Congress shed tens of billions of dollars in state and local public health departments in response to coronavirus pandemic, paying for masks, contact tracers and education campaigns to persuade people to get vaccinated.
Public health officials who have been juggling empty-handed budgets for years are happy to have the extra money. However, they worry that it will soon dry up with the withdrawal of the pandemic, continuing a funding cycle that has plagued the US public health system for decades. If budgets are cut again, they warn, this could leave the nation where it was before the coronavirus: unprepared for a health crisis.
“We need funding that we can depend on every year,” said Dr. Mysheika Roberts, health commissioner in Columbus, Ohio.
When Roberts started in Columbus in 2006, an emergency preparedness grant was paid for more than 20 employees. Until the coronavirus pandemic hit, paid for about 10. The aid money that came in last year helped department staff pick up their coronavirus response teams. While funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.
After the pandemic ends, US public health officials fear they will return to raising money from a package of sources to provide basic services to their communities – just 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 newborns, members of Congress could not agree on how much and how much to spend in the US for prevention efforts, such as education and mosquito reduction. The Centers for Disease Control and Prevention took money from its Ebola efforts and funding from state and local health departments to pay for Zika’s initial response. Congress eventually allocated $ 1.1 billion to Zika, but by then, the mosquito season had largely passed through the United States
“Something is happening, we throw away a lot of money and then in a year or two we go back to our low budgets and we can’t do the minimum things we have to do every day, not to mention preparing for the next situation. urgency, ”said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents the leaders of more than two dozen public health departments.
Funding for emergency preparedness in the field of public health, which pays for emergency capacity for state and local health departments, fell by about half between fiscal years 2003 and 2021, representing inflation, according to the Trust for America’s Health., a public health research and advocacy organization.
Even the Federal Fund for Prevention and Public Health, which was established by the Affordable Care Act to provide $ 2 billion a year for public health, has been cashed in over the past decade. If the money had not been reached, the local and state health departments would eventually have raised another $ 12.4 billion.
Several lawmakers, led by US Democratic Sen. Patty Murray in Washington, seek to end cycle of boom-bust with legislation which would ultimately provide $ 4.5 billion annually in basic public health funds. Health departments perform key government functions – such as managing water safety, issuing death certificates, tracking sexually transmitted diseases and preparing for outbreaks.
Expenditures for state public health departments fell by 16% per capita from 2010 to 2019, and expenditures for local health departments fell by 18%, KHN and The Associated Press found in a July survey. At least 38,000 public health jobs were lost at local and state level between the 2008 and 2019 recessions. Today, many public health workers are temporarily or part-time employed. Some are paid so poorly that they qualify for public aid. These factors reduce the ability of departments to retain experienced people.
Worsening these losses, the coronavirus pandemic 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 of state and local health departments 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 giant cash flow of Congress in response to the “wallpaper and curtains” crisis because it does not restore the collapsed public health foundation.
“I’m worried at the end of this that we’ll hire a bunch of contact tracers – and then we’ll fire them soon after,” Castrucci said. “We continue to move from one disaster to another without ever talking about real infrastructure.”
Castrucci and others say they need reliable money for highly qualified professionals, such as epidemiologists – detectives of data-driven diseases – and for technological improvements that would help track outbreaks and obtain information from the public.
In Ohio, the computer system used to report cases to the state predates the invention of the iPhone. State officials have said for years that they want to update it, but they lacked the money and political will. Many departments across the country relied on fax machines to report COVID-19 cases.
During the pandemic, the Ohio state auditor found that almost 96% of the local health departments he studied had problems with the state’s disease reporting system. Roberts said workers interviewing patients had to navigate multiple pages of questions, a major burden when dealing with 500 cases a day.
The system was so outdated that some information could only be entered into a searchable comment box, and officials struggled to extract data from the system to report to the public – such as how many people tested positive. attended a Black Lives Matter rally, 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 will not be able to update it.
“You’ll have to upgrade,” Roberts said. “And you’ll need dollars to support that.”
In Washington, Patty Hayes, director of public health for Seattle and King County, said she is constantly asked why there is no central place to register for a vaccination program. The answer comes down to money: Years of underfunding left departments across the state with old computer systems that were out of reach when it hit the coronavirus.
Hayes remembers a time when her department would perform mass vaccination drills, but this system was dismantled when the money dried up after the 9/11 spectrum disappeared.
About six years ago, an analysis found that her department was about $ 25 million in addition to what it needed annually for basic public health work. Hayes said last year it was an understatement. For example, climate change causes several public health problems, such as the effect on residents when the smoke from the fire covered much of the Pacific Northwest in September.
Public health officials in some areas may struggle to support more stable funding, as much of the public has questioned – and has often been openly hostile to – the masked mandates and business restrictions that officials in public health imposed them by 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 told a video posted in the fall, which showed a photo of health officials after referring to “sinister forces”. Later, someone painted the “DEATH” spray on the department’s office building. The Health Committee was disbanded in March and given an advisory role. A city hall 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’s going to change it here.”
A KHN and AP investigation in December found that at least 24 states are drafting legislation to limit or eliminate public health powers.
Back in Seattle, locally based companies earned money and staff members for vaccination sites. Microsoft is hosting a single location, while Starbucks has provided customer service expertise to help design them. Hayes is grateful, but wonders why a critical government function did not have the necessary resources during a pandemic.
If public health had obtained reliable funding, its staff could have worked more efficiently with the data and prepared for emerging threats in the state where the first US COVID-19 case has been confirmed.
“They will look back at this response to this country’s pandemic as an excellent example of a country’s failure to prioritize the health of its citizens because it has not engaged in public health,” she 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 the report.
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Follow Michelle R. Smith on Twitter @MRSmithAP, Lauren Weber @LaurenWeberHP and Hannah right @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 the survey, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is a gifted nonprofit organization that provides information on health issues to the nation.