However, as we witnessed in the response to Hurricane Katrina and recent terrorist threats around the
world, more needs to be done to prevent and better respond to all hazards—future acts of bioterrorism, natural disas-
ters and other public health emergencies and their adverse health consequences. Steps that still need to be taken
include making a substantial investment in the recruitment, retention and training of the public health workforce;
ensuring a dependable distribution system for needed countermeasures; ensuring adequate funding is available for all
those responsible for preparedness; and protecting food and water supplies.
Ultimately, bioterrorism preparedness should go hand-in-hand with everyday public health activities. Programs such as
immunization and chronic disease prevention programs cannot be neglected to pay for bioterrorism preparedness. In
addition, careful attention needs to be paid to overtaxing public health professionals such as environmental health practi-
tioners and nurses who are already stretched with their everyday responsibilities. In many cases, preparedness for bioter-
rorism and other emergencies is added to their existing responsibilities without adequate training or additional resources.
Bioterrorism preparedness is the responsibility of a complicated
web of federal, state and local agencies and involves a wide array
of professionals from planners, public health officials, nurses, fire
and police personnel, to hospital and school personnel.
No state or city is fully prepared to respond to a bioterrorist
attack and its resulting health consequences.
All 50 states have now developed bioterrorism response plans.
All states have the systems necessary to rapidly detect a terrorist
event through mandatory reportable disease detection systems.
Thousands of state and local public health personnel have been
funded with federal bioterrorism dollars. Without this stream of
funding, these positions will be eliminated, exacerbating the
current public health workforce shortage.
Fewer than one-quarter of states and very few cities have
achieved “green” status for the Strategic National Stockpile.
Without this status, they won’t be able to receive countermea-
sures and medical supplies from the Strategic National Stockpile
to administer and distribute during a public health emergency.
Over 25 percent of states lack the capacity and infrastructure
in their laboratories to respond in the event of a bioterrorist
51 of 83 state and local Laboratory Response Network (LRN)
reference laboratories have had delays receiving CDC-supplied
reagents for detection of bioterrorist agents.
40 of the 51 State Public Health Laboratories have cited dif-
ficulty recruiting and retaining staff for bioterrorism pre-
Many hospitals remain insufficiently prepared. Hospitals, in gen-
eral, lack the ability to stockpile certain supplies and counter-
measures in the event of a public health emergency. In the
event or a bioterrorist attack or other public health emergency
as pandemic flu, there will not be enough beds to provide care
for a sharp increase in patients. Also, most hospitals do not have
plans that address how to respond to a shortage of health care
workers in the event of an emergency.
Sources: U.S. Department of Health and Human Services,Trust for America’s
Health,Association of Public Health Laboratories
800 I Street, NW
Washington, DC 20001
Centers for Disease Control and Prevention (CDC).
the Health Resources and Services Administration (HRSA).
scholarship and student loan repayment programs for public health students and professionals.
ensure that people who receive countermeasures—such as vaccines—and become ill, disabled or die, receive compensation for their
losses. Without such a fund, first responders and the public will hesitate to receive such countermeasures, as was witnessed during the
smallpox vaccination campaign. This fund would also provide increased certainty for industry as it would guarantee demand for
countermeasures, as people will be more likely to get vaccinated and receive a countermeasure if they have some protection against
the worst-case scenario.
towards all-hazards preparedness. A “carve out” of these funds is necessary to ensure that states and localities have adequate resources
to prepare—not only for pandemic flu, but for other public health emergencies as well. This should not be at the expense of other
public health programs.
Agents and diseases used for bioterrorism are likely to be spread easily from person to person and cause severe
illness and death. Bioterrorism agents are classified into three categories—A, B and C—depending on how
easily they can be transmitted from person to person, how sick they make people and their death rates.
Category A agents are those that pose the highest risk to the public’s health and safety.
spread from one person to another. However, people can get infected with anthrax from animals, or when it is used as a
weapon, as it was in 2001. There are three types of anthrax: skin, lung and digestive. Anthrax ingested through the lungs is the
most severe, whereas anthrax infection on the skin can be cured with early treatment of antibiotics. In 2001, mail containing
anthrax was sent to members of Congress and the news media.
Ricin is a Category B agent that prevents cells from making the proteins they need, which causes cells in people it infects
to die. People can be exposed to ricin by inhaling or swallowing it, or through skin and eye contact. As it commonly takes the
form of a mist or powder, it was used as a weapon through the mail in 2004. The symptoms of ricin exposure vary depending
on how someone is exposed to it and can range from difficulty breathing to nausea to seizures. There is no specific treatment for
ricin poisoning; victims should seek medical attention immediately to minimize the health effects of the poisoning.
Hantavirus is a Category C agent. Although preventable by eliminating or minimizing your contact with rodents, han-
tavirus—a disease that can be fatal—does not have a specific treatment. Many of its symptoms are like those of the flu and