community. However, public health has its own rich knowledge base, which includes lessons from recent public health emergencies such as food-borne disease outbreaks, emerging infectious diseases, and the anthrax attack of 2001. Unfortunately, there is no systematic, comprehensive agenda for public health preparedness research to provide a structure for public health emergency preparedness and response research. Such an agenda would be a part of the broader public health research agenda that has recently begun to take shape, but it still requires infrastructure and funding (Council on Linkages between Academia and Public Health Practice, 2004). Systematic public health and interdisciplinary research is essential to inform preparedness against bioterrorism and other threats.

In general, the knowledge gathered from recent outbreaks and other public health emergencies is available predominantly in reports (e.g., from GAO, from nongovernmental organizations) or anecdotal assessments (e.g., in media reports). The peer-reviewed literature seems to offer little research on this subject. Recent anecdotal reports about the ways in which bioterrorism planning and training improved response to a crisis are encouraging, but it is important that such observations are documented and somewhat more quantitative and objective studies are undertaken to determine whether the public health system’s performance (and therefore, response capacity) has indeed been enhanced by expanded resources, surveillance and information systems, and linkages with other partners.

In a study of 12 nationally representative communities, respondents acknowledged general improvements made possible by public health preparedness funding and requirements, including more training of personnel and the development of relationships to first responder and other local agencies and organizations (Staiti et al., 2003). Also, state officials in Massachusetts and Virginia attributed their states’ rapid response to Severe Acute Respiratory Syndrome (SARS) to their public health preparedness efforts supported by funding for bio-terrorism (Staiti et al., 2003; Stoll and Lee, 2003). A GAO report (GAO, 2004) also found that some states have increased laboratory capacity and that the coverage by HAN, CDC’s Health Alert Network, has increased to 90 percent of the nation, which can be assumed, would result in improved rapid notification of health care providers and other health personnel. However, the effect of HAN’s expansion is yet to be determined. In 2003, the executive director of the American Public Health Association and former director of the Maryland Department of Health and Mental Hygiene asserted that previous experience with West Nile virus and anthrax taught the state public health agency in Maryland valuable lessons about communication and cross-jurisdictional coordination—lessons which paid dividends during Maryland’s encounter with SARS (Benjamin, 2003). In April 2004, bioterrorism preparedness efforts were credited with the swift response to



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