Local health care organizations, including hospitals, are generally  responsible for the initial response to a public health emergency, be it a  bioterrorist attack or a naturally occurring infectious disease outbreak. In  the event of a large-scale infectious disease outbreak, hospitals and their  emergency departments would be on the front line, and their personnel  would take on the role of first responders. Officials view influenza vaccine as the cornerstone of efforts to prevent  and control annual influenza outbreaks as well as pandemic influenza. State and Local Officials Reported Varying Levels of Public Health Preparedness for Infectious Diseases Outbreaks

In the cities we visited, state and local officials reported varying levels of  public health preparedness to respond to an infectious disease outbreak. 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. We found that  regional planning was lacking between states. States were working on  their own 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 response capacity of the workforce  and the disease surveillance and laboratory systems. 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. Most Hospitals Lack Adequate Equipment, Facilities, and Staff Required to Respond to a Large-Scale Infectious Disease Outbreak

Most hospitals lack adequate equipment, isolation facilities, and staff to  treat a large increase in the number of patients for an infectious disease  such as SARS. Officials Have Been Slow to Finalize Plans for Federal and State Response to an Influenza Pandemic

Federal and state influenza pandemic response plans, another important  component to public health preparedness, are in various stages of  completion and do not consistently address the problems related to the  purchase, distribution, and administration of supplies of vaccines and  antiviral drugs during a pandemic. Federal and State Pandemic Response Plans Are Not Finalized

Federal and state officials have not finalized plans for responding to  pandemic influenza. Although to a certain extent planning efforts for other  emergencies can be used for pandemic response, additional planning is  important to deal with specific aspects of a pandemic response.
Why GAO Did This Study

Following the bioterrorist events of the fall of 2001, there has been concern that the nation may not be prepared to respond to a major public health threat, such as the current outbreak of Severe Acute Respiratory Syndrome (SARS). Whether a disease outbreak occurs naturally or is due to the intentional release of a harmful biological agent by a terrorist, much of the initial response would occur at the local level, particularly hospitals and their emergency departments. Efforts to plan for worldwide influenza pandemics are useful for understanding public health preparedness for other large-scale outbreaks. GAO was asked to examine (1) the preparedness of state and local public health agencies and organizations for responding to a large-scale infectious disease outbreak, (2) the preparedness of hospitals for responding to a large-scale infectious disease outbreak, and (3) federal and state efforts to prepare for an influenza pandemic. This testimony is based on GAO's report, Bioterrorism: Preparedness Varied across State and Local Jurisdictions, GAO-03-373 (Apr. 7, 2003), a survey of hospitals GAO conducted to assess their level of emergency preparedness, and information updating GAO's prior report on federal and state planning for an influenza pandemic, Influenza Pandemic: Plan Needed for Federal and State Response, GAO-01-4 (Oct. 27, 2000).

What GAO Found

The efforts of state and local public health agencies to prepare for a bioterrorist attack have improved the nation's capacity to respond to infectious disease outbreaks and other major public health threats, but gaps in preparedness remain. GAO found workforce shortages and gaps in disease surveillance and laboratory facilities. The level of preparedness varied across cities GAO visited. Jurisdictions that have had multiple prior experiences with public health emergencies were generally more prepared than others. GAO found that regional planning was generally lacking between states but that states were developing their own plans for receiving and distributing medical supplies for emergencies, as well as plans for mass vaccinations in the event of a public health emergency. GAO found that many hospitals lack the capacity to respond to large-scale infectious disease outbreaks. Most hospitals across the country reported participating in basic planning activities for large-scale infectious disease outbreaks and training staff about biological agents. However, most hospitals lack adequate equipment, isolation facilities, and staff to treat a large increase in the number of patients that may result. Federal and state officials have not finalized plans for responding to pandemic influenza. These plans do not consistently address problems related to the purchase, distribution, and administration of supplies of vaccines and antiviral drugs that may be needed during a pandemic.