Congress has poured tens of billions of dollars into state and local public health departments in response to the coronavirus pandemic, pay for masks, contact tracers and education campaigns to convince people to get vaccinated.
Public health officials who have been juggling bare budgets for years are happy with the extra money. Still, they worry it will dry up quickly as the pandemic abates, continuing a funding cycle that has plagued the U.S. public health system for decades. If budgets are cut again, they warn, it could leave the country where it was before the coronavirus: unprepared for a health crisis
“We need funds that we can rely on year after year,” said Dr. Mysheika Roberts, the Columbus, Ohio, health commissioner.
When Roberts started in Columbus in 2006, an emergency scholarship was paid for more than 20 staff. By the time the coronavirus pandemic hit, it paid for about 10. Aid money that came in last year helped department staff strengthen its coronavirus response teams. While the funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.
After the pandemic is over, public health officials in the US fear they will scrape together money again from a patchwork of sources to provide basic services to their communities – much like after the September 11 attacks and the SARS and Ebola outbreaks. .
When the mosquito-borne Zika virus Torn across South America in 2016 causing severe birth defects in newborns, members of Congress disagreed on how and how much to spend in the US on prevention efforts, such as education and mosquito control. The Centers for Disease Control and Prevention raised money from their Ebola efforts and funding from state and local health departments to pay for the initial Zika response. Congress ultimately allocated $ 1.1 billion to Zika, but by then mosquito season was over in much of the US
“Something happens, we throw in a lot of money, and then in a year or two we go back to our shrunken budgets and we can’t do the minimum things that we have to do day in and day out, let alone be prepared … for the next emergency, ”said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders from more than two dozen public health departments.
Funding for public health emergency preparedness, which pays for emergency capabilities for state and local health departments, fell by about half between fiscal years 2003 and 2021, good for inflation, according to Trust for America’s Health, a public health research and advocacy organization.
Even the federal Prevention and Health FundEstablished with the Affordable Care Act to provide $ 2 billion a year for public health, cash has been demanded for the past decade. Had the money not been touched, the local and state health departments would have ended up getting an extra $ 12.4 billion.
Several lawmakers, led by Democratic US Senator Patty Murray of Washington, are trying to end the boom-bust cycle with legislation that would ultimately generate $ 4.5 billion a year in major public health funding. Health departments perform essential government functions – such as managing water safety, issuing death certificates, detecting sexually transmitted diseases, and preparing for contagious outbreaks.
Spending on state public health departments fell 16% per capita from 2010 to 2019, and spending on local health departments fell 18%, KHN and The Associated Press found in a July studyBetween the 2008 and 2019 recession, at least 38,000 public health jobs were lost at the national and local levels. Today, many public health workers are hired on a temporary or part-time basis. Some are so poorly paid that they qualify for government support. Those factors reduce the ability of departments to retain people with expertise.
In addition to those losses, the coronavirus pandemic has led to an exodus of public health officials due to intimidation, political pressure and exhaustion. A one-year analysis by the AP and the KHN found that at least 248 state and local health department leaders resigned, retired, or were fired between April 1, 2020 and March 31, 2021. Nearly 1 in 6 Americans lost a local. public health leader during the pandemic. Experts say it is the largest exodus of public health leaders in American history.
Brian Castrucci, CEO of the Beaumont Foundation, which advocates for public health, calls the massive cash influx from Congress in response to the crisis “wallpaper and drapes” because it fails to restore the crumbling foundation of public health.
“I’m concerned that at the end of this we are going to hire some contact investigators – and then fire them soon after,” said Castrucci. “We keep going from disaster to disaster without ever talking about the actual infrastructure.”
Castrucci and others say they need reliable money for highly skilled professionals such as epidemiologists – data-driven disease detectives – and for technology upgrades that can help detect outbreaks and get information to the public.
In Ohio, the computer system used to report cases to the state predates the invention of the iPhone. State officials had said for years that they wanted to upgrade it, but they lacked the money and the political will. Many departments across the country have relied on fax machines to report COVID-19 cases.
During the pandemic, the Ohio state accountant found out that nearly 96% of local health departments surveyed had problems with the state’s disease reporting system. Roberts said employees who interviewed patients had to navigate through several pages of questions, a great burden in handling 500 cases each day.
The system was so outdated that some information could only be entered into a non-searchable comment box, and officials struggled to pull data out of the system to report to the public – like how many people who tested positive, a Black Lives Matter meeting attended. , which last summer was an important question for people trying to understand whether protests contributed to the spread of the virus.
Ohio is working on a new system, but Roberts is concerned that without a reliable budget, the state will not be able to keep it up to date.
“You’ll have to upgrade that,” said Roberts. “And you need dollars for that.”
In Washington, Patty Hayes, the director of public health for Seattle and King County, said she is constantly asked why there isn’t a central place to register for a vaccination appointment. The answer comes down to money: Years of underfunding left departments across the state with outdated computer systems that couldn’t do the job when the coronavirus hit.
Hayes recalls a time when her department was conducting mass vaccination drills, but that system was dismantled when the money dried up after the 9/11 ghost disappeared.
About six years ago, an analysis found that her department was about $ 25 million less than what she needed annually for core public health work. Hayes said the past year has shown this to be an underestimate. For example climate change is raising public health concerns, such as the effect on residents when wildfire smoke engulfed much of the Pacific Northwest in September.
Public health officials in some areas may struggle to advocate for more stable funding, as much of the public is questioning – and often openly hostile to – the mask mandates and business restrictions imposed by public health officials by the pandemic.
In Missouri, some provincial commissioners frustrated with public health restrictions withheld money from the departments.
In Knox County, Tennessee, Mayor Glenn Jacobs told a video posted in the fall with a photo of health officials after referring to ‘sinister forces’. Later someone sprayed “DEATH” on the department’s office building. The Health Council was stripped of its powers in March and given an advisory role. A spokesman for the mayor’s office declined to comment on the video.
“This is going to change the position of public health and what we can and cannot do across the country,” said Dr. Martha Buchanan, the head of the health department. “I know it will change here.”
An investigation by KHN and AP in December found that at least 24 states were legislating that would limit or remove powers over public health.
Back in Seattle, local businesses raised money and staff for vaccine sites. Microsoft hosts one location, while Starbucks provided customer service expertise to help design them. Hayes is grateful, but she wonders why a critical government position during a pandemic did not have the necessary resources.
Had public health received reliable funding, its staff could have worked more effectively with the data and prepared for emerging threats in the state of the first US COVID-19 case was confirmed.
“They will look back on this response to the pandemic in this country as a prime example of a country’s failure to prioritize the health of its citizens because it failed to commit to public health,” she said. “That will be part of the story.”
KHN senior correspondent Anna Maria Barry-Jester and Montana correspondent Katheryn Houghton contributed to this report.
Follow Michelle R. Smith on Twitter @MRSmithAP, Lauren Weber @LaurenWeberHP and Hannah right @Hannah_Richard
This story is a collaboration between The Associated Press and KHN (Kaiser Health News), a national newsroom that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operational programs at KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information on health issues to the nation.