With the Zika virus now spreading across South Florida and threatening the Gulf states, we are faced with another public health crisis that could potentially have been averted with stronger disease surveillance systems in the U.S. and elsewhere.
There are dozens of emerging infectious diseases like Zika simmering at any given time around the world. For reasons not entirely understood, Zika has spread swiftly into the Western Hemisphere. The disease was likely being transmitted undetected within populations in the Caribbean and South America for a period of time. It became a public health emergency only when Brazil experienced high numbers of babies born with a disorder called microcephaly that was linked to Zika infection during pregnancy.
We have the tools and expertise to stop diseases like Zika from spreading uncontrollably. But our public health system in the U.S. and those elsewhere are not adequately resourced or staffed for effective disease surveillance and response.
Like Zika, Ebola emerged and spread with little warning in 2014. Public health systems in the West African countries where the outbreak originated lacked the basic health infrastructure and personnel to identify and contain the disease. Nigeria, however, was the shining exception. When a Liberian businessman infected with Ebola traveled to Lagos, the country's public health system activated to contain the outbreak. Well-trained public health workers applied best practices in field epidemiology to trace contacts of the businessman and his caregivers, and they contained the disease before it could spread into the population.
Nigeria's textbook response to Ebola also demonstrated the vital role of accurate and timely information for disease surveillance and response. I recently spoke to African health ministers attending the African Field Epidemiology Network, or AFENet, meeting about the important role of data and informatics in field epidemiology training programs, or FETPs. AFENet, which assisted with Nigeria's Ebola response, is part of a global network of 63 FETP programs that the Task Force for Global Health supports.
The early public health response to Zika could have been more effective if data had been available about those infected with the disease. Patient health records would have been an ideal resource for this information and could have provided an early warning of the disease's presence. Most public health systems, however, do not have access to health records needed for disease surveillance. This includes the U.S., where electronic health record data—de-identified for privacy concerns—are currently not shared with state or local public health departments.
Our organization, along with our partners, is trying to bridge the digital divide between healthcare and public health, which would greatly improve our country's disease surveillance capacity. Earlier this summer, our Public Health Informatics Institute and Deloitte Consulting, with support from the Robert Wood Johnson Foundation, coordinated a visioning session with representatives from healthcare providers, health information technology, and the public health communities to begin mapping out a plan for electronic case reporting of reportable infectious diseases. If successfully implemented, such reporting will give the U.S. public health system greater power to know about and contain infectious disease outbreaks before they spread.
But a public health system can work effectively only if it has an adequately staffed workforce. By the most recent estimate, we have lost 51,000 public health positions since 2008 because of budget cuts. This represents more than 19% of the total state and local health department workforce. Today, few public health departments are adequately staffed to respond to health emergencies such as Ebola or Zika.
At the conference in Nigeria, I was surprised to see a number of finance ministers in the audience. Their presence showed me that more governments in Africa are seeing the close link between health protection and economic development. Zika and other emerging health threats will continue to be costly to these countries and the U.S. without stronger disease surveillance systems. Our challenge is persuading our own lawmakers that sustained public health investment is needed for health security.
