It was not apparent to the committee what framework was used to develop and structure the readiness indicators and to ensure that there are indicators identified for every major component of preparedness. CDC noted that it is moving away from the focus areas described in the CDC cooperative agreement guidance for FY 2003 (CDC, 2003a) but did not explain what, if any, new framework would be used, and one does not emerge from the indicators document, other than the four chronological goals (pre-event activities; detection and reporting; response and containment; recovery).

The committee recommends that CDC consider utilizing the Ten Essential Public Health Services as a framework for the readiness indicators (see Box F-1). There are several reasons for this recommendation. The 10 essential services are fundamental in identifying the core responsibilities of public health and, therefore, the capacities and resources a public health system needs to be effective. The importance of a strong public health infrastructure for preparedness has been emphasized repeatedly (GAO, 2000; IOM, 2002a; Salinsky, 2002), because preparedness for bioterrorism does not occur in a vacuum but is one component of a public health system