We’re not prepared for the next public health emergency

March 27, 2018

This post was originally published on August 21, 2017 in The Hill.

From Ebola to Zika to the opioid epidemic, health departments and the healthcare system, now more than ever, must be able to work 24/7 to detect, prevent and contain multiple crises — often at the same time.

Unfortunately, because of a consistent lack of funding, this life-saving work can come at the expense of addressing the day-to-day health needs — from obesity to diabetes to lead poisoning to vaccinations — of their communities.

In reality, public health has faced brutal cuts over the past decade, which has made Americans less healthy and safe.

The House Appropriations Committee recently approved its Labor, Health and Education appropriations bill for fiscal year 2018 in a party line vote.  And, while the Senate Labor-HHS-Education Appropriations Subcommittee has not yet publicly released its bill, there are some hopeful signs in the House version.

For instance, the House bill preserves current funding for the Hospital Preparedness Program (HPP), and provides an increase of about $20 million to the Public Health Emergency Preparedness Program (PHEP). These two programs are the only sources of federal funding that specifically benefit the readiness of our nation’s healthcare system and state and local health departments, respectively.

The bill also includes funding increases to develop and manage stockpiles of medical countermeasures — the drugs, devices and vaccines that are needed to prevent and treat emerging health threats. These public-private partnership are critical to ensuring continued innovation for products that may not be profitable or otherwise have a ready customer. Some of these countermeasures have been deployed in response to the Zika virus, the H1N1 flu outbreak and Superstorm Sandy.

While some of this increased funding comes as a pleasant surprise, key preparedness programs remain chronically underfunded. The PHEP and HPP programs are now funded at 30 percent and 50 percent, respectively, below their peak funding levels over a decade ago.

This House bill also does little to create a realistic public health emergency response fund, a standing pot of money to meet the immediate needs of a public health crisis. We saw how long it took to get emergency funds to respond to Zika, Ebola and Hurricane Sandy, with each event taking longer and longer to help these communities respond to devastating disasters.

Instead of creating this emergency fund, the House bill expands transfer authority within the Department of Health and Human Services (HHS) to support an emergency response, but with little clarity on the how this authority would work. In reality, it appears this would just move money from existing HHS programs, thereby taking resources away from other ongoing lifesaving efforts. And, in actuality, the funds would still likely be inadequate to respond to a major health emergency.

At the same time, key programs that build our public health defenses remain vulnerable.  For example, the House bill includes a $50 million cut to the Centers for Disease Control and Prevention’s (CDC) immunization program, which continues to be integral to supporting state vaccine infrastructure. This program also the main source of funding for states to respond to outbreaks of vaccine-preventable diseases, like measles.

Further, the House funding bill cuts CDC’s programs to combat emerging and zoonotic infectious diseases and environmental health threats, which help states and communities detect, prepare for and respond to a range of emerging health threats such as Zika, dengue, drug-resistant bugs, and exposures to harmful substances like bio weapons.

The budget process is far from over, and many of these budget lines can be changed. However, if these cuts are preserved for this fiscal year and the administration follows through on intentions to further reduce public health funding, our nation’s ability to respond to future public health emergencies will be severely hampered.

Within this budget cycle, it is up to the House and Senate to negotiate an even better deal for our public health preparedness infrastructure, and the health of all Americans.