¶ … 2001 there was an Anthrax attack which created an alert of how bioterrorism had an impact on the public health emergencies. These types of emergencies can not only spread illnesses but also cause several deaths. The can also affect government operations which include the economic growth, creating fear which can cause International crisis. There has been an alert on illnesses that have previously been curbed reappearing with most of them resisting the drugs in the market. There has also been an alert of the food supplies in the market due to the terrorists because they can be used to spread infections. The public health system is highly responsible for detecting any bioterrorist attacks enabling the government to prepare for any attacks. This means that the government should enhance all infrastructure connected to health systems in order to integrate any threats related to biological or chemical terror attacks (Hamburg 2003).This is when the congress granted the government the Public Health Securities and Bioterrorism Preparedness and Response act in 2002 in order to stay alert of any bioterrorist attacks.

Public Health Infrastructure

The public health fully depends on the type of infrastructure of the health department and its agencies. It also depends on the laws, regulations, both public and private laboratories, health care providers including hospitals, statistics, and lastly communication programs. The whole system operates via unified activities from the local, through state, to federal levels.

The preparedness activities can be categorized in to three levels which include prevention, discovery and the reaction. In prevention, the environmental and agricultural conditions are regulated so that the threats can be minimized. The access to some biological agents is also limited in order to prevent the situation. Lastly the intelligence to uncover any planned attacks is enhanced so as to uncover the plans before the attacks (Koblentz 2003). Detecting the attacks has also been enhanced by offering special training to improve diagnosis. Surveillance has also been enhanced to not only detect outbreaks but to also improve laboratory potentials. Response plans have been established through drills. They have also offered medical skills through immunization, decontamination and medication. All these capacities can be applied in attacks or just general ailments.

Once a breakout has been detected, the local health agencies are on the frontline whereby they act after getting information from the traditional responders, through to medical providers and hence to the government. Sometimes treatment may be offered from the local level before communicating to the other levels. They take the responsibilities of detecting the attack through watch, epidemiology, and essential laboratory services.

The preparedness of a bioterrorist attack has the state directly responsible through the public health. There are cases when the government directly gives authority while at times it uses a centralized method. However, most of the detection activities are handled by the government. Other than providing enhanced laboratories, they also offer epidemiological know-how. (Hamburg 2003).They are also responsible for organizing surveillance, organizing the localities, enforcing laws, and any other state agencies. The government also advises on analysis, and treatment of dangerous conditions. The state is also responsible for funding the local health agencies.

Federal government has also taken responsibility for preparedness actions such as organic research, pharmaceutical, healthy food assurance, and also intelligence actions. It is also responsible for providing support to both local and state efforts in detecting and responding to these attacks. They do this by providing some training programs, national scrutiny, early warning detection signals, and both funding and technical laboratory support, developing and maintaining the vaccines stocks, and also giving the financial support.

The physicians within the hospitals and other health care should be able to detect any arising health crisis. The people on the ground treating the victims should report any suspected outbreaks. In case of an outbreak, these health providers are called upon to put into practice both state and local preparedness strategies and nurse the victims. This means they have to go through trainings and exercises to enable them handle any type of influx (Heinrich 2003).

Some problems were highlighted by the institute of medicine in 2002 in the public health infrastructure. They included obsolete technologies, workforce lacked good training and enforcement, outdated laboratory facilities, lack of real-time watch and epidemiological systems, unsuccessful and fragmented communication networks, and partial emergency responsive potentials.

Other researchers have shown that there are gaps between the state and the local public health systems regarding the basic needs. For instance, most of the local...

Some of the heads in both local and state departments did not have a graduate training. Most of the hospitals lacked basic commodities like beds, medicines, ventilations among other facilities. Recommendations for addressing the threats were as crucial as the improvement of the awareness programs.
Federal program's support for state and local preparedness

Most of the federal agencies have the mandates over activities linked to bioterrorism or any other infectious diseases. However, today's support at the state and local level is being handled by Department of Health and Human Services. A greatest federal exertion to support state preparedness comes from Public Health Security and also Bioterrorism Preparedness and Response Act of 2002 (Heinrich 2003). The law has provided for the Secretary of the Health and Human Services to build up and put into practice a coordinated method to prepare and respond to bioterrorism attacks or any other public health crisis. The same law has emphasized the need for the federal government to coordinate the same with the state. The law has allowed the secretary to give funding to states for emergency preparation and evaluation, and infrastructure development. These funds can also be used for improving communication and trainings. All the states are receiving these funds and the cooperation agreement programs work through Centers for Disease Control and Prevention (CDC). They also operate through Health Resources and Services Administration (HRSA).

The states and localities apply for funding annually by giving a detailed work plan to the agencies. There is the per capita allocation plus the base distributed to each one of them. These funding have cost up to 3.7billion dollars by the year 2004. The CDC and HRSA are responsible for identifying whatever amount each state requires. The CDC looks into seven crucial areas which include assessment of preparedness, readiness and planning. They also look at surveillance and epidemiology capability (Heinrich 2003). They also check on both the biological and chemical capacities of their laboratory. CDC also checks the IT and communication network on health alerts. They communicate on the health risks, and lastly, on education and training.

HRSA similarly identifies some specific areas like administration, surge in the number of victims, emergency medical services, connection to public health departments, education and preparedness training, and terrorism preparedness drills. These two programs provide for a standard mode of identifying progress in not only preparedness, but also deadlines of reporting guidelines. These benchmarks may differ from one year to the other depending on the activities they have put in to consideration (Heinrich 2003).

Progress towards preparedness

Allocations of these funding differ with some of the states spending everything while others spending less than half of the amount. This unspent money can be carried forward to the next year at the request of the state. These programs allow the state to determine how the allocation to localities ill be done although they also direct the states to plan together with the local health agencies on the proper use of these funds in order to benefit the localities.

Most of the states managed to meet the targets as per the report by CDC for the cooperative agreements in the financial year of 2002. Some of the areas that highly progressed included designation of directors in the preparedness programs, setting up of bioterrorist advisory committee, creating interim plans to supervise the stocks, expanding coverage of epidemiologists, and improving communication between laboratories. Most of the states reportedly met the targets of the basic regions. However, no hospital had fully developed a plan on how to respond to a large scale epidemic (Koblentz 2003). No state came up with a plan on how to ensure that perfect medication got to pregnant women, children, and the elderly people. However there are good indications that the targets will soon be met. By 2004, HRSA had reported that most hospitals had put up more beds, and other procedures that would allow bigger capacities, with enhanced training and education to both members of staff and the community. More evaluations confirmed an enhanced communication between the states and the local health agencies with advanced systems.

The areas with most problems like the laboratories have often hired personnel in cases of large scale emergencies or during vaccination programs and area coordination. Some assessments have shown a shortage of staff who can handle stock taking, laboratory capability, testing of the preparedness plans, communicating across different government levels, and training private personnel.

Problems in preparedness

However, there have been challenges encountered by the states in preparedness programs. Financial problem is the major factor. Unfortunately most of the states are going through a…