Preparedness report card spells out programs at risk for cuts

Dec 20, 2011 (CIDRAP News) – Public health programs that detect and respond to bioterror events and disease outbreaks are at risk from federal and state budget cuts, a threat that could worsen over the next year if automatic across-the-board cuts kick in, according to an annual preparedness report card released today.

The big-picture preparedness view and warning come from Trust for America's Health (TFAH), a nonprofit health advocacy group, and the Robert Wood Johnson Foundation.

The report, Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism, is the group's ninth annual assessment. Last year, the report gave states their highest-ever marks for emergency preparedness. This year the report looks at preparedness funding in different states and goes a step further by naming programs in cities and states that are at risk due to continued federal funding cuts.

Over the years, TFAH has said the nation has made significant preparedness strides since the terrorist attacks of 2001 and pointed out remaining gaps in the public health system. However, at a press telebriefing today to release to report, Jeffrey Levi, PhD, executive director of TFAH, said recent federal and state budget cuts are chipping away at the gains.

Over the past year, 40 states and Washington, D.C., have experienced cuts in state public health funds, according to the report. Of that group, 29 states and Washington, D.C., sustained cuts 2 years in a row, and 15 are in their third year of state cutbacks. "The great recession is taking its toll on response to public health threats," he said.

At the same time, federal support for state and local preparedness activities has declined 38% from fiscal year 2005 through 2012, after adjusting for inflation, according to TFAH.

Continued federal public health emergency preparedness cuts put a host of key programs at risk, according to TFAH. For example, 51 of 72 cities could be eliminated from the Cities Readiness Initiative, a program designed to speed the distribution and administration of vaccines and medications during emergencies.

In addition, cuts could wipe out funding that enables top-level chemical testing at 10 state labs, leaving the US Centers for Disease Control and Prevention (CDC) as the only public health lab with full ability to test in the event of chemical attacks or accidents.

Twenty-four states could lose the support of CDC epidemiology field officers who respond to outbreaks such as the 2009 H1N1 pandemic, according to the report.

Mel Kohn, MD, MPH, state health officer and public health director of the Oregon Health Authority, told reporters that Americans expect a high level of preparedness and response capacity.  "It's not an optional service," he told reporters.

For example, federal and state funds support the salaries of epidemiologists and lab specialists who responded quickly to an Escherichia coli outbreak linked to fresh strawberries, and strong state lab capacity meant that Oregon didn't need to rely on sending flu virus samples to the CDC during the pandemic, which helped the state get timely information to its physicians during a public health emergency.

TFAH's report contained several recommendations, which include:

  • Ensuring dedicated funds for the core capabilities of public health preparedness
  • Improving biosurveillance to rapidly detect attacks and outbreaks
  • Enhancing research, development, and production of medical countermeasures
  • Boosting mass care capabilities during public health emergencies
  • Increasing support to communities recovering from disasters
  • Coordinating food safety with other preparedness efforts through targeted implementation of the FDA Food Safety Modernization Act of 2011

Congress is currently considering reauthorizing the Pandemic and All-Hazards Preparedness Act of 2006, which Levi said would address many of TFAH's preparedness concerns. However, he said spending caps at fiscal year 2011 levels cut into the base of preparedness support, and the federal government won't be able to address TFAH's recommendations and goals without restoring the cuts.

Another looming threat is additional shortages expected from automatic cuts (sequestration) that kick in as part of the federal Budget Control Act, the results of Congressional negotiation over raising the nation's debt ceiling.

A bipartisan "super committee" of 12 lawmakers was appointed to find $1.2 trillion in debt reductions over the next 10 years, a measure that would have avoided the automatic cuts. However, in November the committee ended its deliberations, saying it couldn't meet its December deadline to have a recommendation to Congress.

Levi said if the full cuts take effect, sequestration could cut preparedness funding by as much as 10%.

The National Association of County and City Health Officials (NACCHO) today in a statement commended TFAH and the Robert Wood Johnson Foundation for drawing attention to the shrinking preparedness resources. Dr Robert Pestronk, NACCHO's executive director, said in the statement that recent threats such as a novel flu strain, natural disasters, and the global economic crisis affect all sectors of American society.

"Local health departments are part of a safety net for all people in their communities, but with a workforce already stretched thin, it's only a matter of time before the net lets the unsuspecting through," he said, adding that health departments are now "doing less with less."

See also:

Dec 20 TFAH press release

Full text of TFAH report

Dec 20 NACCHO press release

Dec 14, 2010, CIDRAP News story "Report: Bleak economy threatens state preparedness gains"

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