Many states continue to fall short in their ability to respond to an infectious-disease outbreak despite increased focus on readiness triggered by the Ebola outbreak in West Africa and its arrival in the U.S., a new report finds.
Half of states and Washington, D.C., scored low on several indicators regarding their ability to detect, diagnose, prevent and respond to disease threats, according to a report by the public health advocacy organization Trust for America's Health and the Robert Wood Johnson Foundation.
A number of states did not meet goals in administering preventive services such as vaccination. More than 2 million preschool kids and 35% of seniors did not receive all recommended vaccinations. Only 14 states were found to have vaccinated at least half of their total populations against influenza during the 2013-14 flu season, while only 35 states and D.C. reached a goal of vaccinating at least 90% of young children against hepatitis B.
Other health indicators examined in the report included healthcare-associated infections, which have declined in recent years but still affect 1 in 25 patients annually, according to the Centers for Disease Control and Prevention.
More than 720,000 infections occurred in hospitals in 2011, resulting in about 75,000 deaths. Only 10 states reduced the number of central-line-associated bloodstream infections between 2011 and 2012, while 16 performed better than the national standard ratio for such infections.
Though the recent Ebola epidemic prompted some new infusions of public health spending, advocates are concerned one-time emergency funding mechanisms such as the recently passed $5.4 billion to address Ebola preparedness are not enough to sustain public health readiness after years of cuts in federal initiatives such as the Hospital Preparedness and Public Health Emergency Preparedness programs.
Twenty-eight states either increased or maintained public health funding from fiscal 2013 to fiscal 2014, while 22 states and Washington, D.C., cut funding during the same period.
“The Ebola outbreak is certainly a wake-up call and it does raise attention to some real serious gaps we have in our ability to manage disease outbreaks,” said Richard Hamburg, deputy director for Trust for America's Health. “You can't have increased threats with decreased capacity.”
Maryland, Massachusetts, Tennessee, Vermont and Virginia were among states that scored the highest, with each achieving eight out of 10 indicators examined. Arkansas had the lowest score of any state, achieving only two of 10 indicators.
Perhaps most troubling are the number of children who are receiving vaccinations for preventable diseases such as mumps, measles and whooping cough, which has contributed to a rise in the number of cases reported in recent years. Between Jan. 1 and Nov. 29, there have been 610 measles cases and 20 outbreaks reported, the highest total since the disease was declared eliminated in 2000.
“Public health can be a victim of its own success where there is complacency and public perception that certain diseases are no longer a threat,” Hamburg said.
The report offers recommendations to improve states' public health readiness, such as sustaining funding support in order to maintain health departments' abilities to track, identify and contain disease outbreaks. Other recommendations include increased integration between public health agencies and hospitals for better coordination in emergencies.
Follow Steven Ross Johnson on Twitter: @MHsjohnson
