The findings aren't unique to Alabama. No state or U.S. territory analyzed in the federal report received good marks across the board.
Kelly Stevens, director of planning for the Alabama Department of Public Health Center for Emergency Preparedness, said the state is better prepared than it was two years ago.
The weaknesses are being addressed, she said.
"If you average everything together, we're really in the top 10 percent of preparedness," Stevens said. "Different sections of the plan may have some gaps in them and some do and we acknowledge that."
Several categories showed no gaps, she noted.
On Wednesday, Alabama officials identified two probable cases of swine flu at an elementary school in Madison, leading to the temporary closure of the county's schools. State officials reported a third possible case Thursday evening.
The study found weaknesses in the state's plan for closing schools in the case of a pandemic.
The study found overall most states left that responsibility to local boards of education and local governing bodies. Lack of a coordinated response could hamper a state's ability to stop the spread of the virus, the study found.
Stevens, who mostly answered questions pertaining to the Department of Public Health, referred those questions to the state Education Department. Attempts to reach the Education Department on Thursday were unsuccessful.
Another finding in the report said Alabama's plan has major gaps in managing mass fatalities that could result from an outbreak. It said the state had not developed a system for processing death certificates on the Web. The state also had no system in place to educate people to expect death at home, not in a hospital. Nor does the state have a system for public messages to address stress management, the report found.
Stevens said the state Health Department has worked since January to improve the plan for managing large numbers of deaths. She said the department held 11 conferences across the state on this subject that included funeral home directors, the coroners' association, 911 and hospitals.
"We do have a fatality management plan that is at the county level now," Stevens said.
The state also received low marks on making sure it has the ability to communicate with the public during an outbreak. The federal government found the state did not have enough "redundant" communications in place in case primary communications are unavailable. Federal evaluators asked for more evidence to decide whether the state's plan to send messages in different languages would work as designed. The state did not provide some information requested by the government, according to the report.
Stevens said the Health Department is working on it.
"Again the work that has been done was very beneficial already in our response to this…and it will only improve because the work that's been done," she said.
The state did receive ratings of "no major gaps" in several categories, including all seven categories dealing with critical infrastructure and key state resources, a level achieved by only nine other states.
The state also had no identified major gaps in acquiring and distributing anti-viral drugs and medical supplies, ensuring mass vaccinations and providing healthcare.
Other reported gaps included:
• Most states had major gaps in sustaining operations of state agencies and protecting government workers during an outbreak.
• The state had a few major gaps adding the Alabama National Guard into its pandemic planning.
• Alabama's plan had a few major gaps for sustaining its transportation systems; some of the state's responses said the state Transportation Department had no role in outbreak planning functions.
"What we realize is that the different stage agencies are intermingled with some of these responsibilities so they are now working," Stevens said. "The Public Service Commission is working to get that. We realize we can not plan in silos. We need to plan together."
• The plan showed gaps in reducing the impact of the flu on workers in the state.
• There were gaps integrating EMS and 911 and dispatch centers into the plan. Stevens said, "They are on-board. They have been planning and… we're actually using their plans now."
• The assessment found a few major gaps in public safety and law enforcement's role in the plan.
"Every bit of planning that has been done has really already benefited us in this response to swine flu," Stevens said. "We are working very closely with EMA and all of our state agencies. We are in constant contact with them. Really, it's just working."
Todd Stacy, press secretary for Gov. Bob Riley, said much of what the report found stemmed from incomplete information or technical problems. He said the report "doesn't necessarily condemn Alabama's response plan."
"Alabama's … response plan has been rehearsed, tested and proven to be effective," Stacy said. "In just the last few days, we've seen officials from Public Health, the state Department of Education and local superintendents work seamlessly together in responding to a real-life situation in North Alabama. The proof of our plan's effectiveness is in the performance of the people on the ground."
Officials with the U.S. Department of Health and Human Services, which participated in reviewing Alabama's plan, said every state's plan could use improvement.
Matt Minson, senior medical officer for strategic initiatives with the Assistant Secretary for Preparedness and Response, said, "I don't think one can compare a state against another state."
"What I do think is legitimate is that different states have different needs and different considerations and frankly I think that was reflected in the plans," he said.
The current outbreak will provide a wealth of information about crafting flu plans in the future, he said.
"I think it would probably be somewhat distracting to talk about the plan when we're dealing with the event," Minson said.