D.C. Struggles to Ensure Public Spending is Helping U.S. Prepare for Bioterrorism

More than five years after the Sept. 11 attacks, the U.S. government cannot show how the $5 billion given to public health departments has better prepared the country for a bioterrorism attack or flu pandemic.

Congress responded to the 2001 attacks and anthrax-tainted letters sent to lawmakers and others by putting much more money toward emergency preparedness. State health departments typically get tens of millions of dollars per year to prepare for bioterrorism; it was in the hundreds of thousands before Sept. 11.

But Washington had to set criteria to evaluate how well the money was spent. That assignment fell to the U.S. Centers for Disease Control and Prevention, which has struggled with the task.

“We’re not able to demonstrate accountability,” said Craig Thomas, chief of the CDC office that evaluates and monitors public health departments. “It’s not just accountability to the CDC. It’s accountability to your community. It’s accountability to your local stakeholders and the people who fund you as well.”

Thomas was speaking to public health leaders at a recent conference in Washington. His candid assessment does not mean local departments have wasted the money. Indeed, health officials say the departments are much better able to respond to major threats than they were five years to 10 years ago.

It is, however, an acknowledgment the CDC relies on anecdotal evidence to demonstrate the improvement. Congress demanded statistical evidence.

“The difficulty comes down to, how do you measure (improvement), how do you quantify that, so you have something you can track over time, something you can use to identify gaps that have to be filled,” said the CDC’s Dr. Richard Besser. He oversees the Office for Terrorism Preparedness and Emergency Response.

The government began awarding money for bioterrorism preparedness in 1999, sending $40.7 million to the states. In 2002, the total jumped to $950 million. That is about one-quarter of what the U.S. spends each year on bioterrorism and emergency preparedness – not counting the money for preventing a pandemic.

The government also has increased spending on research at the National Institutes of Health and for improving the capabilities of hospitals and first responders.

Health departments used federal grants to stock up on antivirals, buy needles and syringes and hire more doctors and nurses. One of the most important upgrades came in disease surveillance.

CDC officials point to two reasons for the lag in developing the measures.

The CDC makes recommendations based on scientific data, but such data does not exist when it comes to showing which steps taken by health officials would bring about the best result during a particular emergency.

Also, the agency had difficulty getting health departments to agree about what the government should measure.

“Every health department is different, so where one may have strengths and they feel very confident in measuring something, another may have that as a weakness and feel less confident,” said Donna Knutson, a senior adviser at the CDC.