The anthrax incidents during the fall of 2001 raised concerns about the nation's ability to respond to bioterrorist events and other public health threats. The incidents strained the public health system, including surveillance and laboratory workforce capacities, at the state and local levels. Several months after the incidents, the Congress appropriated funds to strengthen state and local bioterrorism preparedness. The Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) distributed the funds in 2002 through two cooperative agreement programs with state, municipal, and territorial governments. To strengthen preparedness, the two cooperative agreement programs--CDC's Public Health Preparedness and Response for Bioterrorism Program and HRSA's National Bioterrorism Hospital Preparedness Program--require participants to complete specific activities designed to build public health and health care capacities. The 2002 cooperative agreements for both programs ended on August 30, 2003. For the 2002 cooperative agreements, CDC's and HRSA's programs distributed approximately $918 million and approximately $125 million, respectively. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 directs us to report on federal programs that support preparedness efforts at the state and local levels. We have previously reported on state and local efforts and hospital preparedness. As agreed with the committees of jurisdiction, for this report, we examined the extent to which states completed 2002 cooperative agreement requirements and whether states identified any factors that hindered implementation of CDC's program and HRSA's program.
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