A Dose of Reality for The Health Watchdogs

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One change might involve making it clear to the public just what the Federal Government's limits are, and making sure the government remembers that as well. When an infection occurs in Boca Raton, Fla., New York City or anywhere else, the local police, fire fighters and medical teams are our first line of defense. Washington's job is to be ready when summoned and also--more important--to provide local governments with the money and resources they need so that they'll be more able to manage things on their own.

Last year Congress and the Clinton Administration took steps to accomplish just that, enacting the Frist-Kennedy Public Health Threats and Emergencies Act. The law was designed to provide massive training of local public health personnel, upgrade and expand the National Pharmaceutical Stockpile and fund vaccine research and expansion of hospitals' emergency capabilities--in short, to respond to exactly the kind of crisis the nation may now be facing. Though $1.4 billion was originally earmarked, that money was never appropriated. The Bush Administration originally seemed indifferent too, requesting a mere $345 million to combat bioterrorism. Now that's changed. Thompson has requested nearly $2 billion to achieve the Frist-Kennedy objectives, and Congress may up the bid considerably and ask Bush for $10 billion.

However much money is ultimately allocated, the bulk of it should go to training and recruiting first responders, bringing local emergency teams up to speed on dealing with biological and chemical terrorism. Thompson likes to boast about HHS's metropolitan medical response system, federal teams in 97 cities that would provide mass immunizations or treatments within 24 hours of a bioterrorist attack. The GAO, however, estimates that only 22% of the population is within reach of trained first responders, making the need for greater local investment all the more pressing.

Money to increase the number of local hospital beds will be well spent, since many hospitals, facing budget crunches, have slashed bed capacity as much as 40% in recent years. Experts agree that even a small overflow of patients would overwhelm hospitals in nearly every city. Also due for a cash infusion are the woeful local labs, whose technicians are expected to test for diseases and report any outbreaks they discover to the CDC in Atlanta. Many of these labs don't even have fax machines or computer links to the CDC. "Our idea of disease monitoring is to send a postcard to Atlanta," notes a senior Senate aide. Says Senator Ted Kennedy: "Some labs are in an extraordinary state of disrepair; some have been ignored for years."

More money will also have to go to producing and stockpiling drugs to treat anthrax, such as Cipro and other antibiotics, as well as vaccines to protect against other potential threats like smallpox. But getting the drugs manufactured will do no good if they can't be shipped out into the field. The National Pharmaceutical Stockpile has in place around the country eight "push packets"--50-ton pallets of medical supplies and drugs that are kept in secure locations and can be airlifted to the site of a disaster within 12 hours. Thompson ordered one such packet driven to New York immediately after the World Trade Center attacks. The White House is now seeking $643 million in new spending, in part to expand the stockpile by at least four new packets.