We have all seen thriller movies that show societies scrambling to react to a deadly disease outbreak, but a recent report from the Trust for America’s Health suggests that there may be some truth behind these frightening cinematic scenarios. According to UPI, the report asserts that less than half of U.S. states received a passing score on key indicators for detecting and responding to deadly outbreaks.

The study found that 28 states and the District of Columbia were ill prepared to react to highly infectious diseases, or “superbugs,” that are resistant to most commonly used antibiotics. These states would also likely struggle in addressing outbreaks in hospitals, food-borne illnesses, influenza, and highly contagious diseases like the Middle East Respiratory Syndrome.

According to Dr. Jeffrey Levi, the executive director for the Trust for America’s Health, the current pace of antibiotic use and the lack of widespread vaccinations have left the people of the country at a high risk for an outbreak of an infectious disease. The study found that when a clear disease threat is present, the health system is more ready to respond to an outbreak. When there are no clear threats, however, health professionals become complacent and fail to focus on constant preparedness.

The study ranked each of the 50 states based on their score on a list of 10 indicators of preventive measures and methods. These included funding for public heath initiatives, rate of vaccination for the flu, childhood vaccination requirements, HIV and AIDs monitoring, needle exchange programs, climate change and its effect on certain infectious diseases, bloodstream infections associated with the central line, the availability of pubic health research facilities with biosafety professionals on site, training for clinical laboratories, and attention to food safety.

The highest score of any state was eight passing grades out of ten, achieved by Delaware, Kentucky, Maine, New York and Virginia. Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah all scored just three out of ten on the scale.

According to Paul Keuhnert, a director from the Robert Wood Johnson Foundation, “We need to reboot our approach so we support the health of every community by being ready when new infectious threats emerge.”

A press release from the Trust for America’s Health outlining the details of the report can be found here.