The deadly Ebola outbreak in West Africa has claimed the lives of more than 4,000 people already — and the longer it lasts and farther it spreads, the greater the risk to our health worldwide.
We know that effective public health interventions have stopped Ebola in the past, and that a properly funded and trained public health workforce can do it again. And although the public health care system in the U.S. is dramatically more advanced than those in West Africa, currently the site of the largest Ebola outbreak in history, CDC officials and lawmakers who support the agency warn that years of austerity have hobbled both the CDC and the National Institutes of Health, both in terms of their ability to combat future outbreaks and their ability to prevent them from happening in the first place.
It’s not just federal agencies that are affected, either: more than half of local health departments rely solely on federal funding for their emergency response services, which include detecting disease outbreaks, dispensing life-saving medications and providing accurate and timely information to their communities. Nationally, since 2008, we’ve seen more than 50,000 jobs eliminated from our state and local public health workforce, with many more having been furloughed.
That’s why it’s imperative that Congress prioritize funding for bedrock public health agencies and programs such as the Centers for Disease Control and Prevention, Health Resources and Services Administration, and the Prevention and Public Health Fund. Unfortunately, Congress continues to put our health in jeopardy when it fails to work together to develop and pass fully thought out annual appropriations bills.
Additionally, annual spending caps — which are further reduced by budget cuts enacted by a law known as sequestration — continue to challenge the ability of public health professionals to prevent and respond to a health emergency, or provide basic public health and preventive services. The CDC has been among those agencies hardest during the last four years of ongoing austerity, with hundreds of millions of dollars cut from its already tight budget. And a memo the CDC released on sequestration highlighted a number of areas that would suffer with less funding. At the top of the list: “Reduced ability to ensure global disease protection.”
As Brett Norman explains in Politco, “Since an infusion of preparedness funding following the Sept. 11, 2001 and anthrax attacks, a program for hospital preparations for infectious disease outbreaks and other disasters has dropped from $515 million in 2003 to $358 million last year, according to Trust For America’s Health. State and local health departments disaster preparation funds were slashed by roughly a third, from about $1 billion to $623 million, in the same period.”
Those cuts have had an alarming impact on our nation’s level of preparedness: A 2009 survey found that only 37 percent of state epidemiologists reported substantial-to-full capacity for bioterrorism emergency response — a 10 percent decline since the peak of federal funding in 2004. Similarly, advances in laboratory reporting are tempered by the reality that in 2010, nearly a quarter of state labs (24 percent) could not submit 90 percent of E. coli test results to CDC’s PulseNet database within 4 working days, compromising rapid identification of outbreaks and subsequent recalls.
There are also a number of steps we could be taking to further protect the health of the American people, but most public health agencies have been unable to do so because of budget constraints. For example, just 24 percent of state epidemiologists in the survey reported using automated cluster-detection software, a tool that enables near-real time analysis of incoming data and helps to identify outbreaks (“clusters”) based on characteristics that might otherwise escape detection. Similarly, only 31 percent of state epidemiologists reported using an outbreak management system, which supports the initial characterization, investigation, response, and containment of outbreaks through data collection and analysis.
The sooner public health professionals can detect the source and spread of diseases or other health threats and investigate their effects in the community, the more quickly they can protect the public. But states cannot adequately meet everyday needs — let alone increase efforts for emergency incidents that have potential national implications — without reliable, dedicated, or sustained federal funding. And because all responses are initially local, this limitation is the primary vulnerability to national preparedness for Ebola and other existing and emergent threats.
Until the spending caps are lifted, sequestration ends, and Congress gets back to the business of passing adequately funded appropriations bills under regular order, vital public health services will remain on the chopping block. And although Congress did manage to approve $30 million in additional funding for the CDC before they left town for the rest of their 7-week vacation (following their 5-week vacation in August), public health officials are concerned that the political support won’t last, particularly given Congressional Republicans’ long history of neglecting critical health and welfare programs.
“Public health funding kind of goes away quietly, often with too little protest and not a lot of private sector pressure, and then when something happens, everyone wonders: why aren’t we ready?” Tom Inglesby, director of the Center for Health Security at the University of Pittsburgh Medical Center, who helped brief Congress last month on Ebola, told Politico. “I do hope that as people look at the actual crisis now that we also look at how to prepare to handle it next time around, and what we need to do for the thing that is certainly just over the horizon.”
Public health is the shield that protects America from Ebola and many more threats to our individual and collective health and well-being. The dedicated scientists who work for the CDC and other federal, state, and local public health agencies are all that stand between Americans and a potentially catastrophic epidemic imported from abroad. Congress should recognize the significant cuts already made to public health and pass a true fiscal year 2015 spending bill that prioritizes these important programs and includes adequate funding for research to prepare for future threats.