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How Prepared Are States for Infectious Disease Outbreaks?

A new report shows signs of progress, particularly in public health funding, but many states face difficulties quickly responding to outbreaks.

As the Ebola outbreak in West Africa led many to be concerned about U.S. capability to respond to its infectious disease threats, an annual report shows only half of states score well on 10 key public health measures.   

Many states scored poorly on measures of communication and coordination responses to threats, vaccination rates and infections from contact with the health care system, according to the report, released annually by the Robert Wood Johnson Foundation and Trust for America’s Health. 

"Over the last decade, we have seen dramatic improvements in state and local capacity to respond to outbreaks and emergencies,” said Jeffrey Levi, executive director of the Trust, in a statement. “But we also saw during the recent Ebola outbreak that some of the most basic infectious disease controls failed when tested.” 

The two groups measure states using 10 indicators that often change substantially each year, depending on available data and the relevance of each issue. That makes it hard to draw direct comparisons with previous years, though this year 25 states scored 5 or lower. Last year, 34 states had scores five or lower. 

States receive a point for each indicator. None received a perfect score, but five scored eight out of 10, better than last year, when only New Hampshire scored an eight or higher. States scoring the highest this year included Maryland, Massachusetts, Tennessee, Vermont and Virginia. The worst score was Arkansas, at two. 


Source: Robert Wood Johnson Foundation and Trust for America’s Health

One factor that did carry over into the 2014 ratings was spending on public health, which took major blows following the recession. This year, 28 states increased or maintained funding for public health, up from 17 last year. Oklahoma boosted it by 13 percent, far more than any other. Public health spending doesn’t include Medicaid or the Children’s Health Insurance Program, and the overall level remains lower than pre-recession levels per capita.  

Two of the indicators specifically measured states’ preparation for emerging threats. On the plus side, the report found that 47 states and Washington, D.C., conducted recommended exercises to evaluate the amount of time it took for front-line, hospital-based labs to receive urgent messages from state labs.  But only 27 states scored equal to or higher than the national average on the National Health Security Preparedness Index’s measure of information management, which indicates difficulties in mobilizing and coordinating outbreak responses. It’s a critical measure of a state’s ability to swiftly handle an outbreak of Ebola, flu or other threats, according to the report. 

On the issue of vaccinations, the report measured how many states are meeting Centers for Disease Control recommendations for hepatitis B vaccinations and flu. Only 14 states vaccinated at least half of their population against the seasonal flu, while 35 met the goal for vaccinating young children against hepatitis B, which is spread by infected blood and leads to liver disease.  Up to 1.4 million people in the U.S. have it, according to the CDC.

Other findings from the report included:

  • 38 states and Washington, D.C. met the national performance target of testing 90 percent of reported E. coli cases within four days.
  • 37 states and Washington D.C. required reporting of potential HIV cases to their surveillance programs 
  • While health-care borne infections have declined in recent years, about one out of every 25 people who are hospitalized each year contracts an infection.
  • 16 states performed better than a national standard for certain bloodstream infections 
Chris covers health care for GOVERNING. An Ohio native with an interest in education, he set out for New Orleans with Teach For America after finishing a degree at Ohio University’s E.W. Scripps School of Journalism. He later covered government and politics at the Savannah Morning News and its South Carolina paper. He most recently covered North Carolina’s 2013 legislative session for the Associated Press.
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