Ready or Not? 2009

New Report: «state» Scored «Score» out of 10 Key Indicators for Emergency Health Preparedness; New Report Finds H1N1 Reveals Gaps in Readiness

Washington, D.C., December 15, 2009 – The seventh annual Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report, released today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), found that the H1N1 flu outbreak has exposed serious underlying gaps in the nation’s ability to respond to public health emergencies and that the economic crisis is straining an already fragile public health system.

«state» achieved «Score» out of 10 key indicators of public health emergency preparedness.

Overall, the report found that 20 states scored six or less out of 10 key indicators of public health emergency preparedness. Nearly two-thirds of states scored seven or less. Eight states tied for the highest score of nine out of 10: Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma, Texas, and Vermont. Montana had the lowest score at three out of 10. The preparedness indicators are developed in consultation with leading public health experts based on data from publicly available sources or information provided by public officials.

“The H1N1 outbreak has vividly revealed existing gaps in public health emergency preparedness,” said Richard Hamburg, Deputy Director of TFAH. “The Ready or Not? report shows that a band-aid approach to public health is inadequate. As the second wave of H1N1 starts to dissipate, it doesn’t mean we can let down our defenses. In fact, it’s time to double down and provide a sustained investment in the underlying infrastructure, so we will be prepared for the next emergency and the one after that.”

Overall, the report found that the investments made in pandemic and public health preparedness over the past several years dramatically improved U.S. readiness for the H1N1 outbreak. But it also found that decades of chronic underfunding meant that many core systems were not at-the-ready. Some key infrastructure concerns were a lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity, and a shrinking public health workforce. In addition, the report found that more than half of states experienced cuts to their public health funding and federal preparedness funds have been cut by 27 percent since fiscal year (FY) 2005, which puts improvements that have been made since the September 11, 2001 tragedies at risk.

No.	Indicator	«state»	Number of States Receiving Points
A checkmark means the state received a point for that indicator
1	Purchased 50 percent or more of its share of federally-subsidized antiviral medications to prepare for a potential pandemic flu outbreak	«Indicator1»	37 and D.C.
2	Submitted data on available hospital beds weekly for at least 50 percent of the facilities within the state to the U.S. Department of Health and Human Services during the 2009 H1N1 response.	«Indicator2»	40
3	Public health lab has the capacity in place to assure the timely pick-up and delivery of disease samples on a 24/7, 365 day basis. «asterisk_wa»	«Indicator3»	36 and D.C.
4	Public health lab reports having enough staff to work the intense hours needed during an emergency, like H1N1 (five, 12-hour days for six to eight weeks).	«Indicator4»	39
5	Tracks diseases through an Internet system used by the CDC.	«Indicator5»	44 and D.C.
6	Identified the pathogen responsible for reported food-borne disease outbreaks at a rate that met or exceeded the national average of 46 percent (combined data 2005-2007).	«Indicator6»	36 and D.C.
7	Meets the Medical Reserve Corps (MRC) readiness criteria for medical volunteers during an emergency.	«Indicator7»	41 and D.C.
8	Requires all licensed childcare facilities to have a multi-hazard written evacuation and relocation plan for emergencies, and verification that the laws are implemented.	«Indicator8»	20 and D.C.
9	Has a law or legal opinion in place to limit liability against organizations that provide volunteer help during emergencies. «asterisk_hi»	«Indicator9»	33 and D.C.
10	Increased or maintained level of funding for public health services from FY 2007-08 to FY 2008-09	«Indicator10»	23 and D.C.
Total		«Score»

«footnote»

“State and local health departments around the country are being asked to do more with less during the H1N1 outbreak as budgets continue to be stretched beyond their limits,” said Michelle Larkin, J.D., Public Health Team Director and Senior Program Officer at the Robert Wood Johnson Foundation. “Public health provides essential prevention and preparedness services that help us lead healthier lives — without sustained and stable funding, Americans will continue to be needlessly at risk from the next public health threat.”

The report also offers a series of recommendations for improving preparedness, including:

Ensure Stable and Sufficient Funding. The 27 percent cut to federal support for public health preparedness since FY 2005 must be restored, and funding must be stabilized at a sufficient level to support core activities and emergency planning. Increased funding must also be provided to modernize flu vaccine production, improve vaccine and antiviral research and development, and fully support the Hospital Preparedness Program.
Conduct an H1N1 After-Action Report and Update Preparedness Plans with Lessons Learned. Strengths and weaknesses of the H1N1 response should be evaluated and used to revise and strengthen federal, state, and local preparedness planning, including assessing what additional resources are needed to be sufficiently prepared. Identified gaps in core systems, including communications, surveillance, and laboratories much be addressed. In addition, continued surge capacity concerns, including establishing crisis standards of care, must be addressed.
Increase Accountability and Transparency. Federal and state health departments should regularly make updates on progress made on benchmarks and deliverables identified in the Pandemic and All Hazards Preparedness Act available to the public so they can see how tax dollars are being used and how well protected their communities are from health threats.
Improve Community Preparedness. Additional measures must be taken to reach out quickly and effectively to high-risk populations, including strengthening culturally competent communications around the safety of vaccines. Health disparities among low-income and racial/ethnic minorities, who are often at higher risk during emergencies, must also be addressed.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s web site at www.healthyamericans.org and RWJF’s Web site at www.rwjf.org. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

9 out of 10: Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma, Texas, Vermont
8 out of 10: Alabama, California, Colorado, District of Columbia, Hawaii, Kentucky, Michigan, Mississippi, Ohio, Oregon, Pennsylvania, South Carolina, Wisconsin
7 out of 10: Indiana, Iowa, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, South Dakota, Tennessee, Virginia
6 out of 10: Connecticut, Georgia, Illinois, Kansas, Louisiana, Nebraska, Nevada, New Jersey, New Mexico, Rhode Island, Utah, West Virginia, Wyoming
5 out of 10: Alaska, Arizona, Florida, Idaho, Maine, Washington
3 out of 10: Montana

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need–the Foundation expects to make a difference in our lifetime. For more information, visit rwjf.org

H1N1 Challenges Ahead

«Headline_full»

Country Faces Challenges in Hospital Care, Vaccinations, Antivirals, and At-Risk Community Preparedness

Media Contact: Laura Segal (202) 223-9870 x 27 or [email protected].

(October 1, 2009, Washington, DC) — Trust for America’s Health (TFAH) released a new report today that «estimates_or_finds», if 35 percent of Americans get sick from the H1N1 virus. «this_or_that», based on estimates from the FluSurge model developed by the U.S. Centers for Disease Control and Prevention (CDC).

According to the new report, H1N1 Challenges Ahead, «here_or_there»

In addition, «Cases_at_35_attack_rate» people in «state» could get sick if 35 percent of Americans get H1N1.

“Health departments and communities around the country are racing against the clock as the pandemic unfolds,” said Jeff Levi, PhD, Executive Director of TFAH. “The country’s much more prepared than we were a few short years ago for a pandemic, but there are some long-term underlying problems which complicate response efforts, like surge capacity and the need to modernize core public health areas like communications and surveillance capabilities.”

The report examines other H1N1 outbreak concerns the country faces this fall related to vaccines, antiviral medication, health care, and the special needs of at-risk communities. Additional key findings from the report include:

Last year, only «Vaccination_rate_for_all_adults» percent of adults in «state» were vaccinated against the seasonal flu. This means that there will need to be a major upsurge in vaccinations in order to vaccinate the entire population for H1N1, compared to what states and communities have managed in the past.
«Vaccination_Rates_for_65» percent of seniors (over the age of 65) in «state» are vaccinated for the flu annually, but only «Vaccination_Rates_for_1849» percent of younger adults in «state» receive vaccinations (ages 18 to 49). Seasonal flu vaccination efforts have concentrated on immunizing seniors, but H1N1 is considered to be more dangerous for young adults and children, which means outreach for vaccinations must be very different.
Budget cuts and layoffs in states and communities are hampering preparedness efforts. Local health departments eliminated 8,000 staff positions in the first half of 2009, which adds to the 7,000 local public health jobs lost in 2008. In addition, federal public health preparedness funding was cut by 25 percent from fiscal year 2005 to 2009.
Nearly half of private sector workers do not have any paid sick leave benefits, which means millions of Americans will face losing their jobs if they are sick, or they attend work and risk contaminating others.
While the federal government pays for the purchase and distribution of vaccines, payment for the administration of vaccines will be the responsibility of insurance providers, state and local health officials, or, in some cases, it could be an out-of-pocket cost for individuals.
There are 47 million Americans without health coverage. If 35 percent of the public becomes infected with H1N1, some 15 million uninsured Americans could become sick and either go without care or seek care in already crowded emergency rooms.
African-Americans and Hispanics are more likely to have severe cases of H1N1 because they suffer from more underlying chronic conditions, like asthma and diabetes. At the same time, many significant gaps remain in systems for reaching minority communities. For instance, emergency preparedness information is often disseminated on the Internet, which many people do not have access to, and there is limited availability of non-English information.

The report includes short-term recommendations to address some immediate concerns for the upcoming H1N1 season and long-term recommendations for improving the nation’s overall capacity for preparing for health emergencies. Some of the short-term recommendations include:

Refine plans for rapid distribution and administration of vaccines for the first mass vaccination effort to be conducted in such a short time in U.S. history;
Risk communications must be a top priority. Special efforts must be made to reach out to young adults, minorities, and other at-risk groups to get vaccinated. This should include communications in many languages;
Vaccination campaigns must continue past the fall to prepare for a potential third wave outbreak;
An emergency health benefit should be established to care for the uninsured and under-insured during the H1N1 outbreak;
An emergency sick leave benefit should be made available to Americans without sick leave benefits;
The emergency supplemental funding for H1N1 preparedness has been very important, but it is one-time funding and is insufficient to fill chronic public health infrastructure gaps, including the need to modernize surveillance systems and upgrade other technologies;
All public and private health insurers should waive co-payment requirements for H1N1 vaccines and out-of-network care for H1N1-related illness and allow providers to bulk bill for the administration of vaccines instead of requiring cumbersome paperwork for every individual;
The U.S. Department of Labor should communicate with the private health benefit plans governed by the Employee Retirement Income Security Act (ERISA) to encourage them to waive co-pay requirements for vaccines and out-of-network restrictions and to provide information to state and local health departments to help with their vaccination campaigns in communities; and
Health providers should follow the guidance from the U.S. Department of Health and Human Services and the Occupational Safety and Health Administration on the best way to protect health care personnel; and
Health providers and health departments should develop and disseminate strong public messages about ways to practice good hygiene and understand symptoms and remedies.

Hospital Bed Capacity at Five Weeks into a Pandemic

These estimates are for the peak of an outbreak, based on CDC’s FluSurge, using expert predictions that H1N1 is a relatively mild strain of the flu, similar to the 1968 pandemic flu, and that up to 35 percent of Americans could potentially become sick with H1N1:

15 states would be at or exceed hospital bed capacity: Arizona (117%); California (125%); Connecticut (148%); Delaware (203%); Hawaii (143%); Maryland (143%); Massachusetts (110%); Nevada (137%); New Jersey (101%); New York (108%); Oregon (107%); Rhode Island (143%); Vermont (108%); Virginia (100%); and Washington (107%).
12 states would be at 75 to 99 percent of their hospital bed capacity: Colorado (88%); Florida (80%); Georgia (78%); Maine (83%); Michigan (79%); New Hampshire (84%); New Mexico (93%); North Carolina (95%); Pennsylvania (77%); South Carolina (93%); Utah (83%); and Wisconsin (75%).

The full report, including a chart with state-by-state information on illnesses, hospitalizations, and flu vaccination rates, is available on TFAH’s web site www.healthyamericans.org. The report was supported by a grant from the Robert Wood Johnson Foundation.