In a previous post, I reported on the preparedness of U.S. hospitals to deal with the H1N1 virus. A new report assesses the preparedness of the whole public health system in dealing with the virus, as well as other public health emergencies.

The report, "Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism," found that the investments made to deal with public health emergencies since 9/11 are starting to payoff as the U.S. confronts the H1N1 pandemic. However, many core areas of public health preparedness are still severely lacking and in urgent need of modernization. Some of the major issues of continuing concern are strengthening the public health workforce, health care surge capacity, and disease tracking and surveillance.

The report looked at some key indicators of public health emergency preparedness by state. It found that 20 states scored six or less out of 10 indicators, and nearly 60% of states scored seven or less. The least prepared state was Montana with 3/10. The best states in terms of preparedness were Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma, Texas, and Vermont, as they scored 9/10 on the key indicators.

Other major findings from the report:

• 13 states have purchased less than half of their share of federally-subsidized antiviral drugs to stockpile for use during a flu pandemic.

• 11 states and D.C. do not have enough staffing capacity to work five, 12-hour days for six to eight weeks in response to H1N1.
• Federal funding for public health emergency preparedness and hospital preparedness has declined 27% since 2005.
• Many state health departments are still struggling with limited resources to develop mass vaccination plans to receive, distribute, and administer the H1N1 vaccine.
• During the first wave of H1N1 in the spring of 2009, laboratory testing capability was quickly overwhelmed in some states.
• A majority of states decreased funding for public health services in 2008 and 2009 because of the economic recession.
• Despite the Department of Health and Human Services having spent more than $1 billion to enhance vaccine manufacturing capacity, the system still relies on old production lines, which contributed to delays in production and delivery of the H1N1 vaccine.
• African-Americans and Hispanics were hospitalized at significantly higher rates than white Americans during the spring wave of H1N1.