The federal government also has a role in preparedness for and response  to major public health threats. State and Local Officials Reported Varying Levels of Public Health Preparedness for Infectious Disease Outbreaks

In the cities we visited, state and local officials reported varying levels of  public health preparedness to respond to outbreaks of diseases such as  SARS. In addition, we found that the level of  preparedness varied across the cities. Jurisdictions that had multiple prior  experiences with public health emergencies were generally more prepared  than those with little or no such experience prior to our site visits. In addition, states were working on plans for receiving and distributing the  Strategic National Stockpile and for administering mass vaccinations. Progress Has Been Made in Elements of Public Health Preparedness, But Gaps Remain

States and local areas were addressing gaps in public health preparedness  elements, such as communication, but weaknesses remained in other  preparedness elements, including the disease surveillance and laboratory  systems and the response capacity of the workforce. However, the  state did not have written agreements with its neighboring states for  responding to a public health emergency. Planning for Regional Coordination Was Lacking between States

Response organization officials were concerned about a lack of planning  for regional coordination between states of the public health response to  an infectious disease outbreak. Most Hospitals Lack Response Capacity for Large-Scale Infectious Disease Outbreaks

We found that most hospitals lack the capacity to respond to large-scale  infectious disease outbreaks. Most  emergency departments across the country have experienced some degree  of crowding and therefore in some cases may not be able to handle a large  influx of patients during a potential SARS outbreak. In addition, although  most hospitals across the country reported participating in basic planning  activities for large-scale infectious disease outbreaks, few have acquired  the medical equipment resources, such as ventilators, to handle large  increases in the number of patients that may result from outbreaks of  diseases such as SARS. Key Federal Decisions for Influenza Pandemic Planning Could Facilitate Response to Emerging Infectious Diseases

The completion of final federal influenza pandemic response plans that  address the problems related to the purchase, distribution, and  administration of supplies of vaccines and antiviral drugs during a  pandemic could facilitate the public health response to emerging  infectious disease outbreaks. CDC has provided interim draft guidance to  facilitate state plans but has not made the final decisions on plan  provisions necessary to mitigate the effects of potential shortages of  vaccines and antiviral drugs. Federal and state plans for the purchase, distribution, and  administration of supplies of vaccines and drugs in response to an  influenza pandemic have still not been finalized. Bioterrorism: Preparedness Varied across State and Local Jurisdictions. GAO-03-373. Hospital Emergency Departments: Crowded Conditions Vary among  Hospitals and Communities. GAO-03-460. Bioterrorism: The Centers for Disease Control and Prevention’s Role in  Public Health Protection. GAO-01- 915.
Why GAO Did This Study

SARS has infected relatively few people nationwide, but it has raised concerns about preparedness for large-scale infectious disease outbreaks. The initial response to an outbreak occurs in local agencies and hospitals, with support from state and federal agencies, and can involve disease surveillance, epidemiologic investigation, health care delivery, and quarantine management. Officials have learned lessons applicable to preparedness for such outbreaks from experiences with other major public health threats. GAO was asked to examine the preparedness of state and local public health agencies and hospitals for responding to a large-scale infectious disease outbreak and the relationship of federal and state planning for an influenza pandemic to preparedness for emerging infectious diseases. This testimony is based on Bioterrorism: Preparedness Varied across State and Local Jurisdictions, GAO-03-373 (Apr. 7, 2003); findings from a GAO survey on hospital emergency room capacity (in Hospital Emergency Departments: Crowded Conditions Vary among Hospitals and Communities, GAO-03-460 (Mar. 14, 2003)) and on hospital emergency preparedness; and information updating Influenza Pandemic: Plan Needed for Federal and State Response, GAO-01-4 (Oct. 27, 2000).

What GAO Found

The efforts of public health agencies and health care organizations to increase their preparedness for major public health threats such as bioterrorism and the worldwide influenza outbreaks known as pandemics have improved the nation's capacity to respond to SARS and other emerging infectious disease outbreaks, but gaps in preparedness remain. Specifically, GAO found that there are gaps in disease surveillance systems and laboratory facilities and that there are workforce shortages. The level of preparedness varied across seven cities GAO visited, with jurisdictions that have had multiple prior experiences with public health emergencies being generally more prepared than others. GAO found that planning for regional coordination was lacking between states. GAO also found that states were developing plans for receiving and distributing medical supplies for emergencies and for mass vaccinations in the event of a public health emergency. GAO found that most hospitals lack the capacity to respond to large-scale infectious disease outbreaks. Most emergency departments have experienced some degree of crowding and therefore in some cases may not be able to handle a large influx of patients during a potential SARS or other infectious disease outbreak. Most hospitals across the country reported participating in basic planning activities for such outbreaks. However, few hospitals have adequate medical equipment, such as the ventilators that are often needed for respiratory infections such as SARS, to handle the large increases in the number of patients that may result. The public health response to outbreaks of emerging infectious diseases such as SARS could be improved by the completion of federal and state influenza pandemic response plans that address problems related to the purchase, distribution, and administration of supplies of vaccines and antiviral drugs during an outbreak. The Centers for Disease Control and Prevention has provided interim draft guidance to facilitate state plans but has not made the final decisions on plan provisions necessary to mitigate the effects of potential shortages of vaccines and antiviral drugs in the event of an influenza pandemic.