The General Accounting Office (GAO) found that although States have made progress in developing many important aspects of public health preparedness since April 2003, no State is fully prepared to respond to a major public health threat. Improvements have been made in States' disease surveillance systems, laboratory capacity, communication capacity, and the personnel needed to respond to public health threats; however, gaps remain in each of these areas. Regional planning among States is lacking, and many States lack "surge" capacity, i.e., the capacity to evaluate, diagnose, and treat the large numbers of patients requiring medical service during a public health emergency. Although States are developing plans for receiving and distributing medical supplies and material for mass vaccinations from the Strategic National Stockpile in the event of a public health emergency, most of these plans are not yet finalized. The U.S. Department of Health and Human Services (HHS) has not published the Federal influenza pandemic plan, and most of the State plans have not been finalized. In 2000 the GAO recommended that HHS complete the national plan for responding to an influenza pandemic, but HHS has reported that the plan is still under review. Absent such a Federal plan, key questions remain unanswered regarding the Federal role in the purchase, distribution, and administration of vaccines and antiviral drugs during a pandemic. HHS has indicated that most States continue to develop their State plans despite the absence of a Federal plan. 18 footnotes