Public Health Preparedness for Chemical, Biological, Radiological and Nuclear Weapons

http://www.rand.org/pubs/reprints/2010/RAND_RP1415.pdf

Public Health Preparedness for Chemical,
Biological, Radiological, and Nuclear Weapons


Lois M. Davis and Jeanne S. Ringel


The U.S. public health and health-care delivery systems are important components
of our nation’s preparedness against terrorism and other public health threats (Trust
for America’s Health 2006). The September 11, 2001, terrorist attacks and the anthrax
attacks later that year renewed government, public health, and medical personnel’s awareness of chemical, biological, and, to a lesser extent, radiological and nuclear threats. It also underscored the importance of ensuring the nation’s overall preparedness and ability to respond to terrorism and other public health emergencies. Toward this end, the federal government has invested more than $5 billion (Nelson et al. 2007) in public health preparedness at the state and local levels since 2001. With an investment of this magnitude questions naturally arise as to what
return has been received. Is the nation prepared to effectively respond to the next public health emergency? This is a challenging question to answer for a number of reasons. First and foremost, there is no clear, consensus definition of what public health preparedness is and thus no specific goal against which to gauge progress. In addition, because the investment is relatively recent, there is very little literature evaluating the effectiveness of these federally funded programs. The effect of preparedness activities on the public health system more generally also complicates the question. Some states have leveraged preparedness resources to improve day-to-day public health activities (Staiti, Katz, and Hoadley 2003). However, others have cut state budgets in response to the federal increases, thereby shifting funding away from more traditional public health activities like tuberculosis prevention and control. Finally, the federal contribution to state and local public health preparedness has declined more than 20 percent over the past several years, raising concerns that much of the post-2001 progress will not be sustained (NACCHO 2007). This chapter presents a broad overview of the nation’s public health response system,
recent efforts to improve preparedness, and options for moving forward. Section 11.1 reviews federal efforts to define WMD threats and priorities. Section 11.2 looks at the current national response framework for a coordinated response in four functional areas. Section 11.3 looks at the issues in implementing this framework at the state and local levels, with a focus on coordination issues. Section 11.4 assesses the current state of public health preparedness. Finally, section 11.5 presents some brief conclusions.