Then Secretary of Defense William S. Cohen said the program was "specifically designed so that the people we train become trainers themselves. This approach will greatly magnify our efforts to produce a core of qualified first responders across the nation." In March 1998, Cohen announced an additional Department of Defense support initiative -- the military's first-ever rapid assessment teams, RAID (rapid assessment, identification and detection). "These new RAID teams will quickly reach the scene of the incident in order to help local first responders figure out what kind of attack occurred, its extent, and the steps needed to minimize and manage the consequences." He added: "Getting prepared for such an attack is extremely complicated, given the wide range of possible threats and the many players at the local, state and federal levels (U.S. DOD).
However, a large number of cities do not have any plans to respond to a chemical or biological attack. According to Biodefense.org, an educational and reference library website on this topic, many news stories published across the U.S. during 2004 showed that many cities are not prepared for any type of major incidence.
Florida, however, has been ranked as one of the most prepared states in the country. Florida, a state all too familiar with emergency after four hurricanes battered it last year, presents a model for bioterror preparedness. Yet even its boosters caution that much still needs to be done to address areas of vulnerability. Both Florida and North Carolina passed the grade in nine of the 10 categories that the Trust for America's Health (TFAH), an independent research group in Washington, uses to assess each state's public-health readiness. In 2003, Florida scored seven out of 10. The state has scored so well largely because of the strong public-health infrastructure it has developed that maximizes resources. Among such achievements is the state's coveted "green" status relating to the Strategic National Stockpile of the Centers for Disease Control and Prevention. It means that Florida, the first of only five states to achieve such a grade, is deemed adequately prepared to distribute vaccines and antidotes in the event of a mass disease outbreak.
Last February, health personnel from each of the 67 Florida counties took part in a large-scale exercise that simulated air passengers with bubonic plague arriving at various places in the state. The distribution test was passed. Officials also point to the state's five-year public-health plan, which calls for additional resources to counter bioterror threats. For example, in the event of a biological, chemical, or radiological attack leading to mass casualties, Florida's hospitals will be able to manage emergency treatment for 500 people per one million of population, and they will be able to admit 50 patients per one million. In addition, each region will be able to isolate 10 patients showing symptoms of diseases like smallpox. Florida has almost 17 million residents. Maintaining a strong response capability in Florida's Public Health Department laboratories has also been a priority, and the state has upgraded much of its equipment. Only one-third of states were judged to have enough scientists to be able to cope with a bioterror attack.
Other states are not doing as well in preparing for different scenarios, according to a Trust for America's Health report. It found only six states, like Florida, are adequately prepared to distribute vaccines and antidotes in an emergency. "More than three years after 9/11 and the anthrax tragedies, we've only made baby steps toward better bioterrorism preparedness, rather than the giant leaps required to adequately protect the American people," said former Senator Lowell P. Weicker Jr., president of the Trust. The report concluded that basic bioterrorism detection, diagnosis and response capabilities are not in place, and the country has a long way to go to protect the American public from such an attack.
The most significant downfall among the states was the lack of adequate public health labs and laboratory scientists to handle serious outbreaks. The Trust report found only 16 states have enough labs and 21 have enough scientists. Another report, conducted by Milbank Memorial Fund, found "By and large, most state departments of health were grossly unprepared for September 11 and its aftermath." Georges Benjamin, previous director of the Maryland Department of Health and also president of the Association of State and Territorial Health Officials, noted in October 2001, just weeks after the attacks on the World Trade Center and the Pentagon, that "in a field where communication can save a life, some state health departments did not have an effective e-mail communication system with their local and county departments." The Atlanta Journal and Constitution, citing Benjamin, reported that "public health officials have been warning for years that the [public health] system is antiquated" (Markowitz).
Since 2001, the federal government has spent almost $3 billion developing strategies to prevent or at least prepare for bioterrorism attacks. Is the country better prepared now than four years ago? With the support of the Robert Wood Johnson Foundation, the Century Foundation Working Group on Bioterrorism Preparedness has studied how these funds have been used and assessed what has been done well, what gaps remain, and what should be done in the future. In the project's final report, "Breathing Easier? The Report of The Century Foundation Working Group on Bioterrorism Preparedness," a group of leading public health policy experts and practitioners concluded that the new federal funding has resulted in considerable improvements to the U.S. public health system, but that substantial vulnerabilities remain. The group found that without clearer definitions of what constitutes preparedness and standards for achieving it, the infusion of funds may not succeed in enabling the public health system to respond effectively to a future bioterrorist attack.
The Working Group developed a set of recommendations for how bioterrorism funding can strengthen the fabric of public health, rather than stretch it too thin. The organization's recommendations included the following:
The government should define public health preparedness more clearly and develop minimum national standards.
Federal and state public health officials, in cooperation with experts in public health, should define what local public health capabilities should be.
Laws governing how responses to public health emergencies and public health investigations are conducted must be modernized.
The public health workforce needs to be enlarged and its skills upgraded.
To sustain improvements in the public health system, the flow of federal and state funding must continue without interruption.
A balance must be struck between preparing for a biological attack and maintaining and expanding other vital functions of the public health system.
In the two years following the 9/11 attack, state departments of health throughout the country sought to determine their own state of preparedness and to define exactly what "preparedness" actually meant. According to Southern California's North County Times, one nationwide survey found, "90% of county governments were... unprepared for biological or chemical attacks" (Markowitz).
Such programs as noted above stress preparation and reaction. The other approach that has been recommended for dealing with the possibility of bioterrorism, especially due to budgetary problems with upgrading health departments, is promoting intelligence and motivational methods -- taking a proactive approach -- such as: Reforming and modernizing the U.S. intelligence community; improving international intelligence cooperation; increasing intelligence to detect small-scale nuclear/biological/chemical programs; increasing and improving monitoring of diseases to determine whether a biological attack has occurred and expanding Department of Defense efforts to train personnel who would respond to a large-scale biological or chemical attack (Falkenrath 249).
The programs and approaches noted above are primarily at the state and national levels. Granted, with funding problems, it becomes more difficult for local communities to develop and prepare for plans in case of disaster. However, responsible and caring citizens can take steps on their own that, although small in comparison to other measures, will provide some help in the case of future situations. For example, the Federal Emergency Management Agency (FEMA) has released a new publication to help individuals prepare themselves and their families for disasters. "Are you Ready? A Guide to Citizen Preparedness" brings together facts on disaster survival techniques, disaster-specific information, and how to prepare for and respond to both natural and man-made disasters.
The guide provides a step-by-step outline on how to prepare a disaster supply kit, emergency planning for people with disabilities, how to locate and evacuate to a shelter, and even contingency planning for family pets. Man-made threats from hazardous materials and terrorism are also treated in detail. The guide details opportunities for every citizen to become involved in safeguarding their neighbors and communities through FEMA's Citizen Corps Initiative and Community Emergency Response Team training program. Most communities already have some emergency response programs in place, and all citizens need to know about these programs and what to do in case of a crisis. This includes both natural disasters such as floods, hurricanes, earthquakes and tornadoes, as well as manmade disasters such as terrorism and accidents involving hazardous materials.