Surgeon General David Satcher says the nation needs to spend billions more to upgrade its public health system to respond to bioterrorism like the current anthrax attacks.

Satcher said Monday that the Centers for Disease Control and Prevention should increase its annual budget by "a few billion" dollars to hire trained epidemiologists and public health advisers in all 50 states.

State and local health systems also require improved laboratory facilities to test suspected chemical and biological agents, Satcher said, as well as better communications networks.

"If there's anything these bioterrorism attacks have taught us, it's that the best defense is a strong public health infrastructure," Satcher said. "The CDC has funded some good initiatives, but we need more than we have."

Speaking to reporters at a West Virginia State College conference on rural health care, Satcher acknowledged that federal health authorities have been struggling to find and treat people exposed to anthrax spores.

In the last six weeks, more than a dozen people have been confirmed as having anthrax infections. Three people, including two postal workers near Washington, D.C., have died.

"The attacks have been different than what we anticipated," said Satcher, noting no one knew that anthrax inside a sealed envelope could be inhaled. "We hope we're more ready now than we were. But until an attack comes, we can't be fully ready. We're all learning together."

Satcher cautioned against taking antibiotics, including the anthrax-fighting drug Cipro, if doctors had not specifically prescribed them. Taking Cipro unnecessarily makes the anthrax organism more resistant, he said.

Satcher also called for the elimination of disparities in health care between urban and rural areas. He said incidents of all major forms of illness, including cardiovascular disease, cancer, diabetes and infant mortality, were higher in rural areas.