America is not ready for a major outbreak of an infectious disease.

According to a new report published on December 17th by the Trust for America’s Health and the Robert Wood Johnson Foundation, over half of U.S. states are poorly prepared to respond to infectious disease outbreaks. The data showed that 28 states and Washington, D.C. were not sufficiently prepared to prevent, detect, diagnose and respond to major infectious disease epidemics.

Majority of States not well prepared to handle disease outbreaks

The researchers who produced the Outbreaks report noted that U.S. public health authorities must increase efforts to protect Americans from emerging diseases such as Middle East respiratory syndrome coronavirus (MERS-CoV) and antibiotic-resistant superbugs, along with known infectious diseases including tuberculosis and whooping cough.

Statement from executive director of TFAH

“The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country’s ability to prepare for infectious disease threats,” Jeffrey Levi, PhD, executive director of TFAH, noted in a statement about the 2015 report. “We cannot afford to continue to be complacent. Infectious diseases – which are largely preventable – disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary healthcare costs each year.”

Highlights from TFAH 2016 disease Outbreaks report

Healthcare-associated Infections are a major problem in the U.S. Close to one out of every 25 people who are hospitalized each year in America sends up with a healthcare-associated infection, with more than 75,000 a year dying from the infection. Also of note, a mere 9 states have improved their standardized infection ratio (SIR) for central line-associated blood stream infections from 2012 to 2013.

Avoidance of childhood vaccinations is also a growing issue. Of note, there were over 600 cases of measles and 33,000 cases of whooping cough reported in the U.S. last year. Overall, around 90% of all U.S. kindergarteners did have all recommended vaccinations, but rates are much lower in a few cities and states (making these areas vulnerable to infectious disease outbreaks). Things get worse as children get older, given that 28% of American preschoolers do not get all of the medically recommended vaccinations. The report also highlights that 20 states have laws that either exclude philosophical exemptions to vaccinations or require a parental notarization/affidavit to get a religious or philosophical exemption to attend school without the recommended vaccinations.

Flu vaccinations are another public health problem here in the U.S. Annual flu epidemics typically lead to between 3,000 to 49,000 deaths a year (depending on strain), over $10 billion in direct medical expenses and around $16 billion in lost earnings due days of work missed. In 18 states, at least half of the population (ages 6 months and older) received flu shots or the seasonal flu from Fall 2014 to Spring 2015. The national average is 47.1 percent. Rates are lowest among young and middle age adults (only 38 percent of 18- to 64-year-olds are vaccinated).

Hepatitis C and HIV/AIDS remain problems. Among the more than 1.2 million Americans who currently have HIV, around one in eight do not know they are infected. Hepatitis C infections (largely connected to a increase in heroin and drug use from those starting with prescription painkillers) were up 150%  from 2010 to 2013. Laws in 16 states and Washington, D.C. permit syringe exchange programs, and 43 states and D.C. require reporting all (both detectable and undetectable) CD4 cell count and HIV viral load data to the state HIV surveillance program.

Food safety is another major issue in the U.S. today. The report notes that nearly 48 million Americans become ill from a foodborne illness each year. Moreover, only 39 states met the national performance target of testing 90% of E.coli O157 cases within four days (2013 data).

Preparations for emerging threats still needs more work. Despite notable advances in preparing for public health emergencies, including bioterror or natural disease outbreaks, over the last few years, more work remains. The report highlights that gaps in preparation are getting worse as resources have been cut in many cases. Only 36 states have a biosafety professional employed in their state public health labs. These facilities are a key part of the effort to detect, diagnose and contain disease outbreaks. Of note, 15 states have finalized climate change adaption plans that discuss possible impacts on human health.

Last but not least, the growing number of superbugs, especially in hospitals, is a major public health issue with no solution in sight. Over two million Americans catch antibiotic-resistant infections each year, resulting in an average of 23,000 deaths a year, $20 billion in direct medical costs and over $35 billion in economic productivity losses.