Investing in Infrastructure Improvements

If the United States is going to be appropriately prepared for a terrorist attack (biological, chemical, or otherwise), one of the top priorities must be to strengthen the public health infrastructure at all levels so that it is strong enough, flexible enough, and capable enough to respond to emergency situations of this nature (CDC, 2000a).

An estimated initial investment of approximately $400 million is needed to improve state and local preparedness with regard to personnel, training, epidemiology, and surveillance capacity (Center for Infectious Disease Research and Policy and Workgroup on Bioterrorism Preparedness, 2001). This level of investment would cover the integration of bioterrorism preparedness activities into existing communicable disease prevention and control programs such as CDC's emerging infections program, the training of public health practitioners, and the hiring of designated public health veterinarians for states that do not have one. An estimated additional $200 million was also recommended to begin to improve state and local preparedness with regard to information and communication systems (e.g., Health Alert Network, NEDSS, Epi-X, and rapid communication systems). It was also noted that additional funds would be needed to sustain these systems effectively over time.

Progress toward these estimated needs has been addressed by some of the new resources for infrastructure improvement made available through bioterrorism-related appropriations. A report on the FY 2002 appropriations makes reference to infrastructure improvements such as those authorized by the Public Health Improvement Act of 2000 (P.L. 106-505). Furthermore, in 2002, Congress authorized a variety of bioterrorism-related activities in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (OMB, 2002) (see Table 3-1).

Following the passage of the Public Health Threats and Emergency Act of 2000, there were plans to develop two separate grant programs—one for

THE GOVERNMENTAL PUBLIC HEALTH INFRASTRUCTURE TABLE 3-1 FY 2002 DHHS Bioterrorism Funding

DHHS and Departments of Labor and Education Appropriations for Bioterrorism Preparedness and Response (in millions)

Agency FY 2002 Enacted

CDC 181.9

DHHS Office of Emergency Preparedness 62.0

NIH 92.7

Total 336.6

Emergency Supplemental Appropriations: DHHS Funding for Bioterrorism Preparedness and Response (in millions)
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