Cuts in federal funding threaten public health emergency response

January 19, 2012
by Charles Taylor
County News

Bay County, Mich.’s health department was able to vaccinate only 10 percent of its population during the H1N1 flu pandemic of 2009. The effort took nearly its entire staff working overtime for six weeks, according to Barbara MacGregor, the county’s health director.

“Let’s say the pandemic was worse,” she said. “Let’s say it was a more virulent strain of influenza, and the demand was such that we had to vaccinate a far greater percentage, it would have been very difficult.”Three years later, it might pose even more of a challenge as counties find their funding to detect and respond to disease outbreaks and other public health emergencies, at risk because of federal and state budget cuts.

That was the takeaway from the report, Ready or Not? Protecting the Public from Diseases, and Bioterrorismreleased recently by the Trust for America's Health (TFAH) and The Robert Wood Johnson Foundation (RWJF). It found that after years of progress following the Sept. 11 and anthrax attacks of more than 10 years ago, health departments are losing ground.

“Some of the most elementary capabilities, including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas are experiencing cuts in every state across the country,” said Jeff Levi, executive director of TFAH. He said a number of programs that help detect and respond to bioterrorism and other health emergencies are “at risk for major cuts or elimination.”

The report usually assesses states’ preparedness. But this year, it focused on the future, he said. It projects, instead, how past and proposed budget cuts and funding levels will affect state and local governments’ ability to prepare and respond.

 “While we don’t know precisely how the federal government will implement some of these budget cuts,” he said, “we do know from our analysis of budget documents and other sources that the fiscal ’12 cuts and the potential fiscal ’13 sequestration will impact every state in the nation in one way or another.” The sequestration is the automatic cuts that will take effect because of the failure of the congressional so-called supercommittee to agree on cuts to the federal budget.

Bobby Pestronk, executive director of the National Association of County and City Health Officials (NACCHO), said there’s been a loss of about one-third of the funding that was initially made available to public health departments since 2005. “Local health departments are part of a safety net for all people in their communities...it’s only a matter of time before the net lets the unsuspecting through,” he warned.

Bay County Health Department’s (BCHD) workforce is now 20 percent smaller than it was during the H1N1 pandemic and 40 percent smaller than it was six years ago. The department’s budget has shrunk by 10 percent since 2010, and it expects more cuts this fiscal year, MacGregor said.

BCHD received more than $360,000 in FY09–10 for pandemic influenza response, funding that has since been eliminated, MacGregor said. Yet, the Centers for Disease Control and Prevention expect state and local health departments to continue to maintain pandemic response plans, exercises and surveillance activities. 

“It is my opinion that federal public health emergency preparedness funding is reactive and incident-dependent rather than being proactive and focused on surveillance, education, training and exercising,” she said. However, her beef isn’t with CDC, but rather with the Congress that funds the agency.

Los Angeles County lost about $2 million in CDC public health preparedness funding last year, placing “public health protective capabilities” at risk, according to Alonzo Plough, director of emergency preparedness and response for the L.A. County Department of Public Health. “And in some counties, not only does it put them at risk, it is already causing some of those counties to have to really step back, dismantle programs.”

In an article included in the TFAH report, Plough, a TFAH board member and former health director for King County, Wash., wrote: “[T]here is a logic of preparedness and response that operates inside the Beltway that is sometimes divorced from what has been accomplished by and what would happen in the rest of the country during a [weapons of mass destruction] attack.”

“I stand by that,” he told County News in an interview.

He said legislation that helps fund local public health preparedness is up for reauthorization in Congress. The Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 amends the Public Health Service Act to revise and reauthorize appropriations for public health preparedness activities, including activities such as state and local public health preparedness and response, improving hospital surge capacity and expanding CDC’s capacity to respond effectively to bioterrorism and other public health emergencies.

“It’s very important, particularly for your target audience, county officials, to be very vocal in that reauthorization process — to see if there could be some restoration of funding for public health emergency preparedness as that bill is reauthorized,” Plough said.

Otherwise, the consequences could be dire, according to Bay County’s MacGregor. “One would think after Hurricane Katrina, we would have learned our lesson about ignoring our vulnerabilities,” she said. “Do we have to wait until another disaster occurs before this is understood?  Unfortunately, I believe the answer is yes.”

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