Emergency preparedness improves in US following 9/11 terrorist attacks

A new supplement published today in the American Journal of Public Health highlights considerable progress made in the United States’ public health preparedness capability following the Sept. 11, 2001, terrorist attacks. Researchers found that increases in funding substantially improved efforts against multiple public health threats, including those caused by infectious diseases.

“The September 11, 2001 (9/11), and subsequent anthrax terrorist attacks were pivotal moments in U.S. history,” Bhavini Patel Murthy, MD, MPH, CDC Epidemic Intelligence Service officer, and colleagues wrote. “They heightened awareness about the need for system coordination among federal, state and local governments.”

In response to the terror attacks, Congress established appropriations to support state, local, tribal and territorial public health departments. Rachel Nonkin Avchen, MS, PhD, of the CDC’s Office of Public Health Preparedness and Response, and colleagues noted that the funds are administered through a cooperative agreement with the CDC.

“The Public Health Emergency Preparedness (PHEP) cooperative agreement helps health departments strengthen their abilities to effectively respond to a range of public health threats, including infectious diseases; natural disasters; and biological, chemical, nuclear and radiological events,” Avchen and colleagues wrote in a commentary.

To assess progress made toward emergency preparedness capabilities, Murthy and colleagues examined self-reported data from 62 jurisdictions (50 states, eight territories and four localities) receiving support from the PHEP program from 2001 to 2016. The analysis specifically focused on six domains of public health preparedness, including biosurveillance, community resilience, countermeasures and mitigation, incident management, information management and surge management.

Before Sept. 11, 2001, most jurisdictions reported limited preparedness capabilities. By 2016, however, substantial improvements were recorded across all six domains. According to the researchers, all 62 jurisdictions reported incident management infrastructure capability. When assessing the countermeasures and mitigation domain, Murthy and colleagues observed a 200% increase in the number of jurisdictions with dispensing and storage distribution capability, and a 193% increase in inventory management systems. There also were significant improvements in biosurveillance, including a 150% increase in the number of jurisdictions with electronic lab reporting.

Despite these gains, more than 20% of jurisdictions still reported a lack of coordination between the health system and public health agencies in 2016. The top three challenges included missing or incomplete plans, difficulties in securing or training personnel and inadequate funding for personnel recruitment.

During their review, Murthy and colleagues found that $12.5 billion has been allocated to PHEP since 2001, and $1.9 billion in supplemental funding has been used to support public health outbreaks of national concern, including the influenza pandemic in 2006, the H1N1 pandemic in 2009 and 2010, the West African Ebola outbreak in 2014 and the Zika virus epidemic in 2016. However, further review of PHEP per capita funding revealed steady declines beginning in 2003.

“Total funding for public health as a share of overall health spending declined from 3.18% in 2002 to 2.65% in 2014, and it is projected to fall further to 2.40% in 2023,” the researchers wrote.

Additional studies included in the AJPH supplement illustrate how PHEP enhances emergency preparedness capabilities in the U.S., including those that help jurisdictions prevent and respond to infectious disease threats. With PHEP funds, researchers have been able to develop tests for viral infections, quickly respond to fatal outbreaks, and implement vector control strategies, according to Avchen and colleagues.

“These are just a few examples … The articles in this issue of AJPH provide detailed accounts of preparedness in action, showcasing competencies in biosurveillance, incident management, community resilience, information management, countermeasures and mitigation and surge management,” they wrote. “These articles demonstrate how and why public health agencies, health care systems and communities play a vital role in protecting and securing the nation’s public health.” – by Stephanie Viguers

References:

Avchen RN, et al. Am J Public Health. 2017;doi:10.2105/AJPH.2017.304058.

Murthy BP, et al. Am J Public Health. 2017;doi:10.2105/AJPH.2017.304038.

Disclosure: The researchers report no relevant financial disclosures.

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