Hawai'i scored high in a national report released yesterday rating each state's preparedness to handle public health emergencies such as disease outbreaks, bioterrorism or other threats.

Hawai'i was one of 15 states rated adequate in nine out of 10 categories measured by the Trust for America's Health, a research group. Seven states performed adequately in all 10.

"We are continuing to make progress in emergency preparedness since the Sept. 11, 2001, attacks, but we can still do more," Hawai'i Director of Health Chiyome Fukino said. "Emergency preparedness is a shared responsibility, and we are continuing to get individuals and families in the community involved."

The report concluded that states have made much progress since 9/11, but critical gaps remain.

For example, seven states have yet to participate in a federal program to buy antivirals for a potential influenza pandemic. Thirteen states do not have adequate plans to distribute vaccines and medical supplies from the Strategic National Stockpile.

The fifth annual report, "Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism," said Hawai'i is among the most prepared states, having sufficient lab capability, 24-hour coverage to test for biological threats, liability laws that cover healthcare volunteers during emergencies and at least 14 Medical Reserve Corps volunteers per 100,000 residents.

In other categories, the report noted, Hawai'i has a high rate of flu vaccinations for residents age 65 or older and has maintained or increased public health funding.

Fukino said Hawai'i should have received a perfect 10 out of 10. She said Hawai'i scored a satisfactory rating in the Centers for Disease Control's evaluation tool for its comprehensive plan to stockpile and distribute emergency medication and supplies. However, the Trust for America's Health report did not give Hawai'i credit in that category.

The federal government has had a difficult time measuring progress when it comes to the billions of dollars it has sent states over the past six years to improve preparedness. The money went to upgrade laboratories, buy medical supplies and conduct training exercises.

The Bush administration has encouraged states to stock up on antivirals in the event of an influenza pandemic. Under one program, the federal government will pay for a quarter of the cost of buying Tamiflu or Relenza, and states pay the remainder for a combined investment of about $680 million. Antivirals reduce the severity of influenza.

Seven states have so far declined to purchase any antivirals, according to the report: Colorado, Connecticut, Florida, Massachusetts, Mississippi, North Dakota and Rhode Island. Several more have bought only a fraction of what they're entitled to under the federal program.

A spokesman for the federal Department of Health and Human Services said states have until June 2008 to get their orders in. All states have told the federal government they plan on participating, he said. However, many have only ordered part of the medicine that's available to them.

The report also highlighted the need for nearly half the states to update their "Good Samaritan" laws. Such laws create liability shields for those who come to the aid of another at the scene of an emergency. The trust said states need shield laws that can cover days or even weeks of voluntary work, such as a shield law tied to a declared emergency by a governor. The report deemed Hawai'i's law adequate.

The report also warned that a decrease in federal funding could offset many of the improvements that states have made since 2001.

Dr. Irwin Redlener, associate dean for public health preparedness at Columbia University, said he's concerned that federal funding levels for hospital preparedness, now at about $400 million annually, are inadequate. He said the hospitals need an initial investment of $5 billion just to cover existing personnel and equipment needs, plus $1 billion a year thereafter. He said the money is needed for additional beds, ventilators, medicine and personnel.

"This has been a situation going in reverse," Redlener said.

The trade association representing state health officials said that money for emergency preparedness has also been divvied up among more entities in recent years, which don't coordinate their work. They want the money for preparedness to be distributed through the states.

"It's important that we knit together all these different entities getting federal funding," said Dr. Paul Jarris, executive director of the Association of State and Territorial Health Officials.

The Associated Press contributed to this report.

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