Bioterrorism preparedness coordination: an ataxic saga continues.

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16 Public Health Reports / January–February 2004 / Volume 119 In spite of successes achieved in the war on terrorism and notwithstanding the tremendous investments recently made in our nation’s security, an undercurrent of uneasiness still exists among those engaged in preparedness. As the 1990s drew to a close, recognition of the emerging threat of bioterrorism accelerated. The call went out heralding the need for closer collaboration among federal, state, and local agencies to combat this threat.1,2 Academicians, advisory committees, and government auditors agreed that better coordination is needed at all levels of government.3–5 In 2001, we observed our first bioterrorism fatalities and experienced an unprecedented spending campaign to prepare for future attacks. In spite of our best efforts, we in public health are still apprehensive. In spite of our progress toward better preparedness, we lack confidence in our efforts. There is cause for this anxiety. The barriers to enhancing our collaborations are deeply ingrained in our federal spending processes. On January 31, 2002, the U.S. Department of Health and Human Services (DHHS) sent letters to state governors outlining how much money each state would receive from the $2.9 billion bioterrorism appropriations bill that President Bush had signed into law three weeks earlier. From receipt of that announcement, the states were given only six weeks to submit a detailed plan for responding to a bioterrorism attack or other public health emergency and strengthening core public health capacities related to preparedness.6 Although the sense of urgency is understandable given the events of 2001, this was not an effective approach for promoting the necessary collaboration among federal, state, and local governments. Furthermore, these funding infusions do not generate sustainable progress for public health preparedness. This funding approach only causes further division and duplication of efforts. The timeline for states to respond to DHHS was so severely compressed that there was little coordination between the states and those working on preparedness at the local level. Each state was required to conduct separate needs assessments for the preparedness training of their health care and public health workforce. Rather than mandating this assessment by each of the 50 states, Bioterrorism Preparedness Coordination: An Ataxic Saga Continues