With the increased funding to states to upgrade preparedness for bioterrorism (BT) and other public health threats and emergencies,1,2 some concern has been raised that it would not enhance public health capacity to respond to more common threats.3 The 2003/04 influenza season provided an opportunity to test whether these new resources enhanced their ability to respond to a non-BT crisis. During the 2003/04 influenza season many health departments were faced with an unusually early and high rate of illness and demand for vaccine that outstripped the supply by mid-December.4,5 In 2004, we surveyed public health officials in eight southeastern states regarding their responses to the influenza vaccination shortages, including questions about the impact of BT-related preparations.
As part of a larger survey of state and county health departments in eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee), we assessed the public health response to the 2003/04 influenza season. We used a web-based survey instrument6 distributed between June and August 2004 to public health officials responsible for immunizations. We obtained responses from all eight states and >80% of sampled counties, resulting in 222 completed county surveys representing 235 clinics.
The vast majority of state and county health departments indicated that BT funding did not hinder their ability to respond to influenza in the 2003/04 season. However, we found that state and county immunization managers differed in their assessments of whether bioterrorism funding and related activities enhanced their response to the 2003/04 influenza season. Overall, five (63%) states and 76 (36%) county health departments reported one or more beneficial effects of BT-related funding, with the most common being improved risk communication or media relations capacity (50% of states and 20% of counties). Other benefits (e.g., improved surveillance, pharmacy distribution systems, and laboratory capacity) were reported by less than one-third of states and less than 20% of counties.
Descriptions of how bioterrorism-funded activities supported their response to influenza included: opportunities to hire additional personnel; improved relationships with other government agencies, stakeholders, and constituents, including the media; and strengthened surveillance and enhanced laboratory capacity.
In its assessment of the public health response to the anthrax attacks in 2001, the General Accounting Office emphasized the importance and challenges in managing multiple levels of communication during a complex public health emergency, including communications across agencies, links with physicians and other community partners, and with the public.7 Communication with the media and public was the dimension of public health performance that received the most critical assessment.7,8 Thus, it is noteworthy that improved communications was the most prominent benefit, at least at the state level, of BT-preparedness on public health performance during the influenza crisis of 2003/04. Our findings suggest that BT-related preparations had important although limited positive effects on this response.
Laborers in a brick factory (Nepal 2005)
REFERENCES
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