feature impacts on awardees’ public health laboratories include new constraints on equipment purchase, equipment maintenance, laboratory staffing and staff training.( Between FY 2012 and FY 2014, PHEP awardees dedicated a combined average of $ 77 million each fiscal year to biological and chemical laboratory preparedness.)
• The 61 PHEP awardees reported the combined loss of over 200 full time equivalents( FTEs), and 60 % reported a negative impact on Zika preparedness and response in their jurisdictions.
Even though the $ 44.25 million in PHEP funds was later restored, the cuts will have a lasting effect. Said Rich Hamburg, MPA, executive vice president of TFAH,“ You lose capacity when there’ s unpredictability. You just can’ t rehire staff.”
As one NACCHO survey respondent commented,“ Public health depends on grants to sustain activities. If grants are cut, that activity goes away.... This puts our entire population at risk.”
Though these efforts represent a step forward, they fail to deliver support for the full range of public health threats. And public health threats are unpredictable.
Early Intervention: More Effective— and Less Costly
The importance of immediately accessible, comprehensive surge funding cannot be overstated. As the last three big public health events demonstrate, responders cannot count on the ready availability of emergency appropriations: the time between activation of CDC’ s Emergency Operations Center and Congressional appropriation of supplemental funding was just over 60 days for H1N1, about 160 days for Ebola and roughly 220 days for Zika virus.
In contrast, public health interventions tend to be more effective— and less costly— when they occur swiftly. In the absence of“ bridge funding” and easily scalable procurement systems, public health officials are left to fend for their communities the best they can when crises arise.
Already, Pentella, who until recently headed the Massachusetts Public Health Laboratory, said his staff has developed eight new Zika-related assays and tested over 4,000 potential Zika specimens.
He said,“ It’ s a lot of work, really a lot of work.... We could use some additional people and we can’ t hire them because we don’ t have the money, so it’ s just added to everyone’ s workload.... Maybe we were [ going to ] do some test development or something else beneficial to public health, but we can’ t— you have to attend to the outbreak, always. We have felt really pushed and very concerned about where the dollars are coming from.”
NEEDED: THREE-TIER FUNDING FOR PUBLIC HEALTH
Public health leaders agree that funding for their work should be nonpartisan and based on a three-tier system:
( 1) predictable, long-term funding to sustain and enhance the public health infrastructure via discretionary dollars and vehicles like PHEP grants and the Prevention and Public Health Fund
( 2) mechanisms to surge public health capacity quickly when serious threats arise, and
( 3) emergency supplemental funding to sustain surge capacity until it is no longer needed.
Senator Roy Blunt( R-MO) asked during the Zika appropriations hearings if there were a way to enable authorities to“ prevent some emergencies and be even better positioned to respond to others.” All of those interviewed for this article agree that a rapid response funding mechanism is a key part of the answer.
Said Blumenstock,“ We are having the exact same conversation and challenges today as Congress tried to address 35 years ago. The need never waned, and I would argue the demand is much greater now.”
PublicHealthLabs @ APHL APHL. org
Winter 2017 LAB MATTERS 77