Local health departments brace for funding loss amid Zika standoff

Monday, May 30, 2016

Health departments in all 50 states are scrambling to make up for the combined $45 million they will lose this summer if Congress fails to address a massive federal funding shortfall fighting the Zika virus.

With Congress locked in a billion-dollar stalemate over Zika funding, the Centers for Disease Control and Prevention (CDC) will be forced to eliminate emergency public health funding from as many as 62 health districts starting in July.

The cuts would affect the nation’s largest cities and counties – Washington, D.C., Chicago, Los Angeles County and New York City – as well as already cash-strapped rural districts.

The unprecedented move would also be “paradoxical,” according to one health official: The funding that would be slashed is devoted to emergency-preparedness programs that are designed to deal with outbreaks like Zika.
The effects would be immediate and far-reaching, according to a survey this month of nearly 60 health districts that would be impacted.

About 75 percent of respondents said their district’s lab services, mosquito control or surveillance would be diminished. Another 60 percent said their supplies could be limited.

One-third of the jurisdictions said losing those CDC funds would cause staff cuts or hiring freezes, according to the survey, which was conducted by leading health groups including the National Association of County and City Health Officials and the Council of State and Territorial Epidemiologists.

Dr. Tom Frieden, who has served as director of the CDC since 2009, said in a speech this week that the public health fund was “one of the only places we could go” without more help from Congress.

“States weren’t happy about that, but we had no choice,” Frieden told a crowd in D.C. Thursday, while he was in town to press his case for Zika funding.

Frieden’s last-ditch move, which was first announced in March, has been a tough sell for local governments dreading the cutbacks.

“The CDC says, ‘OK, we cut this money because we had to. But the Zika money is not coming back to you,’” said Dr. Oscar Alleyne, senior adviser for public health for the National Association of County and City Health Officials. “It’s very difficult to translate that to state and local health departments.”

Baltimore City Health Commissioner Dr. Leanna Wen was facing cuts of about a half-million dollars because of the CDC’s move. She would have had to lay off one-third of her emergency preparedness team, until the city’s mayor agreed to make up for any lost funding, staving off the cuts.

Without that funding, Baltimore would have had just four people for all mosquito control and outreach efforts, Wen said in an interview Thursday. That work is tougher in poorer, denser neighborhoods, like those in Baltimore, where more residents lack screens and air conditioning.

But Wen said she also has to balance the countless other parts of her job competing for her attention.

“I can’t just shift people from animal control and restaurant inspections to emergency preparedness,” Wen said.

Few cities besides Baltimore and New York have made large-scale funding commitments to combat Zika.

In April,New York City Mayor Bill De Blasio announced a three-year, $21 million plan of attack against the virus. Most of that comes from city funding, with some state public health dollars through a matching program.

“We are doing all we can locally to address the issue, but we’re going to need federal help as this emerges,” De Blasio said at a press conference in April.

Public health experts say most government health agencies aren’t able to take the big steps like New York. Most departments are reeling from recent years of budget cuts and don’t have extra cash to mount a larger response to Zika without federal help.

The task is far more difficult when existing federal funding streams are being stripped away.

“The problem is, public health funding has been on the decline for year after year for the last several decades,” said Frederick Isasi, who leads health policy for the National Governor’s Association. “Public health agencies are stripped very, very thin. They have to make decisions about what they’re not doing.”

For example, Isasi said, state and local health departments have seen less and less money for mosquito control programs. Now, most districts choose to hire temporary workers instead of paying full-time workers – making Zika efforts particularly challenging.

Frieden says the CDC’s funding cuts could be averted if Congress approves all, or most, of President Obama’s $1.9 billion funding request.

Both the House and Senate have approved funding packages that fall short of Obama’s request, though the two bills are different in terms of size, timing and how they offset their costs. One is broadly bipartisan; the other faces a veto threat from the White House.

Lawmakers from both parties agreed Thursday to begin talks to merge the two bills. The CDC has said it prefers the Senate’s $1.1 billion package, which would restore funds to the local health departments. The House’s $622 million bill does not replenish the CDC’s fund.

The inflection point in Congress’ fight over Zika is how to pay for the package.

Republicans, particularly in the House, argue Congress should not approve more emergency funding – which adds to the debt – while the Obama administration still has remaining funds from its response to the Ebola virus.

Instead, fiscal hawks endorsed a $622 million plan, most of which is paid for through the administration's Ebola funding.

Officials at CDC say they can’t remember a time when Congress has refused to deliver money for a public health crisis, even if that funding isn’t immediately paid for.   

Frieden, who typically avoids politicking, was direct in his plea for Congress to urgently approve the emergency request.

He ticked off the criteria for “emergency funding” — a situation that is unexpected, catastrophic and has the capacity for permanent damage. The Zika virus, which causes birth defects, he said clearly meets all three.

"We lost time fighting Ebola because we couldn’t immediately respond rapidly," he said in a nearly hour-long speech. "I fear that we’re losing time with Zika."


Source : thehill.com