Lily O. Engstrom

ily Engstrom was involved in bioterrorism years before it became a household word. In 1996, Engstrom, whose background is in health policy, was working for the Office of the Assistant Secretary for Planning and Evaluation at the Health and Human Services Department. "We were the only office in the department that was working on bioterrorism," Engstrom says, largely because it was a key interest of then-Assistant Secretary Peggy Hamburg, who was the New York City health commissioner when the World Trade Center was bombed in 1993.

As director of the Office of State and Local Preparedness at HHS's Office of the Assistant Secretary for Public Health Emergency Preparedness, Engstrom oversees programs focused on state and local preparedness for bioterrorism and other public health emergencies. She was appointed in 2002.

Since the September 11 terrorist attacks, efforts to ensure that all health care systems are ready for bioterrorist attacks have moved to the forefront. Engstrom's office spearheads cooperative agreements-which are similar to grants-with state health departments, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration to address state and local preparedness for bioterrorism.

Before September 11, HRSA had no funding for such cooperative agreements. The agency was appropriated $125 million in fiscal 2002 and $498 million in fiscal 2003 to aid hospitals and other health care entities in developing the capacity to deal with mass-casualty events. CDC had $40 million available for such agreements with state and local health departments before September 11; in fiscal 2003, the amount jumped to $870 million.

During an anthrax scare, for example, the county health department, under the auspices of CDC, would activate a plan to get health care providers to interview people who may have come in contact with the bacteria, collect testing samples, and administer antibiotics. Under the auspices of HRSA, an alert would go out to hospitals and health clinics to ensure that the proper medication was on hand and doctors and nurses were ready to respond.

"Since we are providing two streams of funding to the state public health departments, we want to ensure that these activities are harmonized and complementary," says Engstrom. In a variety of government and private-sector positions, Engstrom has developed and managed health care and research policy, managed biomedical research, and evaluated health care systems.

Richard J. Smith, director of HRSA's Health Care Emergency Preparedness Division, says Engstrom "serves a critical function in determining where efforts are targeted and funds spent. She is tireless, extremely conscientious, and she and her staff are very responsive."

A 60-year-old native of Chunking, China, Engstrom lived around the world for much of her life; her father was in the diplomatic service of the Republic of China. She moved to the United States in the 1960s and received a bachelor's degree in Russian language and literature from Vassar College in Poughkeepsie, N.Y. Engstrom earned a master's in linguistics from Georgetown University in Washington, D.C.