Congress has invested tens of billions of dollars in state and local public health departments in response to the coronavirus pandemic, paying for masks, contact tracers and educational campaigns to convince people to get vaccinated.
Public health officials who have been juggling bare-bones budgets for years are happy to have the extra money. Still, they worry that it will soon dry up as the pandemic recedes, continuing a funding cycle that has plagued the U.S. public health system for decades. If budgets are cut again, they warn, this could leave the nation where it was before the coronavirus: without preparing for a health crisis.
“We need funds we can depend on year after year,” said Dr. Mysheika Roberts, the health commissioner in Columbus, Ohio.
When Roberts started in Columbus in 2006, an emergency preparedness grant was paid for more than 20 employees. When the coronavirus pandemic arrived, paid about 10. The relief money that arrived last year helped department staff increase their coronavirus response teams. While funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.
Following the end of the pandemic, public health officials across the United States fear that they will raise money from a set of sources to provide basic services to their communities, such as after the 9/11 attacks. and outbreaks of SARS and Ebola.
When the Zika virus, transmitted by mosquitoes broke South America in 2016, causing serious birth defects in babies, members of Congress disagreed on how and how much to spend in the United States for prevention efforts, such as education and mosquito reduction. The Centers for Disease Control and Prevention raised money from their efforts against Ebola and funding from the state and local health department to pay for Zika’s initial response. Congress eventually allocated $ 1.1 billion to Zika, but by then the mosquito season had passed into much of the US
“Something happens, we throw in a lot of money and, after a year or two, we go back to our tight budgets and we can’t do the minimum things we have to do every day, let alone be prepared for the upcoming 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 the emergency capacities of state and local health departments, was halved between 2003 and 2021, representing inflation, according to Trust for America’s Health, an organization for the defense and defense of public health.
Even the Federal Fund for Prevention and Public Health, which was established with the Affordable Care Act to provide $ 2 billion a year to public health, has been assaulted in cash over the past decade. If the money hadn’t been touched, local and state health departments would eventually have raised an additional $ 12.4 billion.
Several lawmakers, led by Democratic U.S. Sen. Patty Murray of Washington, seek to end the boom-bust cycle which would ultimately provide $ 4.5 billion annually in basic public health funding. Health departments perform essential government functions, such as managing water security, issuing death certificates, monitoring sexually transmitted diseases, and preparing for infectious outbreaks.
Expenditure for state public health departments fell 16% per capita from 2010 to 2019 and spending for local health departments fell 18%, KHN and The Associated Press found in a July survey. Between the 2008 and 2019 recessions, at least 38,000 public health jobs were lost at the state and local levels. Today many public health workers are hired on a temporary or part-time basis. Some pay so badly that they meet the requirements for public aid. These factors reduce the ability of departments to retain experienced people.
Grouping these losses, the coronavirus pandemic has caused an exodus of public health officials due to harassment, political pressure and exhaustion. A one-year analysis by the PA and KHN found that at least 248 leaders in state and local health departments resigned, retired or were fired between April 1, 2020 and March 31. of 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 giant influx of cash from Congress in response to the crisis as “wallpaper and curtains,” as it does not restore the fall of public health.
“I’m worried that at the end of that we’ll hire a bunch of contact tracers and then fire them soon after,” Castrucci said. “We keep going from kind of disaster to disaster without ever talking about the actual infrastructure.”
Castrucci and others say they need reliable money for high-capacity professionals, such as epidemiologists (data-based disease detectives) and for technological upgrades to help track outbreaks and get information from the public.
In Ohio, the computer system used to report cases in 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 political will. Many departments across the country have relied on fax machines to report COVID-19 cases.
During the pandemic, he found the Ohio State Auditor that nearly 96% of local health departments surveyed had problems with the state’s disease reporting system. Roberts said workers interviewing patients had to navigate several pages of questions, a significant burden when dealing with 500 cases a day.
The system was so obsolete that information could only be entered in a search box that could not be searched, and officials struggled to extract data from the system to inform the public, such as how many people who tested positive had attended a rally. Black Lives Matter, which last summer was a key question for people trying to understand whether the protests contributed to the spread of the virus.
Ohio is working on a new system, but Roberts worries that without a reliable budget, the state can’t keep it up to date either.
“You’ll have to update this,” Roberts said. “And you’ll need dollars to support it.”
In Washington, Seattle and King County Public Health Director Patty Hayes said she is always asked why there is no central place to sign up for an appointment with the vaccine. The answer comes down to money: years of underfunding left departments across the state with outdated computer systems that weren’t up to par when the coronavirus arrived.
Hayes recalls a time when his department would conduct mass vaccination drills, but that system was dismantled when the money dried up after the 9/11 specter faded.
About six years ago, an analysis found that his department was about $ 25 million less than it needed annually for basic public health work. Hayes said last year has proven to be an understatement. For example, climate change it is causing more public health problems, such as the effect on residents when fire smoke ravaged much of the Pacific Northwest in September.
Public health officials in some areas may struggle to advocate for more stable funding because a large portion of the public has questioned — and has often been openly hostile to, masked mandates — and business restrictions than health officials. public have imposed through the pandemic.
In Missouri, some county commissioners who were frustrated by public health restrictions withheld money from departments.
In Knox County, Tennessee, Mayor Glenn Jacobs narrated a video published in the fall showing a photo of health officials after referring to “sinister forces.” Later, someone spray-painted “DEAD” in the department’s office building. The health council was stripped of its powers in March and assigned an advisory role. A mayoral spokesman declined to comment on the video.
“This will change the position of public health and what we can and cannot do across the country,” said Dr. Martha Buchanan, head of the health department. “I know he’ll change it here.”
A KHN and AP investigation in December it was found that at least 24 states were drafting legislation that would limit or eliminate public health powers.
Back in Seattle, local companies have earned money and staff members for vaccination sites. Microsoft hosts a location, while Starbucks offers customer support to help them design them. Hayes is grateful, but wonders why a critical government function did not have the resources it needed during a pandemic.
If public health had secured reliable funding, its staff could have worked more effectively with the data and prepared for emerging threats in the state where the first U.S. COVID-19 case occurred. was confirmed.
“They will look back at this response to the pandemic in this country as a great example of a country’s failure to prioritize the health of its citizens, because it was not committed to public health,” he said. “That will be part of the story.”
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KHN Senior Correspondent Anna Maria Barry-Jester and Montana Correspondent Katheryn Houghton contributed to this report.
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Follow Michelle R. Smith on Twitter @MRSmithAP, Lauren Weber @LaurenWeberHP and Hannah well @hannah_recht.
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This story is a collaboration between The Associated Press and KHN (Kaiser Health News), which is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is one of the top three KFF (Kaiser Family Foundation) operational programs. KFF is a gifted non-profit organization that provides information on health issues in the nation.