Five years after the terrorist attacks of Sept. 11, 2001, the United States is inadequately prepared for disease, disaster or bioterrorism, according to a recent report from a health advocacy group.

Georgia ranks somewhere in the middle of the states — short on nurses, pneumonia vaccine and readiness to receive emergency supplies, but adequate in seven other areas.

Kansas and Oklahoma scored highest in preparedness, according to the report, "Ready or Not? Protecting the Public's Health from Diseases, Disasters and Bioterrorism." California, Iowa, Maryland and New Jersey were rated lowest.

"Sept. 11, the anthrax attacks, and Hurricane Katrina were all wake-up calls to the country, putting us on notice that the nation's response capabilities were weak and that we needed to improve preparedness," said Jeff Levi, executive director of Trust for America's Health, the not-for-profit group that prepared the report.

"But, across the board it is clear that we haven't learned the lessons from these tragedies," Levi said in a news release. "We are still too vulnerable to what might come next."

Of 10 categories measured in the report, the weakest area seems to be the nursing work force. Only 10 states report an adequate number of nurses to handle a major emergency.

Georgia is trying to recruit and retain more nurses, said Dr. Pat O'Neal, director of the office of preparedness within the state's Division of Public Health. But, he said, the shortage is a national problem that could get worse.

"If you project the shortage for five, 10 or 15 years from now, with the growth and aging of the population, the need for more nurses is obvious," he said.

The report showed that 62.5 percent of Georgians 65 and older have received a pneumococcal injection, which protects against the bacteria that cause meningitis and pneumonia. That is under the national median of 65.7 percent.

In 1998, about half of all Georgians 65 and older had had the vaccine, O'Neal said.

The state Division of Public Health is trying to make more vaccine available in the state's 18 health districts, and also trying to make more older Georgians aware of the need to be vaccinated, he said.

Georgia was one of 38 states rated unready to distribute the Strategic National Stockpile of emergency vaccines, antidotes and medical supplies maintained by the Centers for Disease Control and Prevention for distribution in communities facing crises. The state has streamlined its plan and beefed up its resources since its last evaluation by the CDC, O'Neal said.

State officials have identified six geographically dispersed sites to receive emergency supplies. "Go-teams" of state personnel will receive and sort the material, leaving local districts with only the responsibility of distribution, O'Neal said.

Under CDC supervision, the state is also collaborating with Business Executives for National Security, a not-for-profit group of large businesses, to increase the volunteer force needed to get the material out into the community, he said.

The report expresses concern about support for a proper nationwide response to an emergency.

With the Public Health Security and Bioterrorism Act of 2002, Congress allocated nearly $1 billion annually to prepare the nation for disaster. An additional $5 billion was appropriated for pandemic flu preparation, mostly in the form of vaccine research, in fiscal year 2006. But, according to the report, some funds have been cut over the past three years, "before many basic improvements could be achieved."

- This article is a reprint from The Atlanta Journal-Constitution.