WASHINGTON — The swine flu outbreak has exposed holes in the nation's emergency-preparedness network, according to a report issued Tuesday on how well states can handle a public health disaster.

"The H1N1 outbreak has vividly revealed existing gaps in public health emergency preparedness," said Richard Hamburg, the deputy director of the Trust for America's Health, a nonpartisan public-health advocacy group, which co-authored the report with the Robert Wood Johnson Foundation.

Hamburg, who spoke on a conference call with reporters, compared what he called the nation's "Band-Aid approach" to emergency preparedness to "only funding the fire department after the fire has already started."

The report, titled "Ready or Not? Protecting the Public's Health From Disease, Disasters and Bioterrorism," found that:

• 27 states cut funds for public health from 2008 to 2009.
• 13 states have only half their share of federally subsidized anti-flu drugs to stockpile for an epidemic.
• 11 states and the District of Columbia reported that they don't have enough lab staff to work the kinds of intense 12-hours days for six to eight weeks during infectious disease outbreaks such as swine flu.

No state met all 10 of the report's indicators used to measure their levels of emergency preparedness. Seven states met nine: Arkansas, Delaware, New York, North Carolina, Oklahoma, Texas and Vermont. Montana met just three.

The report called for restoring money cut from public health budgets and improving flu-vaccine production. Other recommendations: a post-H1N1 outbreak study to reassess emergency planning and education campaigns about vaccine safety.

"We might think that things like the recent H1N1 outbreak, like Hurricane Katrina or 9/11 should be wakeup calls for politicians and key officeholders and the public," said Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness and a professor of pediatrics at Columbia University. "Unfortunately, events like that are too often more like a snooze alarm. We get aroused, we spend money and we then just drift back into a state of complacency."

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The Trust for America's Health report

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