A Public Mess

• Share

(4 of 5)

But there are plenty of holes in the surveillance net. How well a disease gets detected and reported can depend on anything from how good the monitoring is in a given state to how sleepy the emergency-room resident is at a given hospital. To tighten things up, the CDC is establishing a Health Alert Network, a $90 million, two-way computer link connecting the federal center with every state and local health department in the country. When it's completed, the Internet will be used to speedily send out advisories, lab findings, prevention guidelines and educational materials from Atlanta and to gather up information about possible disease outbreaks from everywhere else across the nation. The idea is a good one and the states are behind it, but with so many of them still not wired to the Internet, it could take years before the entire system is up and running.

In the meantime, the CDC is working to give aging labs a boost. The agency already funds and runs a National Laboratory Response network, a coast-to-coast system of diagnostic facilities that receive and analyze specimens from across the country. But at least some of the labs in the network can become overwhelmed, as they were by anthrax, and Koplan hopes for more money to widen the system. And in order to keep the network running, the CDC also wants to expand the public-health workforce, increasing its size and improving training.

None of this, however, will come cheap. The CDC's 2001 budget was only $5 billion, and 75% of that was distributed to states and localities. Wringing more cash out of Washington in wartime won't be easy. After the anthrax scares, Massachusetts Senator Ted Kennedy calculated that it would take $10 billion to bolster the public-health system sufficiently to respond to such threats. The Bush Administration countered with a bare $1.6 billion, a figure that even Thompson was reduced to gamely calling "a great start." Ultimately, Frist and Kennedy agreed to seek $3.2 billion. "That was enough to take us from an unprepared state to a more prepared state," grumbles Frist. "I won't even say 'adequate' yet." Last week the President signed a new appropriations bill that included a $2.1 billion down payment on whatever figure Frist, Kennedy and Congress ultimately send him, bringing the CDC's total budget for this year to $7.5 billion.