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funding. CDC preparedness grants for building and sustaining core capabilities have been reduced by 37 percent since 2006. Training funds to prepare staff for their emergency roles has dropped by 30 percent. One-time federal pandemic flu preparedness funds, which accounted for nearly 20 percent of our preparedness resources in 2006, have not been restored. Consequently, key staff positions responsible for disease surveillance, vulnerable populations planning, risk communications, medical surge planning, and other core preparedness capabilities were recently eliminated. As a result of these cuts, surge capacity planning with key community organizations such as long-term-care facilities, nursing homes, and ambulatory care facilities has been suspended. Similar reductions in funding for hospital emergency preparedness activities threaten the future viability of our regional healthcare coalition and the medical response capacity for future large-scale public health emergencies. Unlike certain material resources, public health personnel trained in emergency response are not a just-in-time commodity.


The spring 2009-H1N1 influenza A outbreak highlighted accomplishments, gaps, and challenges in the local public health and medical response to large-scale health emergencies. It also provided opportunities for improvement across the health emergency response spectrum that should be addressed before the next inevitable outbreak or natural disaster. Inadequate long-term sustainable funding for both core public health and health emergency preparedness undermines the ability of local communities to adequately prepare for and respond to large-scale health emergencies of any type.


The author gratefully acknowledges the ongoing work of many colleagues at Public Health–Seattle and King County responding to the 2009-H1N1 influenza A outbreak, and all who reviewed this manuscript and/or provided valuable comments, including James Apa, Atar Baer, Julia Byrd, Joe Cropley, Cynthia Dold, Carina Elsenboss, Paul Etkind, David Fleming, Tao-Sheng Kwan Gett, Michael Loehr, Jennifer Lloyd, Pegi McEvoy, Shelly McKeirnan, Margaret Neff, Betsy Pesek, David Ralphs, Krista Rietberg, Anne Shields, Mark Tonelli, and Diane Young.


ANZIC Influenza Investigators, S. A. Webb, V. Pettilä, I. Seppelt, R. Bellomo, M. Bailey, D. J. Cooper, M. Cretikos, A. R. Davies, S. Finfer, P. W. Harrigan, G. K. Hart, B. Howe, J. R. Iredell, C. McArthur, I. Mitchell, S. Morrison, A. D. Nichol, D. L. Paterson, S. Peake, B. Richards, D. Stephens, A. Turner, and M. Yung. 2009. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. New England Journal of Medicine 361(20):1925-1934.

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