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Hawaii Poorly Prepared to Resist Infectious Disease Outbreak
By News Release @ 2:47 AM :: 2854 Views :: Hawaii Statistics, Health Care

Hawaii Scored Five Out of 10 on Key Indicators Related to Preventing, Detecting, Diagnosing and Responding to Outbreaks

Report Finds Major Gaps in Country’s Ability to Prevent and Control Infectious Disease Outbreaks

News Release from Trust for America’s Health

Washington, D.C., December 17, 2015 – A new report released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) finds Hawaii scored five out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks.

Twenty-eight states and Washington, D.C. scored 5 or lower out of 10 key indicators. Five states—Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states — Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah — tied for the lowest score at three out of 10.

The report, Outbreaks: Protecting Americans from Infectious Diseases, concluded that the United States must redouble efforts to better protect Americans from new infectious disease threats such as MERS-CoV and antibiotic-resistant Superbugs and resurging illnesses like whooping cough, tuberculosis and gonorrhea.

“The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country’s ability to prepare for infectious disease threats,” said Jeffrey Levi, PhD, executive director of TFAH. “We cannot afford to continue to be complacent. Infectious diseases – which are largely preventable – disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary healthcare costs each year.”

Some key Hawaii findings include:

No. Indicator Hawaii Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding: State increased or maintained funding for public health between FY 2013 to 2014 and FY 2014 to 2015.
Y 34 and Washington, D.C.
2 Flu Vaccination Rates: State vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2014 to Spring 2015. The rate was 52.0 percent in Hawaii, the national average is 47.1 percent.
Y 18
3 Childhood Immunization School Requirement Policies:State law either excludes philosophical exemptions entirely or requires a parental notarization or affidavit to achieve a religious or philosophical exemption for school attendance. In 2014, there were more than 600 cases of measles and nearly 33,000 cases of whooping cough reported. While more than 90 percent of U.S. kindergarteners receive all recommended vaccinations, rates are lower in a number of communities and states. More than 28 percent of preschoolers do not receive all recommended vaccinations.
4 HIV/AIDS Surveillance: State requires reporting of all (detectable and undetectable) CD4 cell count (a type of white blood cell) and HIV viral load data to their state HIV surveillance program. Of the more than 1.2 million Americans are living with HIV, almost one in eight do not know they are infected. (As of July 2013.)
Y 43 and Washington, D.C.
5 Syringe Exchange Programs: State explicitly authorizes syringe exchange programs (SEP). Hepatitis C infections—related to a rise in heroin and injection drug use from people transitioning from prescription painkillers—increased by more than 150 percent nationally from 2010 to 2013.
Y 16 and Washington, D.C.
6 Climate Change and Infectious Disease: State currently has climate change adaptation plans completed.
7 Central Line-Associated Bloodstream Infections (CLABSI):State reduced the standard infection rate (SIR) for CLABSI between 2012 and 2013. Hawaii has a CLABSI SIR of 0.3. The national CLABSI SIR is 0.5. Around one out of every 25 people who are hospitalized each year contracts some form of healthcare-associated infection leading to around 75,000 deaths a year.
8 Public Health Laboratories: State laboratories reported having a biosafety professional from July 1, 2014 to June 30, 2015. 
9 Public Health Laboratories: State laboratories provided biosafety training and/or information about courses for sentinel clinical labs in their jurisdiction from July 1, 2014 to June 30, 2015. 
10 Food Safety: State met the national performance target of testing 90 percent of reported E.coli O157 cases within four days (in 2013). Around 48 million Americans get sick from a foodborne illness each year. 
Y 39 and Washington, D.C.
Total Five


“America’s investments in infectious disease prevention ebb and flow leaving our nation challenged to sufficiently address persistent problems,” said Paul Kuehnert, a Robert Wood Johnson Foundation director. “We need to reboot our approach so we support the health of every community by being ready when new infectious threats emerge.”

The Outbreaks report features priority recommendations, including:

  • Increase resources to ensure every state can maintain and modernize basic capabilities – such as epidemiology and laboratory abilities – that are needed to respond to new and ongoing outbreaks;
  • Update disease surveillance to be real-time and interoperable across communities and health systems to better detect, track and contain disease threats;
  • Incentivize the development of new medicines and vaccines, and ensure systems are in place to effectively distribute them when needed;
  • Decrease antibiotic overuse and increase vaccination rates;
  • Improve and maintain the ability of the health system to be prepared for a range of potential threats – such as an influx of patients during a widespread outbreak or the containment of a novel, highly infectious organism that requires specialty care;
  • Strengthen efforts and policies to reduce healthcare-associated infections;
  • Take strong measures to contain the rising hepatitis C epidemic and other sexually transmitted infections, particularly among young adults; and
  • Adopt modern strategies to end AIDS in every state and city.

The indicators represent examples of important capabilities, policies and trends, and were selected in consultation with leading public health and healthcare officials. The report and state-by-state materials are available on TFAH’s website at

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH's website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator, with zero the lowest possible overall score and 10 the highest. The data for the indicators are from publicly available sources or were provided from public officials.

  • 8 out of 10: Delaware, Kentucky, Maine, New York and Virginia
  • 7 out of 10: Alaska, California, Maryland, Massachusetts, Minnesota and Nebraska
  • 6 out of 10: Arkansas, Illinois, Iowa, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Vermont, West Virginia and Wisconsin
  • 5 out of 10: Arizona, Colorado, Connecticut, Georgia, Hawaii, Mississippi, Missouri, Montana, Pennsylvania, Rhode Island, Texas and Washington
  • 4 out of 10: Alabama, District of Columbia, Florida, Indiana, Louisiana, Nevada, South Carolina, South Dakota, Tennessee and Wyoming
  • 3 out of 10: Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah

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