Iowa Official Puts $11.4M Price Tag on Preparedness


The cost of an official assessment of Iowa's anti-terrorism needs? At least $750,000. The estimated cost per resident of fully equipping Iowa's public health system to deal with a terrorist attack using biological or chemical weapons? $3.91. The peace of mind that would come to state residents from knowing that Iowa's health system is ready to help them in a crisis? Priceless.

State epidemiologist Dr. Patricia Quinlisk, a past president of the Council of State and Territorial Epidemiologists (CSTE), told a U.S. Senate subcommittee last week that bringing Iowa's emergency responders, doctors, nurses, hospitals, rural clinics, laboratories, communications and computer systems up to full anti-terrorism speed this year would cost at least $11,450,000.

That puts Iowa somewhere in the middle of ballpark figures state health officials across the country are attaching to their preparedness needs, with wish-list price tags ranging as high as $15 million for larger and more densely populated states.

If the federal government cut the states a check for these amounts tomorrow, bioterrorism consultant Quinlisk says, short term needs like setting up secure, electronic health alert networks could be met quickly.

Fears that terrorists would use toxic chemicals or biological agents like anthrax bacteria or the smallpox virus in a follow-up assault upon the United States spread rapidly after the Sept. 11 attacks upon New York City and Washington, D.C.

Over the weekend, a pair of confirmed cases of anthrax infection in Delray Beach, Fla., further heightened those fears. The Centers for Disease Control (CDC), the federal agency responsible for front line action against the threat of domestic acts of bioterrorism, rushed 100 cases of anthrax vaccine to Florida Sunday night as local authorities shared information from their investigation with the FBI.

Although the cause of the Florida scare has yet to be identified, experts say evidence of such an attack would surface slowly and initially look like a standard outbreak of more familiar infectious diseases. They also say that a more robust public health system is the nation's best defense against any such attack.

Quinlisk says progress toward preparedness, much of which has taken place since the CDC received its first bioterrorism grant money for state and local health departments in 1998, has left states "something like a third to half prepared.

"There are some areas where we're quite a ways along and other areas where we're still crawling out of the oceans," she said.

Since the terrorist airplane attacks on the World Trade Center and the Pentagon, public health officials have been actively working against the threat of a chemical or bio-terror follow-up.

"Our systems are ... turned on and we don't see any opportunity to turn them off any time soon. So, we still need additional resources to keep those systems turned on," Maryland Health Secretary Dr. Georges C. Benjamin said during an interview with

Benjamin says doing their jobs after natural disasters like the tornado that struck Maryland two weeks ago has helped public health officials prepare for a manmade disaster.

"What's most helpful are large foodborne outbreaks and large infectious outbreaks where we've had to vaccinate a lot of people or do surveillance work to track down people who've been exposed," he says.

Quinlisk estimates the Iowa Department of Public Health (DPH) responds to an average of one significant outbreak of foodborne illness every week, with numbers of victims typically ranging between 30 and 50.

State and federal fiscal belt-tightening makes honoring every emergency budget request unlikely, particularly in the wake of last month's $15 billion federal bailout of the airline industry.

But public health's bigger problem may be finding enough physicians and nurses with training and experience in acute infectious disease epidemiology to lead a response to terrorist assaults on public health, a virtual impossibility at this time, Quinlisk says.

"I would guess that the majority of Iowa health care providers do not know what to look for, how to send laboratory specimens for diagnosis of these rare diseases and whom to notify if they suspect something," she told the U.S. Senate Appropriations' Labor, Health and Human Services, Education and Related Agencies subcommittee.

Iowa faces other problems, too. With one of the oldest populations in the country, the state's hospital beds are full during winter flu season leaving no "surge capacity," the ability to receive and treat victims of a major emergency. That's in a normal year. And like many other states, Iowa is watching its registered nurse workforce evaporate. 

Quinlisk presented Iowa's $11.4 million needs in seven areas:

  • Capacity assessment: $750,000 to $1 million.Workforce: The DPH says it needs 25 more people to conduct adequate statewide epidemiologic surveillance, plus additions to local health departments. $8 million.
  • Laboratory: "Ongoing support for equipment and materials, staff and training" and added chemical terrorism capacity should run $1 million.
  • Communication: Building upon the current $143,000 grant to make the state's Health Alert Network a secure, online, comprehensive and round-the-clock system will likely cost $500,000 to $1 million.
  • Information Systems: Implementing an integrated data collection and analysis system may cost $1 million.
  • Planning: $200,000 Bioterrorism Response: While spending in the other areas would prepare Iowa, "none of these estimated expenditures address the deficiencies of our medical system ... or include the expense involved in conducting a survey ... of hospitals and pharmacies to determine the resources our state has on hand immediately in case of attack," she wrote. Amount unknown.

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