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The Centers for Disease Control and Prevention's (CDC's) Cities Readiness Initiative (CRI) provides funding, program guidance, and technical assistance to improve communities' ability to rapidly provide life-saving medications in response to a large-scale bioterrorist attack, naturally occurring disease outbreak, or other public health emergency. Focusing on both capacities and operational capabilities, the authors examine (1) the current status of communities' operational capability to meet CRI program goals related to delivering medical countermeasures within 48 hours of a federal decision to deploy assets and (2) whether there is evidence that CRI has improved communities' capability to meet the 48-hour goal.

Analysis shows that, overall, state capacity appears to be strong; CRI appears to have improved state capacity, but the data are not conclusive. Performance across Metropolitan Statistical Areas varies considerably, as does performance in particular functional areas. The authors also note that testing of operational capabilities has not been conducted at a large enough scale to measure readiness for the 48-hour scenario, recommending that jurisdictions be required to conduct drills at a larger scale. Other proposed recommendations include improving CDC feedback to jurisdictions, attempting to leverage assessments of non-CRI sites as a comparison group, and assessing program cost-effectiveness.

Table of Contents

  • Chapter One


  • Chapter Two


  • Chapter Three

    Evidence of Current CRI Capacities

  • Chapter Four

    Evidence of Operational Capabilities

  • Chapter Five

    Evidence of CRI's Effectiveness in Improving Readiness

  • Chapter Six

    Policy Implications and Recommendations

  • Appendix A

    Additional Information on the Cities Readiness Initiative

  • Appendix B

    Technical Detail on the Study's TAR Analysis

  • Appendix C

    Technical Detail on the Analysis of Drill Data

  • Appendix D

    Technical Detail on Stakeholder Discussions

This work was sponsored by the U.S. Centers for Disease Control and Prevention. The research was conducted in RAND RAND Health, a unit of the RAND Corporation.

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