Imagine the unthinkable: a contagious disease spreads like wildfire throughout the United States, or a deadly toxin is released into the panicked population on a Sunday morning. Would our health system be able to handle the sudden demands on its infrastructure by Monday, or would it still be fumbling in the dark the following weekend?

It depends. “While our federal, state and local governments, as well as the private sector and healthcare community have taken steps in the right direction, our level of preparedness remains a work in progress,” Frank J.Cilluffo, director of Homeland Security Policy Institute at George Washington University told the U.S. Senate earlier this year. “It is not yet where it needs to be.”

Health and Human Services Secretary Michael Leavitt seconded this assessment. “When it comes to pandemics, we are overdue. And, we are under-prepared,” he warned in April 2006. He went on to deliver a frightening prediction: if we were to have an outbreak today comparable to the 1918 influenza pandemic, 90 million Americans would get ill; 45 million would become sick enough to require serious medical attention, and roughly two million would die.

An obvious frustration of preparing for possible disasters, Secretary Leavitt added, is that “anything you say in advance feels alarmist, but anything we have done once a pandemic starts seems inadequate.”

So should we be worried? There is good news and not-so-good news about our nation’s readiness to deal with disasters.

“If a disease outbreak happens, we can keep it localized and contained,” says Dr. David L. Dalton, who, as President and CEO of UNIVEC, the Baltimore, MD-based company which manufactures and distributes medication and equipment to 50,000 pharmacies, would be actively involved in providing supplies to disaster-impacted areas. His other company, Health Resources Inc. is the only African-American owned and operated pharmacy benefit management firm in the United States.

 “We have contingency plans in place, such as a stockpile of inventory that is perpetually available and rotated to ensure freshness, as well as logistics to get the supplies to the disaster area quickly by helicopters or other means,” he says. “We are constantly training personnel on disaster preparedness and all our computers have backups in real time and are geographically distributed to prevent any delay in operations or information transfer. We have to be prepared for the worst.”

And many agencies are, at least on paper. Centers for Disease Control and Prevention maintain a large quantity of antibiotics, antidotes and other vital medications and equipment geared to current predictable threats. Known as the Strategic National Stockpile, they can be delivered to the affected areas within 12 hours. Additional vendor-managed inventory, such as UNIVEC’s stockpile, can arrive at a disaster area within 24 to 36 hours of the deployment order.

“As soon as we are told by the local or state authority to get moving, we are ready to get moving,” Dr. Dalton says. “We are in a position to leap into action right now if needed.”

Other reassuring data is also emerging: a survey released in October 2006 by the National Association of County and City Health officials shows that over 90% of the nation’s 2,800 local health departments have strengthened their disaster planning and ability to respond.

That’s the good news.

The not-so-good news is that, predictably, the system relying on a rapid deployment and response to disasters that can occur anytime and anywhere is not infallible. Dr. Dalton says red tape could delay the shipment of life-saving medications and equipment. “It all depends on who the controlling agency is, who issues the authorization,” he says. And how quickly. “Unfortunately, the most recent disasters, like hurricane Katrina, are proof that there is room for improvement.”

Another problem area is the lack of a harmonized approach to monitoring disaster survivors, he says. In the aftermath of the September 11, 2001 terrorist attack, for example, many people present on the scene of the World Trade Center towers’ collapse were later treated for respiratory and other ailments, “but no coherent, coordinated follow-up had been done on these cases. If it had, alarming statistics would undoubtedly emerge.”

Statistics that might help public health officials build a more effective infrastructure enabling a better and quicker treatment of disaster victims. “I’d like to see electronic medical records which can be easily and rapidly accessed in any type of a disaster,” Dr. Dalton says. The system would allow first-responders to look at a victim’s medical and pharmaceutical history online and implement potentially life-saving treatments without delay. “We have the technology and the privacy protection laws to do this, but the system is lagging.”

Prior failures and shortcomings of the system do have an upside. Since hindsight is the best insight, “each disaster is a learning experience for the future,” Dr. Dalton says. “Every day we get better.”