The report found only six states are adequately prepared to distribute vaccines and antidotes in an emergency, including Florida, Illinois and Louisiana. But Hawai'i is not among them, the report said.

The report, "Ready of Not? Protecting the Public's Health in the Age of Bioterrorism — 2004," looked at 10 key indicators to gauge state preparedness and evaluate America's overall readiness to respond to bioterrorist attacks and other health emergencies.

Hawai'i is one of 20 states to receive a 6 out of 10 on the agency's readiness standard. Florida and North Carolina scored the highest, at 9 out of 10, while Alaska and Massachusett received the lowest grades, a score of 3 out of a possible 10.

State Health Director Chiyome Fukino said the rating Hawai'i received was fair, but noted that steps are under way that should result in a rating of "10" when the 2005 preparedness report is issued.

In terms of specific shortcomings, the Washington, D.C., agency concluded that Hawai'i:

• Is not among the five states that claim to have public health labs with sufficient capability to fully respond to a chemical terrorism threat and is not among the 17 states to claim sufficient bioterrorism lab response capabilities.
• Does not have enough lab scientists available to run tests in the event of a suspected anthrax or plague outbreak.
• Is not among the 17 states that can electronically track disease outbreak information by national standards, causing serious delays in reporting, which would make early warning of disease threats difficult.
• Is one of 20 states that do not have publicly available response plans to a flu pandemic, which is often viewed as requiring a similar response to a bioterrorism attack. Based on model estimates, a pandemic flu hitting the United States could result in 89,000 to 207,000 deaths throughout the country and up to 1,142 deaths in Hawai'i and 4,933 people hospitalized here in the first wave of the disease to hit the United States, according to the Trust for America's Health report.

"This report found that more than three years after the 9/11 and anthrax tragedies, we've only made baby steps toward better bioterrorism preparedness, rather than the giant leaps required to adequately protect the American people," said Lowell Weicker Jr., Trust for America's Health board chairman and former three-term U.S. senator and governor of Connecticut.

The report echoed fears voiced by outgoing Health and Human Services Secretary Tommy Thompson earlier this month, when he said he couldn't understand why terrorists haven't attacked the country's food supply because it would be "so easy to do."

And the review follows a year in which the country faced a shortage of flu vaccines — normally a routine protection against a known problem.

The report graded states on whether they met 10 criteria, including such elements as the amount of state spending and federal aid allocated to public health, the flu vaccine rates, and the number of scientists and laboratories available to test for anthrax or the plague.

Fukino, meanwhile, said the state is in the process of building a "level three" bioterrorism lab and has a memorandum of understanding with the University of Hawai'i about training and sharing technicians for the new lab.

Lab scientists here will be "cross-trained" to test for anthrax and the plague and the state is close to being able to use an Internet-based system to record and track diseases electronically, Fukino said.

She said the state has a draft flu pandemic plan in place, one that should be finalized and available for public dissemination shortly.