Two private groups say the United States is still not adequately prepared to deal with a biological attack by terrorists. They say that, despite significantly higher spending and advances in some areas, the country's progress has been slow since September 11, 2001.
The threat of bioterrorism changed quickly from theoretical to real with the 2001 al-Qaida attacks on New York and Washington and the mailing of anthrax to several news organizations and members of Congress by a person or people still unknown.
In response, the Bush administration has increased spending on biological preparedness 67 percent since then, from $7 billion to $12 billion. Much of it has gone to expand state and local government capabilities. But experts say that after three years, the nation is still struggling to meet basic readiness requirements at all levels of government.
"Progress has been made, but despite this progress, are we where we should be in dealing with the bioterrorism challenge? No, we are not," said Michael Moodie, the president of the Chemical and Biological Arms Control Institute, a Washington policy research organization.
"We still have a long way to go in some areas. There is clearly work that must be done," he added.
Mr. Moodie says the progress since 2001 includes a national stockpile of drugs, vaccines, and other key materials to treat victims of a bioattack and increased funding for hospitals to attend to them. The massive influx of money from the national government has helped public health agencies at all levels improve planning for a biological attack, upgrade their disease surveillance and emergency communications, build new laboratories, and conduct research on vaccines and antidotes for biological agents.
But Mr. Moodie says substantial obstacles still exist. Chief among them is fragmentation of responsibility across many national government agencies, with no single point of accountability. He says key decisions are made without an integrated strategy or a clear assessment of what the biological threat is.
"Whether this should all be brought under a single agency, I don't know that that would be possible, given all the players," said Mr. Moodie. "What you need, then, is a very strong coordinating mechanism."
At a lower political level, states and cities are still awaiting preparedness guidelines from the Bush administration. That point is made by Michele Orza, a public health specialist at the investigative office of the U.S. Congress.
"We still lack a clear definition of what preparedness is and a common understanding of how preparedness at the local and state level relates to preparedness as a nation," said Mr. Orza. "Is it the case that we are only [as] prepared as the least prepared locality? Is national preparedness simply the sum of preparedness in all the states?"
Another group, called the Trust for America's Health, finds insufficient coordination on bioterrorism matters among federal, state, and local emergency and public health officials.
The group's executive director, Shelley Hearne, says the billions of dollars spent since 2001 have been insufficient for state public health agencies. Bush administration support for their bioterrorism defense efforts actually decreased more than one million dollars per state in 2004. In addition, one-third of U.S. states cut their 2004 public health budgets because economic sluggishness hurt tax revenues. The result is that their public health systems remain antiquated.
"The reality is that this is a public health system that has been extraordinarily neglected. Many facilities were simply using those dollars to get faxes, computers, just a handful of people who could be turning on the lights," said Ms. Hearne. "This is a long term, sustained fix that is needed and miracles are not going to happen overnight."
The Chemical and Biological Arms Control Institute says the U.S. government must commit to continuing to build the country's public health infrastructure. It calls for more stable biodefense funding, with appropriations over a five year period to make it less vulnerable to political disruption.
Beyond these domestic priorities, the institute says the Bush administration should provide the political and financial leadership to strengthen the World Health Organization's global disease surveillance and foster better planning among member countries to prepare for bioterrorism.