This post was originally published on February 23, 2016 in The Hill Congress blog.
Earlier this month the president outlined a request for $1.8 billion to prepare for and respond to the emergence of Zika virus at home and abroad. This request includes funding for vaccine development, targeted efforts to control the mosquito populations, the development of training and communications programs, and efforts to contain its spread internationally. This request should be funded. Not because it is the best way to combat emerging infectious diseases, but because we have painted ourselves into a corner with shortsighted preparedness investments, and this is the only option available to reduce further harm.
We recently published an article in the Journal of Business Continuity and Emergency Planning describing the relationship between emergency funding (in this case, for Ebola), and the need for stronger baseline preparedness funding for health and medical responders. In that article we noted that emergency funding is only useful to expand the existing capabilities of our response systems, and that sustaining effective readiness requires stable, long-term investment. We also point out that funding to state and local public health preparedness programs has been reduced by more than a third since peak levels in 2003. Additionally funding for hospital and health system emergency preparedness funding has been cut by more than half. The president’s recent budget request for FY 2017 shows little promise of improving the situation, as the budget sustains funding at these reduced levels for the next fiscal year.
Many of the capabilities that we cite in our article as eroding due to reduced preparedness funding, such as laboratory and disease investigation capacity, are the very capabilities that are now the focus of emergency funding for Zika virus, as they were for Ebola. Each time we are confronted with a new threat, temporary funding becomes a windfall for contractors who can fulfill the temporary need, because health departments cannot hire full time staff or build resilient response systems with disease specific, temporary funding sources. Emergency funding also gives politicians an opportunity to pat themselves on the back for taking action in response to these threats and for saving lives that should never have been in danger to begin with.
We will always need some emergency funding for diseases threats, and that is reasonable. In this case we need to understand more about Zika virus. The link between Zika exposure and the microcephaly birth defect, as well as the potential link between the virus and Guillain-Barre syndrome, is not fully established or understood. We don’t have viable treatments or vaccines, and even the ability to test for the virus is limited to the short period of time that it is active in the blood stream. These are specific to the disease and justifiable to require emergency funding. Disease investigation, developing trainings and risk communication strategies as well as some degree of controlling mosquito populations should already be part of the public health preparedness toolkit and staffed by an adequate number of professionals. These capabilities are required in nearly every response and should already be funded. But they are not, and so we need all of the categorical funding we can get, including this emergency appropriation for the Zika outbreak.
Unfortunately, this recurring cycle of emergency funding for each new event is necessary because we continue to fail to learn the lessons of prior events, and to make real investments that will reduce the cost of emergency funding and the frequency in which we need it. Responding to disasters is exciting and politically attractive, preventing them is not. As a consequence it costs us more to repeat the same mistakes, and more lives are at risk because it is easier fund and provide leadership for emergency response than emergency preparedness.