The Bush administration is finalizing an agreement with U.S. postal workers to help deliver antibiotics or antidotes within 48 hours of a biological attack to 21 major cities, including the District.
Health and Human Services Secretary Tommy G. Thompson informed key lawmakers yesterday that he intends to take $55 million from state bioterrorism projects to pay for the new program, dubbed the "Cities Readiness Initiative." In addition to paying for the training of letter carriers, the money would be spent installing sophisticated disease surveillance equipment, purchasing vaccines and building new quarantine stations at U.S. airports, according to documents prepared by Thompson's staff.
Sen. Arlen Specter (R-Pa.), chairman of the Senate Appropriations subcommittee on labor, health and human services, praised the move, saying that in a time of tight federal budgets it makes sense to shift money to "high-risk cities" most likely to be targeted by terrorists.
But several governors, lawmakers and public health leaders immediately protested what Shelley A. Hearne, head of the Trust for America's Health, a nonpartisan public health advocacy group, called a "shell game" with potentially dangerous consequences.
"We should not be in a situation of robbing Peter to pay Paul," she said. Tapping letter carriers to deliver emergency supplies is an "innovative idea with great possibilities," she said, but it should not be paid for with money promised to states.
Under Thompson's plan, Washington, Oregon, Idaho and Alaska would lose more than $4 million, said Mary C. Selecky, health secretary of Washington state and president of the Association of State and Territorial Health Officials. In that region, only Seattle is deemed a priority city; it would receive $830,000.
"The redirection has consequences," she said, complaining that federal officials have repeatedly changed priorities and the instructions they have given states.
"First, we were asked to prepare for an all-hazards approach," but then got sidetracked by the last year's push for an extensive smallpox immunization program, she said. "Now we're being told we're getting less next year so the national priority of these 21 cities can be funded."
Relations between the states and HHS have grown increasingly tense in recent weeks with the two sides squabbling over bioterrorism money. Thompson has accused states of being slow to spend the money Congress has allocated, but Selecky and other state officials noted that the Bush administration has not yet issued grant-writing guidance for money that is due to go out on Sept. 1.
Part of the reason for the dispute centers on how government accounting works. State health departments do not "draw down" federal dollars until they have received a bill -- for a new piece of lab equipment, for example. In many instances, Selecky said, the money is pledged but states have not yet requested reimbursement.
"They still haven't defined what preparedness is," said one frustrated public health leader who asked not to be named for fear of exacerbating the situation. "If we had all agreed on what we were going to do, there could be some rational deployment of resources."
Within hours of sending his request to lawmakers on the appropriations committees, Thompson received letters of protest from a bipartisan group of senators and the National Governors Association.
"We shouldn't have to choose between filling the national vaccine stockpile or having a warning system at the state and local level," said Sen. Evan Bayh, the Indiana Democrat who drafted the senators' protest letter to Thompson. "That's a false choice and a manifestation of the budget problems we have."
At least one Senate Appropriations Committee member, Sen. Tom Harkin (D-Iowa), "strongly objects to taking money away from states," according to a spokeswoman. He will urge Specter to deny Thompson's request, she said.
The Cities Readiness grants would be spread over 16 states, ranging from $5.1 million for New York to $690,000 for Pittsburgh and St. Louis. The District would receive $830,000; no community in Maryland or Virginia is on the list.
George Gould of the National Association of Letter Carriers said his union supports the voluntary plan for letter carriers to deliver emergency medical supplies. Postal workers will be trained in handling the materials and in security, he said.