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Support of Public Labs Wanes, a Decade After Sept. 11
WASHINGTON -- Efforts to patch up the U.S. public health safety net really took off after the 9/11 attacks and the anthrax attacks that sickened 22 people and killed five when powdered anthrax spores were sent to news organizations and Capitol Hill offices (see GSN, Aug. 16).
Congress moved fast to boost laboratory capacity and stockpiles of drugs, vaccines, and other medical supplies. But 10 years later, some of that effort has slacked off even if the danger hasn’t, says Dr. Ali Khan, director of the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention.
“Since 9/11, people had really begun to understand the role of public health,” Khan told National Journal. But budgets are tight. “Since 2005 there has been approximately a 30 percent decrease in federal funding to support state and local health departments,” he said.
Khan has a commentary in a special 9/11 issue of the Lancet medical journal noting the huge boost in support to the public health system that followed the attacks, but also the damage being done by the ongoing recession. “From 2008 to 2010, more than 44,000 jobs were lost in state and local health departments, and health workers such as public health physicians and nurses, laboratory specialists, and epidemiologists were reduced,” he wrote.
“A 2009 survey found that only 37 state epidemiologists reported substantial-to-full capacity for bioterrorism emergency response -- a 10 percent decline since the peak of federal funding in 2004.”
Biological attacks may really get the attention of Congress, but the threats are relentless and include foodborne outbreaks, novel viruses such as severe acute respiratory syndrome or SARS, and new pandemics such as the 2009 H1N1 swine flu.
“Central to effective emergency response is rapid surveillance for health problems,” Dr. Thomas Farley and Dr. Isaac Weisfuse of the New York City Department of Health and Mental Hygiene wrote in a separate commentary.
“Immediately after 9/11, the department established a rudimentary emergency surveillance system with manual review of records from hospital emergency departments.” The system has grown to become comprehensive, they added.
“This system allowed the spread of novel H1N1 influenza in 2009 to be tracked, and has many other potential uses in public health, both during and between emergencies.“
Just last month, Cargill Meat Solutions recalled 36 million pounds of ground turkey that likely caused an outbreak of salmonella that killed one person and sickened at least 78 others in 26 states since March 9. The growth of a network of public health labs has allowed seemingly random outbreaks of illness to be linked and traced.
Policymakers are rethinking the whole system of regulating food safety after a series of high-profile food poisoning outbreaks—outbreaks that may not even have been noticed before the advent of systematic testing.
“Public health threats have fiscal, economic, and political ramifications,” Khan said. “Therefore it requires a federal response.” He noted that even seemingly regional events, such as the devastation caused along the Gulf Coast by Hurricane Katrina in 2005, affect the whole country. Disease outbreaks, which can spread on a single airplane ride, have global effects.
“These events are not about some local community with a little outbreak,” Khan said. “The sooner you find out about these events, invest in them, and shut them down, the better it is for the country.”
Khan said CDC will be making these points to Congress as it considers funding for the coming years.
He especially noted the Pandemic and All-Hazards Preparedness Act of 2006, which set up a structure for emergency preparedness in the Health and Human Services Department and which appropriated $824 million for fiscal year 2007 for improving state and local public health security.
“CDC’s Strategic National Stockpile increased its core formulary to support the prophylaxis of more than 50 million people to prevent anthrax, plague, or tularemia, and acquired enough smallpox vaccine to immunize every person in the USA,” Khan points out. “The stockpile also started the forward placement of life-saving antidotes for terrorist attacks with chemical or nerve agents.” This had not existed before 1999.
“Before 1999, CDC did all tests to detect and confirm the presence of biological threat agents, such as anthrax,” he added -- a slow and clunky system. Now, 150 labs can test for such biological agents.
But much more is needed, Khan says. Not only can new diseases arise naturally -- but so can synthetic microbes (see GSN, Feb. 11).
“The genomes of thousands of microbes have been sequenced and their blueprints are available for rapid sharing across the Internet along with instructions for development of chemical agents,” he wrote.
“These and other types of advanced technologies are becoming increasingly accessible and easy to use by less-skilled individuals.”