Lab Matters Winter 2020 - Page 13

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 11