In the wake of a series of still mysterious anthrax attacks in 2002, the U.S. Congress sent $1.6 billion to states and cities to prepare for bioterrorist threats. A non-profit group that examines public policy issues, the Twentieth Century Foundation, commissioned two reports to assess the progress made by state and local public health systems in preparing to counter similar incidents. The reports also looked at the impact of the federal money on public health systems.

Elin Gursky, a senior fellow at the private ANSER Institute for Homeland Security, wrote the first report, called Progress and Peril. She based it on a national survey and interviews with 42 public health officials in 10 states. She says the federal money has helped public health officials acquire needed equipment and updated technology, and develop stronger partnerships with emergency responders at hospitals, law enforcement agencies, and fire departments. At the same time, she found that public health systems were losing staff and their capacity to respond to other emergencies due to severely reduced state budgets.

"The peril issue is that many of these efforts seem to be reshaping our public health system," said Elin Gursky. "In terms of losing state dollars to support traditional public health programs in efforts to improve bioterrorism preparedness, health departments reported losing things like maternal child health service and some communicable disease services, school health, elder care, environmental services and water quality."

The second study focuses on one representative state, Illinois, which received a total of $44 million to prepare for biological threats. The author, Bernard Turnock, heads the Center for Public Health Practice at the University of Illinois' Chicago campus.

Dr. Turnock found obstacles to effectively spending the money, particularly bureaucratic barriers to hiring key personnel such as epidemiologists, laboratory personnel and emergency response coordinators. For example, a year after Illinois had received the money the state had only been able to hire half of the epidemiologists that were needed. And he found concern about the long-term federal commitment.

"The second lesson really relates to the fact that the key elements of bioterrorism preparedness, the surveillance systems and the communications systems and the training systems require a lengthy time to develop and implement and to be fully effective," he said. "Therefore, much of the early progress that has been made in those areas is jeopardized if there is not going to be continued support for these activities over a long period."

Dr. Turnock says friction between state and local governments over priorities for spending the money is also jeopardizing the effective use of resources.