attacks on U.S. military bases.
Also, 37 states and the District of Columbia this year had adequate plans to distribute emergency antidotes, antibiotics, surgical items and other medical supplies stockpiled by the federal government. Last year, only 15 states had such plans in place.
States continued to make strides in vaccinating seniors against the flu. Last year, 37 states and the District of Columbia increased or maintained the vaccination rate of adults 65 and older; this year 39 states and the District of Columbia met that goal.