In the eighth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report, 14 states scored nine or higher on 10 key indicators of public health preparedness. The scores reflect nearly ten years of progress to improve how the nation prevents, identifies, and contains new disease outbreaks and bioterrorism threats and responds to the aftermath of natural disasters in the wake of the September 11, 2001 and anthrax tragedies.  In addition, the real-world experience responding to the H1N1 flu pandemic - supported by emergency supplemental funding - also helped bring preparedness to the next level.