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Funding Cuts Imperil Biothreat Response Capability, Officials Say
ANAHEIM, Calif. -- Spending reductions threaten to seriously undermine the readiness of U.S. public health agencies to limit the potentially devastating impact of disease agents spread either intentionally or by natural means, federal health officials warned on Thursday (see GSN, Feb. 16).
The 2011 film “Contagion” offered a glimpse into the potential deadly consequences of recent and anticipated cuts to public health efforts at every level of government, senior Health and Human Services officials said during a panel discussion at the 2012 Public Health Preparedness Summit.
The fictional portrayal of steps to contain and vaccinate against a highly lethal and communicable virus portrays a “completely ludicrous” level of incompetence among state and local public health authorities, said Nicole Lurie, Health and Human Services assistant secretary for preparedness and response.
Those officials, she said, failed to understand even the basic properties of infectious diseases. In one segment of the film, state personnel in Minnesota deliberated over the budgetary impact of containment measures even after the naturally occurring agent’s threat to human life had become evident.
“If we keep cutting the budget to state and local public health, that is what the public health will look like in the future,” Lurie said.
Public health preparedness initiatives map out contingencies, organize practice drills and design treatment distribution schemes with the aim of providing authorities “clear roles and responsibilities” and understanding of “what capabilities exist and how to use them during a crisis,” according to a report issued in December by the independent Trust for America’s Health and Robert Wood Johnson Foundation. Such efforts also focus on providing aid to disease specialists, research facilities and detection infrastructure, the document states.
Economic turmoil in recent years has led to revenue shortfalls at every level of government. The constraints, coupled with a political push to contain federal deficit spending, have prompted policy-makers to place public health funding on the chopping block alongside numerous other programs.
Last year saw public health spending cuts in Washington, D.C. and 40 states. Meanwhile, state and local governments have eliminated 49,310 public health jobs over the last four years, the independent analysis notes.
Further cuts could be on the way. The Obama administration’s fiscal 2013 budget request for Health and Human Services would provide $641.9 million in state and local readiness funds -- $15.5 million less than in the current fiscal year -- for the HHS Centers for Disease Control and Prevention to disperse through grants, contracts and other methods.
In addition, the proposal would set aside $47 million less than the fiscal 2012 appropriation for the Strategic National Stockpile of countermeasures against biological and other potential WMD agents. The stockpile would receive a $486 million appropriation in the budget cycle that begins on Oct. 1.
The sequestration provision of the 2011 Budget Control Act could force additional medical preparedness spending reductions if lawmakers fail to negotiate an alternative.
Despite being “refreshingly realistic” for its genre, Contagion relied to a disheartening extent on the role of a single CDC Epidemic Intelligence Service officer played by actress Kate Winslet, said Ali Khan, who heads the CDC Public Health Preparedness and Response Office. The character organizes a triage center and struggles to negotiate with Minnesota state officials over response measures prior to her own death from infection by the fictional disease.
“There were apparently, like, three people who ran the whole agency,” but reality could increasingly reflect that scarcity of personnel amid tightening budgetary pressures, Khan said.
“We’ve lost 50,000 public health workers since 2008 in our communities,” he said. “We’ve also lost over 25 percent of money that the federal government provides for ensuring our nation’s health security. So maybe you aren’t too far off from what the response of the future would look like if we continue to allow this erosion in public health and ensuring our nation’s health security.”
A top White House national security staffer acknowledged that further financial constraints could be unavoidable, and said federal Homeland Security and public health grant programs would increasingly consider how neighboring localities might be able to pool resources.
“The fiscal challenges as they are, it is ever increasingly more likely that not every jurisdiction will be able to build the same capability across the nation, and so how do we assess where capability is most needed? How do we best assess where we can get it from? And how do we best assess how we put it together?” said Brian Kamoie, the White House National Security Staff’s senior preparedness policy director.
Preserving public health readiness gains achieved over the last decade requires “being more creative in mixing and matching our respective capabilities and working across disciplines and working across departments and agencies,” Kamoie said earlier.
Separately, one panel participant noted that a Homeland Security official portrayed in the film questions whether the virus might “have been the work of a terrorist.”
“It’s a very appropriate question and it’s one that [Homeland Security Secretary Janet Napolitano] routinely asks when it comes to emerging infectious disease,” Homeland Security Assistant Secretary for Health Affairs Alexander Garza said.
The film draws attention to a significant split between U.S. preparations for a biological catastrophe with “national security” implications and federal plans for other public health emergencies, and the uncertain “tipping point” dividing the two categories, Garza said. Naming one example of the distinction’s potential impact, he suggested a national security event might preclude real-life use of the “lottery” vaccine distribution system portrayed in the film.
Under such a scenario, “is a vaccine now considered a strategic national asset instead of a public health asset?” the official asked, hinting that personnel deemed critical to a response effort could receive priority as a vaccination is distributed. “I have to question whether a plan of random immunizations is even practical or prudent.”
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