health officials, worried about having resources to fight a potential
outbreak of the Zika virus in North Carolina, were heartened this month
when President Barack Obama asked Congress for $1.8 billion to combat
the spread of the potentially debilitating disease.
cuts have left state and local health departments understaffed and,
officials say, in a precariously dangerous situation if the country has
to face outbreaks of two or more infectious diseases – such as Zika,
new strains of flu or the West Nile and Ebola viruses – at the same
have been lucky,” said James Blumenstock of the Association of State
and Territorial Health Officials of states’ and localities’ ability to
contain the flu, West Nile and Ebola threats of the last five years.
only have the last major threats not been as severe as they might have
been, they have also been sequential,” Blumenstock said. “The issue is:
What if the next pandemic is not as mild as the last ones? What if more
than one of them happens at once?”
to varying degrees have cut back spending on public health since the
onset of the Great Recession in 2007. Overall state spending on public
health fell by $1.3 billion between 2008 and 2014, two health research
organizations – the Trust for America’s Health and the Robert Wood
Johnson Foundation – reported last year.
the trend didn’t end as the economy improved. Sixteen states reduced
spending between fiscal 2013 and 2015, the two organizations said in
another report. Those were the same years the nation faced Ebola,
a new outbreak of West Nile and, in 2014, widespread cases of the H3N2
with the biggest cuts over that time: California (13.3 percent),
Massachusetts (11.6 percent) and Washington (11.1 percent). Six states
– Alabama, Indiana, Kansas, North Carolina, Ohio and Washington –
cut their spending all three years.
health departments have suffered too. They lost
nearly 52,000 staff positions as a result of hiring freezes
and budget cuts between 2008 and 2014, the National Association of
County and City Health Officials reports.
steady reduction in public health funding has resulted in a progressive
erosion of manpower and the capacity to do the kind of work that would
be optimal,” said Jeff Duchin, chief medical officer in Seattle and
King County. “Quite frankly, we just don’t have the staff we need.”
MOSQUITO MONITORING SUFFERS
officials are confident they could contain an outbreak of the Zika
virus if Congress approves the president’s request for money, which
would go to eradicating the mosquitoes that spread it, research into
vaccines to inoculate people against it and public education about
albopictus, also known as Asian Tiger mosquitoes, are also capable of
spreading Zika virus. Map courtesy Centers for Disease Control and
of last week, the Centers for Disease Control and
Prevention reported 92 confirmed cases in the United States,
including the U.S. territories. In almost every case, the patients are
believed to have been infected by mosquitoes, either abroad or at home
in Puerto Rico.
mosquito that transmits the virus, the Aedes aegypti, breeds in
the United States and the rest of the Americas, and is also a carrier
of dengue, chikungunya and yellow fever. Scientists say that with
international travel and Zika outbreaks in more than two dozen Latin
American countries, it is inevitable that mosquitoes carrying Zika will surface here.
poses little threat to most people, but it is potentially very
dangerous for pregnant women. There is increasing evidence in
Brazil – which had a virulent outbreak of Zika last spring –
that the virus causes a birth defect, known as microcephaly, in which
children are born with unusually small heads and brains.
That Zika is spread mainly by mosquitoes particularly alarms health officials.
2014 report by the Council of State and Territorial
Epidemiologists found that state and local health departments are less
prepared to track and contain mosquito-borne infections than at any
time since the early 2000s, when they ramped up to deal with the first
outbreak of another mosquito-borne illness, the West Nile virus.
2004 and 2012, there was a 41 percent drop in the number of staff
working at least half time in mosquito surveillance (to detect if they
are carrying disease), according to the report. Seven states no longer
conduct mosquito surveillance.
for mosquito-borne viruses other than West Nile runs from patchy to
absent in the states, the report said. “In particular,” it said,
“public health laboratory capacity for proactive surveillance is poor
to nonexistent in most states.”
with West Nile, declining mosquito surveillance contributed to a new
spike in cases in 2012, particularly in the Dallas area, said Jeff
Engel, director of the Council of State and Territorial
Epidemiologists. “We let our guard down.”
than mosquito surveillance has suffered in the budget cuts. The
Association of State and Territorial Health Officials reports that
since 2008, 20 state health agencies have cut programs for
sexually transmitted diseases, including AIDS, and 15 have cut
has been reduced for public health activities at the same time that
public health threats are coming more often and more vigorously and
with more intensity,” Blumenstock said.
a new infectious disease such as Zika emerges, state and local health
departments face a multitude of tasks: isolating and containing the
threat, identifying people who are infected and assuring they are
treated, reporting cases to the CDC, coordinating responses with
hospitals and other agencies, performing necessary laboratory work and
educating the public and the medical community.
cope with an infectious-disease outbreak amid reduced budgets, state
and local health departments have become adept at crisis management and
deploying staff to meet the latest threat, said Joshua Sharfstein,
former Baltimore health commissioner and Maryland secretary of health.
So the public may not see the effect of the budget cuts when a crisis strikes. But public health officials do.
found responding to Ebola [in 2014] really taxed our ability to respond
to other outbreaks because we needed to pull all the staff” from other
tasks, said Sharfstein, now an associate dean at the Johns Hopkins
Bloomberg School of Public Health.
The same thing is starting to happen now across the country, Blumenstock said.
and local departments today are looking at their staff and deploying
them to deal with Zika,” he said. “But if you send an epidemiologist to
deal with Zika full time, that’s eight hours a day less that he’s doing
foodborne surveillance or HIV surveillance or flu surveillance.”
cuts result in other problems, often hidden from the public eye. They
deprive health departments of needed expertise and trained personnel,
which is difficult to replenish in a crisis. The networks of
relationships that health departments have with other agencies,
hospitals and doctors are often neglected and must be rebuilt every
time there is an emergency. All that can lead to slow response times.
The biggest fear remains that two or more dangerous and quickly spreading diseases break out simultaneously.
been lucky so far, and you don’t want to hope for a different scenario
so you can prove your point,” Blumenstock said. “But there are tipping
points, and there were times when we were close to those tipping
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