Has Bioterrorism Preparedness Improved Public Health?

Issue Brief No. 65 | July 2003 | By Andrea Staiti, Aaron Katz, and John F. Hoadley

In the aftermath of the September 11 attacks and the anthrax incidents that followed, the federal government directed more than $1 billion to states for public health preparedness improvements. HSC's site visits to 12 nationally representative communities during 2002-03 found that this investment in bioterrorism readiness had produced early benefits for the broader public health system, including greater visibility for public health agencies, stronger infrastructure and improved coordination across government sectors. At the same time, modest downsides had emerged, including staff diversions and delays in implementing some routine public health programs.

Federal Funding and Focus Areas

President Bush signed legislation in January 2002 that channeled funds to states based on plans targeting areas identified by the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA). CDC priorities included preparedness planning, surveillance and epidemiology capacity, laboratory upgrades, communications networks, risk communication and training. HRSA focused on improving hospital readiness for bioterrorism events. For 2003, continued federal funding totaled $1.4 billion for states and localities, covering smallpox vaccination efforts alongside broader preparedness activities.

Early Gains for Public Health Infrastructure

The federal focus on bioterrorism preparedness generated several positive developments at the community level. Public health officials gained new prominence in disaster response planning, stepping into leadership roles that had previously been peripheral. In Seattle, increased visibility allowed the city to engage the community on other health concerns including West Nile virus, diabetes and obesity. In Florida, additional funding supported hiring more epidemiologists and strengthening routine immunization work.

Collaboration between public health agencies and other community organizations improved markedly. Before September 11, public health departments often had limited contact with emergency management, law enforcement, fire departments, hospitals and physicians. The attacks forced these agencies to understand each other's capabilities and develop personal working relationships. In Lansing, the local emergency planning commission broadened its membership to include community-wide representatives and established new connections with the medical community.

Communication and surveillance systems received significant upgrades across the 12 study sites. Orange County, California upgraded paramedic radios to link ambulance, fire, police and hospital channels. Northern New Jersey equipped all hospitals with dedicated emergency communication radios. Miami-Dade County developed a Web-based disease tracking system with hospital participation. These infrastructure investments strengthened responses not just to potential terrorist events but to natural disasters and disease outbreaks like SARS as well.

Growing Concerns and Negative Effects

As site visits continued into 2003, worries mounted that the federal smallpox vaccination program was pulling resources away from traditional public health functions. Core activities like routine immunizations, health promotion campaigns and screening programs faced potential disruption as staff time was redirected toward bioterrorism-related work. State and local budget cuts compounded the problem, squeezing funding for everyday public health operations even as federal preparedness dollars flowed in.

Some communities reported that the federal funding allocation process itself created friction. Seattle's public health department objected to Washington state's decision to distribute new federal funds evenly across 10 regions, arguing that Seattle deserved a larger share given its perceived higher threat level and the fact that more than one-third of the state's employed workforce worked in the city.

Sources and Further Reading

This analysis was originally published as Issue Brief No. 65 by the Center for Studying Health System Change as part of the Community Tracking Study, funded by the Robert Wood Johnson Foundation.