The federal government provides funding, guidance and technical assistance to state and local planners, and can require that certain activities be carried out as a condition of funding. Because the states are the seat of most authority for public health and medical preparedness, national preparedness for public health threats depends, in part, on the preparedness of individual states. Certain planning activities were required as a condition of the federal funds. It also presents an approach to the analysis of state pandemic plans, and the findings of that analysis. CRS analyzed pandemic plans available as of July 2006. This analysis is not intended to grade or rank individual state pandemic plans or capabilities. Rather, its findings indicate that a number of challenges remain in assuring pandemic preparedness, and suggest areas that may merit added emphasis in future planning efforts. This report will not be updated. A total of 66 variables were developed for analysis, to assess pandemic planning activities in the following eight topical areas:
(1) Leadership and Coordination;
(2) Surveillance and Laboratory Activities;
(3) Vaccine Management;
(4) Antiviral Drug Management;
(5) Other Disease Control Activities (e.g., isolation and quarantine);
(6) Communications Activities;
(7) Healthcare Services; and
(8) Other Essential Services (e.g., public utilities). This analysis is not intended to grade or rank individual state pandemic plans or capabilities. A discussion of these grants, and associated federal requirements for pandemic planning, is provided in the Appendix . In addition, Congress has continued to refine the delegations of authority among key federal response agencies. States were required to conduct public health emergency response exercises, and to develop pandemic plans, as conditions of their FY2005 CDC public health grants, but they were not required, at that time, to conduct exercises specifically for a flu pandemic. However, many of the plans pre-date 2006, when CDC reported that public health labs in all 50 states and the District of Columbia have the capability to test for H5N1 influenza. The state pandemic flu plans analyzed here reflected their authorship by public health officials. These elements may require stronger engagement by emergency management officials and others in planning. Some flexibility in those requirements is helpful in allowing states to prepare differently for those threats—such as hurricanes, earthquakes and wildfires—that are likely to affect states differently. A pandemic, on the other hand, is more likely to affect states in similar ways that are, to some extent, predictable. But the matter of what the states should do to be prepared for a pandemic is not always clear. For example, uncertainties about the ways in which flu spreads, the lack of national consensus in matters of equity in rationing, and a long tradition of federal deference to states in matters of public health, all complicate efforts to set uniform planning requirements for states.
States are the seat of most authority for public health emergency response. Much of the actual work of response falls to local officials. However, the federal government can impose requirements upon states as a condition of federal funding. Since 2002, Congress has provided funding to all U.S. states, territories, and the District of Columbia, to enhance federal, state and local preparedness for public health threats in general, and an influenza ("flu") pandemic in particular. States were required to develop pandemic plans as a condition of this funding.
This report, which will not be updated, describes an approach to the analysis of state pandemic plans, and presents the findings of that analysis. State plans that were available in July 2006 were analyzed in eight topical areas: (1) leadership and coordination; (2) surveillance and laboratory activities; (3) vaccine management; (4) antiviral drug management; (5) other disease control activities; (6) communications; (7) healthcare services; and (8) other essential services. A history of federal funding and requirements for state pandemic planning is provided in an Appendix. This analysis is not intended to grade or rank individual state pandemic plans or capabilities. Rather, its findings indicate that a number of challenges remain in assuring pandemic preparedness, and suggest areas that may merit added emphasis in future planning efforts.
Generally, the plans analyzed here reflect their authorship by public health officials. They emphasize core public health functions such as disease detection and control. Other planning challenges, such as assuring surge capacity in the healthcare sector, the continuity of essential services, or the integrity of critical supply chains, may fall outside the authority of public health officials, and may require stronger engagement by emergency management officials and others in planning.
Since different threats—such as hurricanes, earthquakes or terrorism—are expected to affect states differently, many believe that states should have flexibility in emergency planning. This complicates federal oversight of homeland security grants to states, however. Which requirements should be imposed on all states? When is variability among states desirable, and when is it not? A flu pandemic is perhaps unique in that it would be likely to affect all states at nearly the same time, in ways that are fairly predictable. This may argue for a more directive federal role in setting pandemic preparedness requirements. But the matter of what the states should do to be prepared for a pandemic is not always clear. For example, uncertainties about the ways in which flu spreads, the lack of national consensus in matters of equity in rationing, and a long tradition of federal deference to states in matters of public health, all complicate efforts to set uniform planning requirements for states.
In addition to assuring the strength of planning efforts, readiness also depends on assuring that states can execute their plans. This assurance can be provided through analysis of the response during exercises, drills, and relevant real-world incidents. Such an analysis is not within the scope of this report.