FEATURE
“When our budget is reduced, we
accept fewer samples”
Although the majority of public health
laboratory revenue comes from fees or
state or local government outlays, the
federal contribution is critical.
Grace Kubin, PhD, head of the Texas
Department of State Health Services
(DSHS) laboratory and APHL president,
said federal funding (mostly ELC and
PHEP cooperative agreement funding)
comprises about 9% of her overall
budget. But, she said, it is “maybe 40%”
of the laboratory’s routine emergency
response budget and as much as 90% of
its emergency response funding during
a major event, such as the 2009 H1N1
influenza outbreak, a 2012 Dallas-area
West Nile virus outbreak, the 2015-17 Zika
virus outbreak in Texas and a few other
states, and Hurricane Harvey in 2017.
“All of these were supported by federal
funding, eventually,” said Kubin.
Typically, she said, federal crisis funding
follows a predictable cycle: “First, the lab
becomes overwhelmed with samples
and we start using our normal funds that
should really be earmarked for other
things to try to get that [emergency]
testing done. And it can be several months
afterward when it does hit a crisis level
that funds become available. Then federal
funds may be available for at least a year,
maybe two, and by the time you do a
no-cost extension it might cover a little bit
more than two years.”
“It’s a crutch,” she said. “It enables us to do
what we need to do. On occasion, it might
provide the flexibility to improve some
of our processes, maybe purchase more
automated equipment instead of having
to do manual work; in that regard it kind
of lives on. But if there’s not another crisis,
you’re left trying to figure out how to
continue these activities and prioritize the
most important things that have to get
done.”
Zika virus is an example of a once-novel
disease that outlasted its federal crisis
funding—just last year, two cases of the
mosquito-borne illness were reported in
Texas. Ongoing surveillance is necessary,
Kubin said, to determine what mosquito
vectors and mosquito-borne diseases are
PublicHealthLabs
@APHL
Molecular Biologist Hima Rambhatla and Microbiologist Joseph Hancock check a culture plate for the presence of virus indicating a
mosquito was carrying a vector borne disease. Photo: TX DSHS Arbovirus Lab
in the state and where. Are there Aedes
aegypti, which carry the Zika virus and are
controlled by backpack spraying close to
homes, where they tend to congregate to
be near their blood meals? Or are there
Culex mosquitos, which carry West Nile
virus and can be controlled by street
spraying, since they prefer to throng
around stagnant water?
Ironically, Hurricane Harvey, provided “a
little bit of money” to support ongoing
vector-borne disease testing through the
Hurricane Recovery Crisis cooperative
agreement. Altogether, CDC disbursed
approximately $64.5 million to nine
jurisdictions for response to hurricanes
Harvey, Irma and Maria. However, the
one-time cash infusion must be spent
down by August 2021, when a no-cost
extension is up.
“When that money goes away, if the
samples are still coming to us, we’re
going to have to figure something out,”
said Kubin. “Or else we’ll just test fewer
samples.”
APHL.org
…Anytime we have a slow
response, it means there is a source
of contamination that is still out there
causing disease.”
Denise Toney, PhD
The Texas laboratory requested ELC
“contingency” funds last year to enable
a rapid ramp-up of clinical and animal
testing in the event of a new vector-borne
disease outbreak, but was denied the full
amount requested. (It was also denied
funding to fully support routine Salmonella
whole genome sequencing.)
In Virginia, Toney has faced similar fiscal
struggles owing to categorical cuts in
the commonwealth’s ELC funding. In
addition to reducing capacity for reflex
influenza testing (to identify non-flu
respiratory pathogens), she said, “We lost
funding to support a full FTE to do non-flu
respiratory disease testing.”
Winter 2020 LAB MATTERS
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