By Mike M. Ahlers
Recent and proposed budget cuts at all levels of government are threatening to reverse the significant post-9/11 improvements in the nation's ability to respond to natural diseases and bioterror attacks, according to a report released Tuesday.
"We're seeing a decade's worth of progress eroding in front of our eyes," said Jeff Levi, executive director of the Trust for America's Health, which published the report with the Robert Wood Johnson Foundation.
Budget cuts already have forced state and local health departments to cut thousands of health officials, the report says. Cuts are jeopardizing the jobs of federal investigators who help states hunt down diseases, threatening the capabilities at all 10 "Level 1" state labs that conduct tests for nerve agents or chemical agents such as mustard gas, and may hurt the ability of many cities to rapidly distribute vaccines during emergencies, it says.
The "upward trajectory" of preparedness, fueled by more than $7 billion in federal grants to cities and states in the past 10 years, is leveling off, and the gains of the last decade are "at risk," the report says.
The 2011 report departs slightly in tone from the nine previous reports prepared by the two health advocacy groups. Earlier reports, while focusing on gaps in the nation's preparedness for pandemics and bioterror attacks, showed a "steady progression of improvement," said Levi.
"Our concern this year is that because of the economic crisis... we may not be as prepared today as we were a couple of years ago," he said.
Once lost, medical capabilities take time and money to rebuild, the report says.
"It would be like trying to hire and train firefighters in the middle of a fire," Levi said. "You don't do that for fire protection, and we shouldn't be doing that for public health protection."
There are few expressions of assurance or optimism in the 2011 report.
The report says:
- In the past year, 40 states and the District of Columbia have cut funds to public health.
- Since 2008, state health agencies have lost 14,910 people through layoffs or attrition; local health departments have lost 34,400.
- Federal PHEP grants - Public Health Emergency Preparedness grants - were cut 27 percent between fiscal 2005 and 2011, when adjusted for inflation.
- Some 51 cities are at risk for elimination of Cities Readiness Initiative funds, which support the rapid distribution of vaccinations and medications during emergencies.
"Two steps forward, three steps back," said Dr. F. Douglas Scutchfield of the University of Kentucky College of Public Health, in an essay accompanying the study. "As certain as the sun will rise in the east, we will experience another event that will demonstrate our inability to cope, as the resources for public health are scarce, and it will prompt the cycle of build-up, neglect, event, build-up, etc."
Federal aid to state and local governments for health preparedness peeked in 2002 at about $1.7 billion, and fell to $1.3 billion in fiscal 2012, Levi said. But the impact of cuts were masked when Congress allocated more than $8 billion in emergency funds to fight the H1N1 flu in 2009, Levi said. "Now that money is gone. And so we're seeing the real impact of these cuts," he said.
The TFAH report comes just two months after another report concluded that the United States is largely unprepared for a large-scale bioterror attack or deadly disease outbreak.
The WMD Terrorism Research Center, gave the country mostly B's and C's for its ability to handle small-scale events, such as the anthrax letter attack of 2001, and failing grades for its ability to handle large-scale events, like the global epidemic depicted in the movie "Contagion." It gave the country a "D" for its ability to develop and quickly approve medical countermeasures, such as diagnostic tools and vaccines, during outbreaks of all sizes.
Report authors said they recognize that budget constraints prevent governments from addressing all of the shortcomings in bioterror preparedness. But they recommend focusing on preparing for large-scale outbreaks, saying those preparations would automatically improve preparedness for smaller outbreaks.