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Emergency Management 5


Recommendations

A. Texas should bolster anti-terrorism capabilities by developing regional epidemic response teams in eight of the Texas Department of Health’s regional offices.

Early detection, identification and response are of utmost importance in the event of a bioterrorist attack. The proposed regional epidemic response teams would consist of three professionals each. An additional team would be based at Texas Department of Health (TDH) headquarters. According to TDH, the teams will work directly with cities within their regional boundaries to develop, implement and exercise bioterrorism response plans as part of their emergency preparedness efforts. The teams will also improve disease detection and tracking with local health departments, hospitals and clinics. Both regional and central office staff will produce written materials and lectures to improve the awareness of physicians, nurses, hospital administrators and others regarding bioterrorism and associated illnesses.

B. Texas should increase state and local health department microbiological and chemical laboratory capacity to detect and respond to bioterrorism and chemical terrorism.

C. Texas should enhance infectious disease epidemiology and surveillance.

Funds would be used to increase TDH’s capacity to rapidly collect and analyze epidemiological and surveillance data.

D. Texas should create an Office of the State Epidemiologist that would assist local governments and hospitals with enhancing their current emergency response plans to include bioterrorism preparedness.

TDH does not currently have a central source of scientific and public health expertise for all disease surveillance and bioterrorism activities within the department. This office would also coordinate the public health efforts related to planning and responding to bioterrorism activities.

E. Texas should expand the Health Alert Network program to more local health departments and train local health department staff to recognize and respond to bioterrorism.


Summary

At the state level, the Associateship for Disease Control and Prevention oversees the operations of six bureaus including the Bureau of Communicable Disease Control, which is responsible for conducting surveillance activities on an ongoing basis to prevent the spread of infectious agents including those associated with acts of bioterrorism. This bureau is essentially a state version of the national Centers for Disease Control (CDC). However, the resources that are available for routine surveillance would be overwhelmed and quickly exhausted in the event of a bioterrorist event.

No one can predict how effectively the public health infrastructure in Texas—or in the nation—would respond to bioterrorist attacks. The CDC, and state and local health departments around the nation have been compiling an inventory of “core capacities” of local public health departments for several years. The collection of surveys from local health departments in Texas is complete but the data have not been compiled, analyzed or checked for accuracy.[1]

Even if Texas’ inventory of public health core capacities were complete and accurate there are no detailed, agreed-upon standards among public health or bioterrorism experts for what comprises adequate public health capacity for bioterrorism or other naturally occurring epidemics. The CDC is expected to publish a document identifying the core capacities needed by state and local health departments for terrorism preparedness and response.[2] But lacking that guidance, state and local health departments and governments must decide for themselves what are appropriate levels of preparedness. As far as Texas is concerned, a TDH report noted that the level of readiness of Texas cities to combat a bioterrorist attack is unknown.

TDH successfully competed for an estimated $1.1 million annual grant from the federal government to improve its disease detection capacity. However, the Texas Department of Health receives no general revenue funding for preparing and responding to bioterrorism attacks. The Texas Legislature rejected a TDH “exceptional item” biennial appropriation request for about $3.8 million in 2001. The appropriation would have added 36 full-time employee equivalents to bolster Texas’ bioterrorism capabilities—even though TDH noted in an August 2000 report to a Texas Senate committee that such expenditures would only develop a modest state capacity to detect signs of illness, support local governments and better educate health care professionals.[3] Another bill to add three professional/technical staff to the Communicable Disease Control and State Epidemiologist’s office was also rejected.

Some states and public health interest groups are trying to calculate what it would cost to deal with bioterrorist attacks. Former president of the Council of State and Territorial Epidemiologists and Iowa state epidemiologist Patricia Quinlisk testified before the Labor, Health and Human Services and Education Subcommittee of the Senate Appropriation committee on October 3, 2001 that Iowa needs a minimum of $11.45 million annually to prepare and respond to biological attacks. She noted that even these estimated expenditures did not address the costs of developing a surge capacity in our medical system for perhaps tens of thousands of patients stricken in a large bioterrorist epidemic. The expenditures in Iowa work out to about $3.91 per resident.

Nebraska passed a law that funded public heath infrastructure improvements with $6 million of tobacco settlement money. Funding per resident in that state was about $3.51.

The federal government’s role in a bioterrorist attack is primarily assisting in the coordination of local and state resources. Tara O’Toole, a senior fellow at the Johns Hopkins Center for Civilian Biodefense Studies testified before Congress on several occasions that the CDC has limited resources. She has noted that there are fewer than 150 officers in the CDC Epidemic Intelligence Service and perhaps only 1,000 to 2,000 other CDC employees with any field experience who could be mobilized in a national crisis. The CDC Office of Bioterrorism Response and Preparedness has about 30 employees. The most efficient and well-coordinated organizational response to a bioterrorist attack cannot compensate for a lack of basic public health resources and surge capacity in the provision of medical care and supplies.[4]

The resources needed to build effective epidemic response capabilities can also serve other very useful, long-term public health goals such as monitoring regular biological threats like West Nile Fever, Bovine Spongiform Encephalopathy (Mad Cow Disease) and Hoof and Mouth disease—all diseases that could significantly harm public health and the economy.

Texas needs more than a modest bioterrorism defense. The potential cost of a bioterrorist attack could exceed those of September 11 in lives and dollars. Rapid response to epidemics can save millions of dollars. As epidemics grow, the costs—both human and economic—grow exponentially. The sooner an outbreak is detected and a response occurs, the greater the chance of containment.


Legislative Changes Required

The Legislature and/or the Legislative Budget Board (LBB) would allocate funds as described below.


Fiscal Impact

The estimated cost to implement this proposal would be about $7.3 million in the first year and $4.8 million thereafter. An additional 59 full-time employees would be added to the department. Any available federal money should be sought for this effort.

The LBB could use its budget execution authority to move $7.3 million from other agencies to fund the recommended increases in public health spending.

Annual Cost

Recommendation A $2,065,782

Recommendation B $2,069,510

Recommendation C $1,080,205

Recommendation D $ 466,360

Recommendation E $1,600,000

Total $7,281,857


[1] Interview with Charlie Todd, Texas A&M University, College Station, Texas, October 2001; and interview with Dennis Perrotta, state epidemiologist, Austin, Texas, October 2001.

[2] Testimony of Dr. Patricia Quinlisk, Council of State and Territorial Epidemiologists, before the Labor, Health and Human Services Subcommittee of Senate Appropriation Committee, Austin, Texas, October 3, 2001.

[3] Texas Senate Health Committee, Report to the 77th Legislature: Texas Senate Health Committee (Austin, Texas, August 2000).

[4] Testimony of Dr. Tara O’Toole before the Governmental Affairs Subcommittee on International Security, July 23, 2001: http://www.hopkins-biodefense.org/pages/library/fema.html.