Blind Preparation

If a family enters an emergency room with inflamed lesions covering their bodies, accompanied by fevers and debilitating weakness - symptoms of a chemical or biological attack - the admitting hospital should know who to call and how to treat each family member.

That wouldn't always happen, however. Almost six years after 9/11 - after spending billions of tax dollars on disaster preparedness - many cities remain unprepared to respond to a biological or chemical attack, according to several leaders in the public health community.

A lack of coherent national policy on biological and chemical weapons preparedness has produced a hodgepodge of ineffective initiatives at the local level, according to critics. Yet others say national standards frequently are ineffective at dictating local issues.

"When you talk about emergency preparedness and disaster response, the important thing to keep in mind is that most of that work is done at the state and local level," said David Quam, director of federal relations for the National Governors Association (NGA). "National solutions sound easy and important, but it is their implementation and their respect for the different roles at the different levels of government that really become the most important."

The lack of a clearly defined, long-term, national consensus on what a prepared America is cripples the nation's biological and chemical preparedness according to some public health experts.

Rhyme and Reason
The U.S. Department of Health and Human Services (HHS) handles most biological and chemical preparedness initiatives for the federal government, which in turn spends hundreds of millions on such initiatives for state and local government. The HHS currently funds activities the public health community typically advocates, like state and local pandemic influenza preparedness, hospital equipment upgrades and similar initiatives.

The problem, according to some public health officials, is that the type of preparedness funding Congress allows seems to shift with whatever preparedness priorities are politically chic at the time.

"There is no long-term plan. There's not even a five-year vision. Everything is just reacting to the political issue of the moment. After Katrina, it was, 'What happened to FEMA? Let's elevate FEMA in the hierarchy so it can report to the Homeland Security secretary during a crisis,'" said Tara O'Toole, who was assistant energy secretary for Environment, Safety and Health during the Clinton administration, and currently is the CEO of the Center for Biosecurity at the University of Pittsburgh Medical Center.

The federal government began ramping up disaster preparedness during the Clinton administration, said O'Toole.

"Congress first started putting money on the streets to train first responders," she said. "But they didn't really think through what we were responding to, or who the first responders were, so all police and fire got a piece of the pie."

That money, she said, was used to purchase a lot of equipment that is largely useless.

"There were constraints against spending it on people," O'Toole added. "You had to buy equipment. They bought a lot of test kits to diagnose whether a powder was anthrax, which didn't work very well. They bought suits to protect against chemical attacks, some of which were OK, some of which were just kind of sitting in lockers moldering away."

There was no rhyme or reason to what people bought, she said, and there weren't any standards to guide agencies on what type of equipment to purchase. "Some people bought good stuff," she said. "Other people bought low-quality or unreliable stuff. It was all over the place."

Lack of a cohesive plan for those involved in incident response may have cost the nation an opportunity, said Elin Gursky, principal deputy for biodefense in the National Strategies Support Directorate of ANSER, because future funding availability is difficult to forecast. "