The Ebola outbreak in West Africa and its arrival in the U.S. placed a renewed focus on state and local public health departments' preparedness for handling infectious disease threats. But some experts say the country is far from ready for the next outbreak.
In December, Congress approved $5.4 billion in emergency funding to fight the outbreak in West Africa, with a portion of that money dedicated to preparing U.S. hospitals for domestic Ebola cases. The funding was most of what President Barack Obama had requested.
But experts say readiness efforts have been stymied by years of reduced funding. Local health departments cut about 4,400 positions in 2013, according to an April report from the National Association of County & City Health Officials. Since 2008, more than 48,000 jobs in local health departments have been eliminated through layoffs and attrition.
The cuts have left state and local health departments stretched thin to provide services such as vaccinations and HIV/AIDS education, and have limited their ability to recruit personnel who can help detect and identify disease threats. “What happens is one program has to borrow money from another program,” said Chris Aldridge, senior director for infectious disease prevention and control at NACCHO.
Concentration on an immediate disease threat, such as Ebola or influenza, also can divert resources from other programs such as tuberculosis and HIV preventive services, he added.
Public health advocates hope the recent attention on Ebola will compel local and federal officials to fund a sustained effort to rebuild the nation's public health infrastructure for improved preparedness and more rapid identification and response to public health threats. They note that when Ebola first arrived in the U.S., there was no widely available rapid diagnostic test for suspected cases.
“Unless we can continue to make a compelling case, the absence of a crisis will result in a whole degree of apathy and lack of foresight in terms of what we are going to need,” said Dr. Georges Benjamin, executive director of the American Public Health Association.
In the aftermath of the Sept. 11 terrorist attacks, Congress funded the creation of the Centers for Disease Control and Prevention's Office of Public Health Preparedness and Response, which provides grant funding to state and local health departments. Funding has fallen every year since 2006, when it peaked at more than $1 billion. It was $585 million for fiscal 2013. “Congress is going to have to look at building systems for the long term,” Benjamin said.
Despite the improving economy, 27% of state health departments reported budget cuts in 2014, with 24% expecting additional cuts this year, according to NACCHO.
“The Ebola outbreak raises attention to some serious gaps in our ability to manage disease outbreaks,” said Richard Hamburg, deputy director of Trust for America's Health, a not-for-profit public-health advocacy group.