Study Finds Improved Preparedness for Disease Outbreaks and Bioterror

A federal program designed to help metropolitan public health agencies prepare to deliver essential medicines to the public after a large-scale bioterror attack or natural disease outbreak has succeeded in improving the level of readiness, according to a new RAND Corporation study.

Researchers found that the federal Cities Readiness Initiative, a program active in 72 metropolitan areas, appears to have improved agencies' ability to rapidly and widely dispense life-saving medications and other medical supplies in the event of a large-scale bioterror attack or a naturally occurring infectious disease outbreak.

The study from RAND Health concludes there is merit in extending the program so the impact can be further monitored, although the analysis did not assess the cost-effectiveness of the effort or compare it to other public health priorities.

"The Cities Readiness Initiative has helped agencies in the nation's most-populous regions become better able to dispense life-saving medication following a bioterrorism event or after an infectious disease outbreak," said Henry Willis, the study's lead author and a policy researcher at RAND, a nonprofit research organization.

Researchers concluded that a key reason the Cities Readiness Initiative has helped promote improvements has been its focus on a single scenario with a well-defined numeric goal and the technical assistance it has provided to public health officials.

Researchers say the initiative has helped increase the number of local public health staff members working on medication dispensing planning, strengthened partnerships between public health officials and local first-responder agencies, and helped pay for new equipment such as mobile drug dispensing units.

Other public health improvements fostered by the Cities Readiness Initiative are the development of more-detailed plans for medication dispensing, including creation of new strategies that rely less on medically trained staff and take greater advantage of nontraditional venues such as hotels, resorts, churches as well as drive-through dispensing in parking lots and fairgrounds.

The Cities Readiness Initiative was created in 2004 to improve the ability of the nation's largest metropolitan regions to provide life-saving medications in the event of a large-scale bioterror attack or naturally occurring disease outbreak. The program has spent about $300 million on efforts thus far.

Administered by the federal Centers for Disease Control and Prevention, the program helps jurisdictions improve their ability to provide antibiotics and other life-saving medications to 100 percent of a region's population within 48 hours of a large-scale anthrax attack or large-scale infectious disease emergency. The 72 regions that have received funding account for about 57 percent of the nation's population.

RAND researchers conducted their study by reviewing plans and technical surveys completed by agencies that assessed capabilities in 12 functional areas (e.g., distribution of medication, dispensing of antibiotics), as well as conducting in-depth interviews with officials from nine regions.

Researchers say that the program should be evaluated again after two to three years to see whether jurisdictions continue to make progress and to examine whether the program should be revised. Future evaluations could be extended to include an assessment of public health risks and the cost-effectiveness of public health programs.

The study, "Initial Evaluation of the Cities Readiness Initiative," is available at www.rand.org. The work was sponsored by the federal Centers for Disease Control and Prevention (CDC).

Other authors of the study are Christopher Nelson, Shoshana Shelton, Andrew M. Parker, John A. Zambrano, Edward W. Chan, Jeffrey Wasserman, and Brian A. Jackson. The study was done through the RAND Center for Domestic and International Health.