Trust for America's Health released a study that ranks Iowa, Alabama, Alaska and New Hampshire as the least prepared for bioterrorism and pandemics.
These states met two of ten preparation goals. Delaware, South Carolina and Virginia ranked the highest with eight.
Dr. Shelley Hearne is executive director of Trust for America's Health. She tells CBS News "four years after 9/11, the lessons of anthrax, SARS, and now most recently, [Hurricane] Katrina, we are still not prepared when it comes to a major health emergency.
"We still have not paid serious attention and it's time to roll up our sleeves and get the job done."
Among the report's criticisms are that many states are unprepared to distribute vaccines in an emergency; that hospitals can't handle surges of critically sick people; and that there are insufficient labs to test for germs.
There have been some improvements to the national health care system. Dr. Hearne says, "we have more laboratories, we have more health detectives on the beat, we have communications that link our CDC with our state health officials. But it's been baby steps. WE have to be in a full, outright sprint here because we don't know what the next disaster will be."
Trust for America's Health is a nonpartisan group that uses grant money from the Robert Wood Johnson Foundation and other foundations.