Cuts to public health could hamper Zika preparation, response

Liz Szabo

USA TODAY

City environmental health specialists Gerardo Valdez, left, and Aaron Salazar transfer live mosquitoes caught for testing on April 14, 2016 in McAllen, Texas. City workers are catching mosquitoes and sending them to labs to test for Zika and other mosquito-borne diseases. Health departments, especially in areas along the Texas-Mexico border, are preparing for the expected arrival of the Zika virus, carried by the Aedes aegypti mosquito, which is endemic to the region. The U.S. Centers for Disease Control announced this week that Zika is the definitive cause of birth defects seen in Brazil and other countries affected by the outbreak.

Recent cuts to public health could hamper the USA's ability to fight the Zika virus, widely expected to arrive here this summer as mosquitoes begin biting.

A report released Tuesday shows the USA reduced spending on public health by hundreds of millions of dollars in the past several years. According to the report from the Trust for America's Health, a non-profit health advocacy group:

Federal funding to help states and localities prepare for disasters — from infectious disease outbreaks to hurricanes — fell 30% in the past 14 years, declining from $940 million in fiscal year 2002 to $651 million in 2016.
A federal program to help hospitals prepare for emergencies has been cut by more than half since the peak of its funding in fiscal year 2004, when it received $515 million.
The budget for the Centers for Disease Control and Prevention decreased from a high of $7.07 billion in fiscal year 2005 to $6.34 billion in 2016.

"We're not adequately funding state and local health departments," which will provide the "boots on the ground" if Zika cases are diagnosed in the USA this summer, said Richard Hamburg, interim president and CEO at the Trust for America's Health.

Money that could specifically help fight the Zika virus also evaporated. Federal funding to monitor mosquito-borne diseases fell to $9.3 million in 2013 from $23.5 million in 2006, a drop of 60%, according to a 2015 paper in Emerging Infectious Diseases.

Although that funding was designed to monitor the mosquitoes that spread West Nile virus, some of the same mosquitoes also transmit Zika. Authors of the report concluded mosquito monitoring "is inadequate in many states to rapidly detect and control outbreaks and to give the public the critical information it needs for prevention."

"Ebola was a wake-up call last year," Hamburg said. "Zika is now a reminder that an infectious disease threat anywhere is a threat everywhere."

President Obama has asked Congress to provide $1.9 billion in emergency funding for Zika. Congressional Republicans have been unwilling to provide the White House with what they call a blank check. For now, Obama has announced he will transfer $510 million of money allocated to find Ebola toward Zika preparation.

Obama's $1.9 billion Zika request: 'Slush fund,' or needed flexibility?

While a jolt of emergency funds could help, the USA would be better prepared with a steady level of higher public health funding, Hamburg said. Funding for public health tends to wax and wane with each crisis, such as the arrival of West Nile virus in 1999, the 2001 anthrax attacks and the 2014 Ebola outbreak.

"We have a long way to go before we have a system that's what we need it to be for containing outbreaks," Hamburg said. "Our tendency is to focus on the newest and most alarming threat, at the expense of maintaining a steady defense against ongoing threats."

Allowing public health spending to fall makes it hard to ramp up the response to each new threat, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.

States and localities lost nearly 20% of their public health staff from 2008 to 2014, a decline of more than 51,000 people, according to reports from the Association of State and Territorial Health Officials and the National Association of County and City Health Officials.

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"Our public health infrastructure has been depleted for so long that we've lost a lot of expertise," Hotez said. "You can't rebuild a health system in one day. It takes time and it takes expertise."

Health departments may be forced to spend money on Zika at the expense of other important services, such as responding to outbreaks of food poisoning, meningitis or vaccine-preventable diseases, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

"We probably will respond to Zika with some urgency," Osterholm said. "But just know that these other crises are going to take a back seat. The public will get what they pay for in public health."

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