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Bioterrorism funds can't mitigate states' deep budget cuts. (Public Health Funding Still Down Overall).

PHILADELPHIA -- Stepped-up federal funding for bioterrorism preparedness has yielded some beneficial effects at the state level, notably by helping health officials temper the impact of budget cuts, two state health officials said at the annual meeting of the American Public Health Association.

The new focus on bioterrorism comes at a time when state health budgets have been reduced in every state in the nation, said Dr. Georges C. Benjamin, then secretary of the Maryland Department of Health and Mental Hygiene.

"Overall, we are losing money in the public health budgets in the fifty states, despite the funds for terrorism preparedness," said Dr. Benjamin, who recently resigned his post in Maryland to become the new executive director of the APHA.

The widely publicized flow of dollars into bioterrorism preparedness has obscured the larger reality of budget cuts, he observed.

"With regard to bioterrorism and our national public health response, there is an impression that we are building a house on a solid foundation. However, the foundation is being pulled out from under the house," Dr. Benjamin said.

He cited Maryland as an example of the trade-offs that states face. "We have received and spent money to increase our epidemiology capacity and thus to identify and track diseases. However, at the same time, we had to freeze new hires and essentially cut our budget for food safety, which includes some of the same type of workers.

Cutbacks in food safety--often an early casualty of health budget reductions--may inadvertently weaken the ability of states and municipalities to deal with bioterrorism. "Other than the anthrax incidents, the only other previous terrorist [biologic] attack in recent U.S. history is the case of deliberate salmonella poisoning in salad bars in Oregon," Dr. Benjamin said.

Still, he praised progress made in several areas of public health in the new era of bioterrorism: improved identification of new diseases, increased laboratory capacities, and better communication between public health authorities and acute care and primary care providers.

"We are now much better and more proactive in identifying new diseases. In the past, there has been a lackadaisical approach to the problem," Dr. Benjamin said. "Communication throughout the U.S. health care system is also much improved. Historically, acute care provision and public health have frequently had disparate agendas. But, for the most part, doctors now know who to call, when to call, and what to call about."

With $6.3 million of bioterrorism preparedness funds from the Centers for Disease Control and Prevention for 2002, Vermont has maintained a high level of communication and education with instate physicians, said Dr. Jan Carney, commissioner of the Vermont Department of Health.

With the federal funding--which has also been used to expand laboratory capacities and communicate with the public--Vermont is using a wide range of media to communicate with physicians about bioterrorism-related matters: the Health Alert Network, a Web site that includes physician information; a newsletter called the Disease Control Bulletin; a toll-free phone line; and direct mailings from Dr. Carney.

"We have a variety of formats to use to ensure we reach and appeal to as many physicians as possible," Dr. Carney said.

The state has dispatched state epidemiologists to medical grand rounds at hospitals and local medical meetings. "One of the state epidemiologists and myself presented recently at the Vermont chapter meeting of the American Academy of Pediatrics. We discussed preparedness for biologic and chemical weapons and gave special attention to potassium iodide and its use in treating children for radiation poisoning," she said. Vermont has a nuclear power plant in Brattleboro, in the southern part of the state.

"Public health needs to get itself on the calendar in places where doctors receive their continuing education," Dr. Carney said. "We can run miles with that CDC funding," she added. "It is a huge boost to our effort to expand our bioterrorism response capabilities."

RELATED ARTICLE: Public health experts rate bioterrorism preparedness

Efforts by the federal government and other organizations to improve public health readiness for a bioterrorist attack got mostly passing grades on a "report card" that the American Public Health Association issued at its annual meeting.

The wide-ranging report is a follow-up to a set of guiding public health principles that the APHA issued after the Sept. 11 terrorist attacks against the United States.

Here are some highlights from the report card:

* A grade of B+ has been given for efforts to ensure availability and accessibility to health care, including medications and vaccines. Efforts include the stockpiling of enough smallpox vaccine for the entire U.S. population and of enough of the antibiotic Cipro to treat 20 million cases of anthrax. The National Disaster Medical System now has 10,000 volunteer health care workers that can be deployed within hours of an attack.

* A grade of B for efforts to educate and inform health care professionals about bioterrorism. Efforts include special programs sponsored by medical schools and societies. But there is no consensus as to how medical schools should address bioterrorism in the curriculum, the report noted.

* A grade of B for efforts to strengthen the public health infrastructure to respond to terrorist attacks. Efforts include the funding by the Centers for Disease Control and Prevention to support new laboratories for evaluating microbes and chemicals; there is now one in each state.

* A grade of D for efforts to advocate for the immediate control and eventual elimination of biologic, chemical, and nuclear weapons. Efforts seen as not helpful include the U.S. termination of participation in the Anti-Ballistic Missile Treaty and U.S. rejection of a protocol to strengthen the 1975 Biological Weapons Convention, the report said.
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Author:Mulcahy, Nicholas
Publication:OB GYN News
Date:Feb 1, 2003
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