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Executive Summary
Public health threats are inevitable. Being
prepared for these threats can save lives and
protect the health and safety of the public
and emergency responders. The Centers for
Disease Control and Prevention (CDC) works
to support public health preparedness for all
hazards, including natural, biological, chemical,
radiological, and nuclear events. This work falls
under one of the agency’s overarching health
protection goals: “People prepared for emerging
health threats - people in all communities will
be protected from infectious, occupational,
environmental, and terrorist threats.” CDC
has established nine preparedness goals to
strategically direct resources towards achieving
this overarching goal.
The events of September 11, 2001, and the
subsequent anthrax attacks both highlighted the
importance of public health during emergencies
and showed weaknesses in public health’s ability
to respond during a potential crisis. In 2002,
Congress authorized funding for the Public
Health Emergency Preparedness cooperative
agreement (hereafter referred to as the
cooperative agreement) to support preparedness
nationwide in state, local, tribal, and territorial
public health departments. As of 2007, the
cooperative agreement has provided more than
$5 billion to these public health departments.
CDC administers the cooperative agreement
and provides technical assistance to public health
departments. This report outlines progress and
challenges. It also describes how CDC and its
partners are working to address these challenges.
Progress continues. With support from
the cooperative agreement, public health
departments have improved their ability to
respond to emergencies.
Public health departments can better detect and
investigate diseases because of improvements
in the public health workforce and in data
collection and reporting systems.
• The number of epidemiologists in public
health departments working in emergency
response has doubled from 115 in 2001
to 232 in 2006.* Epidemiologists detect
and investigate health threats and disease
patterns and work to minimize the negative
effects of a health threat in a community.
• The number of users for the Epidemic
Information Exchange (Epi-X), a secure
CDC-based communications system that
helps track disease outbreaks, has increased
to 4,646 in 2006, up from 890 in 2001.
Users are primarily from state and local
health departments (75%
.
• All state public health departments now can
receive and evaluate reports of urgent health
threats 24/7/365, whereas in 1999 only 12
could do so. Previously, it was often difficult
for clinicians to reach a public health
professional after normal work hours.
Public health laboratories have increased
capability to test for biological and chemical
threats and to communicate information.
• The number of state and local public health
laboratories able to detect biological agents
has increased to 110 in 2007, from 83 in
2002.
• The number of state and local public health
laboratories able to detect chemical agents
has increased to 47, from 0 in 2001.
• All states now have public health
laboratories that can quickly communicate
with clinical laboratories. In 2001, only
20 states reported having public health
laboratories with this capability. Once a
threat is confirmed in one laboratory, other
laboratories need to be quickly alerted since
they might receive related case samples
(indicating that the threat is spreading).
• More than twice the number of state public
health laboratories are conducting exercises
to test their ability to handle, confirm, and
report results for chemical agents (from 16
in 2003 to 38 in 2006).
Public health departments have developed
response plans, implemented a formalized
command structure, and conducted exercises.
Such activities were rare prior to 2001.
• All states now have plans to receive, store,
and distribute the Strategic National
Stockpile (SNS), a national repository of
antibiotics, other life-saving medications,
and medical supplies.
• Seventy-three percent of states reviewed
have satisfactorily documented their SNS
planning efforts.
• In 2005, public health departments in
50 states and DC trained public health
professionals about their roles and
responsibilities during an emergency as
outlined by the Incident Command System,
while in 1999 only 14 did so.
• All states now participate in the Health
Alert Network, which allows for the
rapid exchange of critical public health
information.
Challenges remain. Building on progress in
public health preparedness will require ongoing
commitment.
• Public health departments report difficulties
in recruiting and retaining qualified
epidemiologists, according to a 2006 CSTE
survey.
• Disease surveillance systems need to be
strengthened. In 2007, 16 states did not
report any plans to electronically exchange
health data with regional health information
organizations (networks of healthcare
provider organizations that allow the
electronic sharing of health information
among members).
• To facilitate surveillance, public health
departments need to ensure an appropriate
legal framework before a disaster occurs;
otherwise, states may be unable to share
critical public health information with other
jurisdictions.
• The public health laboratory workforce
needs improvement. Thirty-one state public
health laboratories reported difficulty
recruiting qualified laboratory scientists,
and 39 state public health laboratories
reported needing additional staff to perform
polymerase chain reaction, a rapid DNA
testing technique to quickly identify
bioterrorism agents, according to a 2007
Association of Public Health Laboratories
survey.
• Public health laboratories need to increase
the use of advanced technology and broaden
testing abilities, including radiological
testing. Currently, no state public health
laboratory can rapidly identify priority
radioactive materials in clinical samples.
• Public health departments need to sustain
a system of all-hazards planning, training,
exercising, and improving. This system
should be ready to help at-risk populations,
such as the elderly and others who may need
help controlling chronic diseases.
• Public health and other response
agencies need interoperable emergency
communication systems. In 2007, the
Department of Homeland Security reported
that many cities and metropolitan areas have
established multi-agency communications,
but more progress is needed to expand
interoperable communication across
jurisdictions and levels of government.
Moving forward. CDC is working with state
and local public health departments on initiatives
that include:
• Increasing the use of electronic health
data for preparedness and response by
networking surveillance systems and using
real-time data;
• Expanding laboratory testing;
• Establishing commercial partnerships
to supply needed medicines to at-risk
populations during an emergency;
• Developing and evaluating a core
curriculum for preparedness through the
Centers for Public Health Preparedness, a
national network of academic institutions
with a common focus on public health
preparedness;
• Improving legal preparedness by helping
states and other jurisdictions implement
public health mutual aid agreements, which
enable sharing of supplies, equipment,
personnel, and information during
emergencies;
• Exercising public health systems to
continuously improve capability and
demonstrate readiness; and
• Collaborating with partners to develop
accreditation programs for state and local
public health preparedness.
Achieving the overarching goal, “people prepared
for emerging health threats,” is critical to the
health and safety of our communities. This
report represents CDC’s commitment to sharing
information on a program that contributes to
this goal.
Public health threats are inevitable. Being
prepared for these threats can save lives and
protect the health and safety of the public
and emergency responders. The Centers for
Disease Control and Prevention (CDC) works
to support public health preparedness for all
hazards, including natural, biological, chemical,
radiological, and nuclear events. This work falls
under one of the agency’s overarching health
protection goals: “People prepared for emerging
health threats - people in all communities will
be protected from infectious, occupational,
environmental, and terrorist threats.” CDC
has established nine preparedness goals to
strategically direct resources towards achieving
this overarching goal.
The events of September 11, 2001, and the
subsequent anthrax attacks both highlighted the
importance of public health during emergencies
and showed weaknesses in public health’s ability
to respond during a potential crisis. In 2002,
Congress authorized funding for the Public
Health Emergency Preparedness cooperative
agreement (hereafter referred to as the
cooperative agreement) to support preparedness
nationwide in state, local, tribal, and territorial
public health departments. As of 2007, the
cooperative agreement has provided more than
$5 billion to these public health departments.
CDC administers the cooperative agreement
and provides technical assistance to public health
departments. This report outlines progress and
challenges. It also describes how CDC and its
partners are working to address these challenges.
Progress continues. With support from
the cooperative agreement, public health
departments have improved their ability to
respond to emergencies.
Public health departments can better detect and
investigate diseases because of improvements
in the public health workforce and in data
collection and reporting systems.
• The number of epidemiologists in public
health departments working in emergency
response has doubled from 115 in 2001
to 232 in 2006.* Epidemiologists detect
and investigate health threats and disease
patterns and work to minimize the negative
effects of a health threat in a community.
• The number of users for the Epidemic
Information Exchange (Epi-X), a secure
CDC-based communications system that
helps track disease outbreaks, has increased
to 4,646 in 2006, up from 890 in 2001.
Users are primarily from state and local
health departments (75%
.• All state public health departments now can
receive and evaluate reports of urgent health
threats 24/7/365, whereas in 1999 only 12
could do so. Previously, it was often difficult
for clinicians to reach a public health
professional after normal work hours.
Public health laboratories have increased
capability to test for biological and chemical
threats and to communicate information.
• The number of state and local public health
laboratories able to detect biological agents
has increased to 110 in 2007, from 83 in
2002.
• The number of state and local public health
laboratories able to detect chemical agents
has increased to 47, from 0 in 2001.
• All states now have public health
laboratories that can quickly communicate
with clinical laboratories. In 2001, only
20 states reported having public health
laboratories with this capability. Once a
threat is confirmed in one laboratory, other
laboratories need to be quickly alerted since
they might receive related case samples
(indicating that the threat is spreading).
• More than twice the number of state public
health laboratories are conducting exercises
to test their ability to handle, confirm, and
report results for chemical agents (from 16
in 2003 to 38 in 2006).
Public health departments have developed
response plans, implemented a formalized
command structure, and conducted exercises.
Such activities were rare prior to 2001.
• All states now have plans to receive, store,
and distribute the Strategic National
Stockpile (SNS), a national repository of
antibiotics, other life-saving medications,
and medical supplies.
• Seventy-three percent of states reviewed
have satisfactorily documented their SNS
planning efforts.
• In 2005, public health departments in
50 states and DC trained public health
professionals about their roles and
responsibilities during an emergency as
outlined by the Incident Command System,
while in 1999 only 14 did so.
• All states now participate in the Health
Alert Network, which allows for the
rapid exchange of critical public health
information.
Challenges remain. Building on progress in
public health preparedness will require ongoing
commitment.
• Public health departments report difficulties
in recruiting and retaining qualified
epidemiologists, according to a 2006 CSTE
survey.
• Disease surveillance systems need to be
strengthened. In 2007, 16 states did not
report any plans to electronically exchange
health data with regional health information
organizations (networks of healthcare
provider organizations that allow the
electronic sharing of health information
among members).
• To facilitate surveillance, public health
departments need to ensure an appropriate
legal framework before a disaster occurs;
otherwise, states may be unable to share
critical public health information with other
jurisdictions.
• The public health laboratory workforce
needs improvement. Thirty-one state public
health laboratories reported difficulty
recruiting qualified laboratory scientists,
and 39 state public health laboratories
reported needing additional staff to perform
polymerase chain reaction, a rapid DNA
testing technique to quickly identify
bioterrorism agents, according to a 2007
Association of Public Health Laboratories
survey.
• Public health laboratories need to increase
the use of advanced technology and broaden
testing abilities, including radiological
testing. Currently, no state public health
laboratory can rapidly identify priority
radioactive materials in clinical samples.
• Public health departments need to sustain
a system of all-hazards planning, training,
exercising, and improving. This system
should be ready to help at-risk populations,
such as the elderly and others who may need
help controlling chronic diseases.
• Public health and other response
agencies need interoperable emergency
communication systems. In 2007, the
Department of Homeland Security reported
that many cities and metropolitan areas have
established multi-agency communications,
but more progress is needed to expand
interoperable communication across
jurisdictions and levels of government.
Moving forward. CDC is working with state
and local public health departments on initiatives
that include:
• Increasing the use of electronic health
data for preparedness and response by
networking surveillance systems and using
real-time data;
• Expanding laboratory testing;
• Establishing commercial partnerships
to supply needed medicines to at-risk
populations during an emergency;
• Developing and evaluating a core
curriculum for preparedness through the
Centers for Public Health Preparedness, a
national network of academic institutions
with a common focus on public health
preparedness;
• Improving legal preparedness by helping
states and other jurisdictions implement
public health mutual aid agreements, which
enable sharing of supplies, equipment,
personnel, and information during
emergencies;
• Exercising public health systems to
continuously improve capability and
demonstrate readiness; and
• Collaborating with partners to develop
accreditation programs for state and local
public health preparedness.
Achieving the overarching goal, “people prepared
for emerging health threats,” is critical to the
health and safety of our communities. This
report represents CDC’s commitment to sharing
information on a program that contributes to
this goal.
