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U.S. Unprepared Despite Progress, Experts Say

The scenario is not as far-fetched as it sounds. The government's real-world test involved thousands of emergency personnel and mock patients responding to the imagined release of aerosolized germs at O'Hare International Airport and at a Chicago Blackhawks hockey game on a Saturday night.

Just as conceivable is the breakdown of the U.S. public health system after an actual, large-scale biological attack, experts say.

Chris Schmidt, an emerging infectious disease fellow in the poxvirus section of the Centers for Disease Control in Atlanta, shows the use of a biohazard suit. (Ric Feld -- AP)

_____Rising Spending_____
Charts: Federal spending on biodefense grew rapidly after 2001, with large portions going to NIH and Bioshield program. Also, smallpox vaccination efforts fall well short of goal.
_____From This Series_____
Impervious Shield Elusive Against Drive-By Terrorists (The Washington Post, Aug 8, 2004)
U.S. Eyes Money Trails of Saudi-Backed Charities (The Washington Post, Aug 19, 2004)
In Search Of Friends Among The Foes (The Washington Post, Sep 11, 2004)
From a Virtual Shadow, Messages of Terror (The Washington Post, Oct 2, 2004)
Moroccans Gain Prominence in Terror Groups (The Washington Post, Oct 14, 2004)
About This Series

Three years after the Sept. 11, 2001, attacks, the U.S. government has undertaken extensive efforts to root out Islamic terrorists around the world and to defend the U.S. homeland. These articles are part of a series that considers the elusive nature of the threat and the problems authorities confront in battling it. Today's stories examine the difficulty of devising defenses and responses to bioterrorism. Previous parts of this series can be found at www.washingtonpost.com/nation.

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According to former White House official Falkenrath, the U.S. government's reliance on state and local health agencies to speedily distribute vaccines and drugs is "the Achilles' heel" of U.S. biodefenses.

"The single biggest problem is the nonperformance of state and local public health agencies" in drawing up plans that U.S. officials have requested on how they would respond rapidly to a biological attack, he said. The plans would detail how officials expect to deliver medicine to people after the drugs are flown to airports. "From tarmac to bloodstream, their time frames are way too lackadaisical," he said.

Federal officials have given state health agencies and hospitals $4.4 billion in the past three years to develop such plans. But experts say that beyond buying computers or walkie-talkies and hiring some staff, the funds have hardly helped them prepare for large-scale bioterrorist strikes.

"This won't be solved by money alone," said Elin Gursky, a biodefense specialist at the private Anser Institute for Homeland Security.

Federal statistics show that among the 50 states, only Florida, Illinois and Louisiana are close to being ready to swiftly distribute vaccines or antidotes from the national stockpile, according to the nonprofit Trust for America's Health, which studies public health issues.

Local and state health officials say their underfunded agencies, which focus mostly on caring for the poor, have received inadequate federal funds and guidance on what the states should address in their bioterrorism master plans.

"The public health system has been running full steam without a break since 9/11," said Georges Benjamin, executive director of the American Public Health Association. "To do added things that are being requested, it's going to need more resources."

Most U.S. hospitals also lack the "surge capacity" to respond to a bioattack -- the ability to rapidly bring in hundreds of trained medical professionals to care for a huge influx of very sick people. Expanding staffs runs counter to the decades-long trend of hospitals reducing staff sizes because of budget pressures.

"The main priority of our biodefense program should be enlisting hospitals and private doctors to prepare [for bioattacks], but hospitals and private doctors are not now in the game," said a federal official with direct knowledge of the shortcomings. "This issue has completely fallen through the cracks. . . . No part of the federal government can deal with mass casualties."

"There's a lack of an overarching federal game plan in biodefense," said Shelley Hearne, executive director of the Trust for America's Health. "States aren't being told, 'Here are the things you need to do, and why.' . . . Nobody's in charge."

But in some respects, too many are in charge. The jurisdictions of the departments of Homeland Security and Health and Human Services overlap in many areas of biodefense. Overall, HHS handles health matters, while Homeland Security handles crises. But the two departments, for example, offer sometimes indistinguishable biodefense training for local health agencies.

Administration officials say the two departments mesh well, with their roles delineated in a recent presidential directive. But bureaucratic bottlenecks persist, as the two departments' lawyers and contracting officers hash out turf, experts said.

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