But, they concluded that without clearer definitions of what constitutes preparedness and standards for achieving it, "the infusion of funds may not succeed in enabling the public health system to respond effectively to a future bioterrorist attack."

The report should give some reassurance to the insurance industry, which numbers a bioterrorism attack among the risks it finds difficult to quantify and price effectively.

But the study should also give some pause to members of Congress reluctant to support extension of the Terrorism Risk Insurance Act, which expires at the end of this year. Its renewal has been established as a priority for the insurance industry.

The report was prepared by the Century Foundation Working Group on Bioterrorism Preparedness with the support of the Robert Wood Foundation.

It was undertaken to gauge how much better the U.S. is prepared to deal with a public health attack in the wake of Congress' decision in the fall of 2001 to authorize expenditure of almost $3 billion to improve preparedness.

According to the report, the funding is the single largest investment in state and local public health capacities since World War II.

"While increased federal funding has improved the capacity of the public health system to respond to bioterror threats, this report underscores the need of sustained investments in public health or we risk losing the gains we've made," said Dr. Georges C. Benjamin, executive director of the American Public Health Association.

Dr. Benjamin said, "Investments in preparedness must also be made in concert with other public health goals. Strengthening the work force and rebuilding this infrastructure will enhance our ability to support an all-hazards approach to public health."