CDC had awarded over $120 million to state and local public health agencies to support bioterrorism preparedness and response activities (CDC, 2003a). Through the Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism (Program Announcement 99051) (hereafter, referred to as the “CDC cooperative agreement”), CDC awarded $918 million in fiscal year 2002 and $870 million in fiscal year 2003 (with an additional $100 million for smallpox preparedness) to support state and local agencies’ bioterrorism preparedness activities.

In the past 6 months, CDC has launched the Public Health Preparedness Project to help define a baseline level of public health preparedness and to assess how states are using the funds received through the CDC cooperative agreement. The goals of the Public Health Preparedness Project are (Henderson, 2003b):

  1. Define and establish a fundamental level of public health preparedness—initially associated with the CDC bioterrorism preparedness and response cooperative agreement program.

  2. Serve as the basis of score-carding state and local preparedness.

  3. Provide the framework for the fiscal year 2004 cooperative agreement guidance;.

  4. Assist in identifying technical assistance needs of state and local public health agencies.

At the time of the November meeting, the score cards were intended to be used for identifying states’ gaps in preparedness and areas where more resources are needed and were not intended to be used to reduce funding to states that are not performing as well as others (Henderson, 2003a). The committee endorses this view and believes that it is important that the score cards be used as opportunities for improvement.

In developing and implementing this project, CDC has made the following assumptions (Henderson, 2003a):

  • It is important to focus first on bioterrorism and other infectious disease outbreaks, and then on chemical and radiological/nuclear terrorism.

  • Flexibility is needed to address jurisdictional variability.

  • Little science-based evidence exists for clear-cut criteria.

  • Current resources may not be sufficient to fully address indicators.

  • State and local health agencies have primary responsibility for assuring community capacity.

After an internal CDC workgroup, an external workgroup of national stakeholders, public health partners, and the IOM committee (through this report) provide feedback on the 4 goals, 22 objectives, and 127 indicators,

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