Public Health Service Preparedness: “Ready or Not ?”

A report by the Trust for America’s Health and the Robert Wood Johnson Foundation revealed the H1N1 flu outbreak has exposed serious underlying gaps in states’ ability to respond to public health emergencies. The report titled, Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, concluded had the outbreak had been more severe, the “nation’s public health safety system could have been stretched beyond the breaking point.”

Despite recent improvements in pandemic preparedness, key concerns were:

Shortfalls in laboratory testing capability: 14 states cannot assure 24/7 turnaround (i.e. receipt and delivery) on lab samples; 11 states and D.C cannot surge lab staffs for 6-8 weeks in response to outbreaks
Lack of an integrated approach to biosurveillance, capable of reponding to catastrophic health threats and uneven quality of reporting from the states
Cuts in public health services, across 27 states, arising from economic crisis and recession
No reported plan to replenish the Strategic National Stockpile (e.g. antivirals, surgical masks, N95 respirators) to prepare for the next H1N1 wave

Editor’s Comment: The report makes a compelling case for more investment in public health infrastructure and a comprehensive array of reforms for emergency preparedness. All of which should happen. The report provides the contours of a 24/7 public health emergency response capability. What isnt clear is the eventual standard for the public health service system, i.e. gold, silver or bronze, in terms of capacity for prevention, planning, preparedness, detection, surveillance, mitigation, response and recovery.

Some news accounts have described the public health service system as “fragile”; that characterization may be somewhat overdrawn. Given the circumstances, the public health system responded reasonably well to the second H1N1 wave. However, the report correctly observes that the system was not severely tested by a relatively moderate pandemic.