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Many public health agencies are unprepared to respond to acts of bioterrorism or natural outbreaks of dangerous infectious diseases, according to a small but novel study sponsored by the U.S. Department of Health and Human Services and the RAND corporation. Posing as physicians, researchers phoned 19 public health clinics in 18 states to report fictitious cases of such diseases as botulism, anthrax, smallpox, and bubonic plague. The results were discouraging. Only 2 of the 19 agencies consistently met the federal standard of responding to all calls within 30 minutes.


Researchers placed multiple calls to each agency to evaluate performance. Although 91% of calls were answered within 30 minutes, some calls weren't returned for days. Delays were most likely when calls were made toward the end of the workday, in the evening, or on a weekend. Three agencies didn't respond to any of the first five calls.


Some clinic workers answering calls seemed unconcerned about reports suggesting bioterrorism or an infectious disease outbreak. In one case, a researcher who described classic symptoms of bubonic plague was advised to "go back to sleep" because no other cases had been reported. No one in any of the clinics surveyed suggested isolating a patient who had classic smallpox symptoms.


Public health agency directors agreed in advance to participate in the study, but didn't inform their staffs. Individual agencies weren't identified in the report.


Patrick M. Libbey, executive director of the National Association of County and City Health Officials, charges that the study report is "rife with negative bias." Noting that 91% of calls were returned within 30 minutes, he said, "We consider that a good record."


No federal standards govern how the nation's 2,800 public health clinics dispense medical advice, but the Centers for Disease Control and Prevention provides an emergency response guide for public health directors at http://www.bt.cdc.gov/planning/responseguide.asp. An operations manual that public health officials can use to test agencies is available at http://www.rand.org/publications/TR/TR260.




Public health response to urgent case reports, Health Affairs eletters,[Web Exclusive], DJ Dausey, et al., pp. W5-412-W5-419. August 30, 2005, http://content.healthaffairs.org/cgi/eletters/hlthaff.w5.412v1.