January 11, 2017 - 235 days: the number of days between the request for emergency funds to address Zika and the day Congress approved the funds. During those eight months, the United States saw its first locally-acquired mosquito-borne cases, hundreds of pregnant women contracted the virus, and, sadly, the first babies were born in the United States with Zika-related birth defects.[i],[ii]
While states and locals waited for the emergency funding, the Department of Health and Human Services (HHS) was forced to redirect money from the Ebola response in Africa, from the Public Health Emergency Preparedness (PHEP) grants, and from other health priorities.
Specifically, due to the redirection of PHEP, most local health departments were forced to cut staff, training and other preparedness capabilities. These are highly skilled professionals who are not easily hired back with short-term, emergency funding—that can disappear at any time.
Unfortunately, this wasn’t a one-off, but, rather, part of a troubling pattern when it comes to public health preparedness. We normally see:
While there is no consistency, there is a significant amount of complacency. This is no way to prepare for and mitigate the damages of severe events that continually cost the country billions and kill thousands of Americans.
In December, Trust for America’s Health (TFAH) released a report, Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, which shines a light on progress and challenges in preparing for an array of public health emergencies. The report found that 26 states and Washington, D.C. scored a six or lower on 10 key indicators of preparedness.
While there has been some considerable progress – states now have excellent emergency operations coordination and public health laboratories thanks to ongoing investments from the U.S. Centers for Disease Control and Prevention (CDC), for instance – most states are not doing well enough at routine aspects, such as vaccinating against the seasonal flu.
In addition, half of states cut public health funding. The fractured response to the Zika outbreak is one example of what can happen when we cut public health funding.
For example, in response to the West Nile Outbreak from 1999-2004, many states built up their capacity to detect and control arboviruses (viruses transmitted by mosquitos and ticks). Then, from 2004-2012, there was a 61 percent decrease in the epidemiology and laboratory capacity grants used to support these surveillance functions. As a result, most jurisdictions decreased mosquito trap sites, mosquito pools tested and testing on humans. Then, when Zika hit, we had little infrastructure in place to detect and prevent a mosquito-borne outbreak. This is infrastructure and expertise we had already built, but let languish.
This is just one example of why we need to maintain investments in ongoing public health and health system preparedness and infectious disease prevention. States are simply unable to support these systems on their own, so federal investment is key. In addition to this major recommendation, TFAH outlined a number of other recommendations for policymakers and communities to help build national health security in Ready or Not:
If there is one certainty for 2017, it is that a new infectious disease, natural disaster, or manmade event—or all of the above—will impact the United States. These events pose a very real threat to our national security, health and economic stability. We cannot afford to continually cut public health funding, then scramble to replace the expertise, research and coordination that only comes with a consistent commitment to readiness.