Public Health & the Congressional Budget Standoff

In 2002, the U.S. Congress authorized funding for public health laboratories through the Public Health Emergency Preparedness Cooperative Agreement. Administered by the U.S. Centers for Disease Control and Prevention (CDC), this Agreement has given the nation’s taxpayers a significant return on investment. To date, CDC has invested billions of taxpayer dollars in state and local public health preparedness programs and helped to achieve its institutional goal to strengthen the nation’s basic health infrastructure, expand partnerships, and enhance disease surveillance systems. However, the decline in federal funding in recent years, and several delays in approving future budgets, could continue to jeopardize the significant successes already achieved at the state and local levels.

The Role of State & Local Agencies

State and local government agencies responding to anthrax or ricin attacks and/or other emerging threats – as well as such emergencies as the SARS outbreaks and the Influenza A H1N1 pandemic – rely primarily on federal funding and technical support from CDC to mount effective responses to these difficult and unforeseeable events. To cite but one recent example, the CDC is already very busy behind the scenes preparing members of the nation’s Laboratory Response Network to respond to the emerging Middle East Respiratory Syndrome Coronavirus.

This effort does not in any way, though, lessen the continuing support from the CDC that already has enabled state and local public health laboratories to:

  • Prepare for such major and recurring national events as the Super Bowl and the Democratic and Republican National Conventions;
  • Carry out routine testing throughout the year to distinguish potentially lethal white powders from their benign “look-alikes”;
  • Detect emerging threats such as the dengue virus, SARS, and Influenza A H1N1;
  • Increase the growing number of Biosafety Level 3 facilities available, which allow scientists to work safely with biological threat agents;
  • Expand the size and capabilities of the previously mentioned Laboratory Response Network for Chemical Threat Preparedness;
  • Develop additional training courses on such esoteric topics as biosafety, the packing and shipping of infectious substances, and the detection and transfer of threat agents;
  • Plan for and help develop a growing number of nationwide healthcare competency programs and full-scale preparedness exercises;
  • Participate in a growing number of outreach programs to the nation’s first responder and sentinel clinical laboratory communities; and
  • Evaluate new assays and platforms for the rapid detection of threats.

The CDC Public Health Emergency Preparedness funding also has strengthened the entire public health laboratory infrastructure via: (a) the recruitment of highly skilled personnel; (b) the training of laboratorians to help facilitate the responses to a broad and growing spectrum of biological threats; (c) the purchase/funding of additional state-of-the-art equipment, maintenance contracts, critical reagents, and other material supplies and resources; (d) the implementation of new systems for electronic communications and data messaging; (e) the enhancement of new and innovative partnerships with private clinical, local public health, food, agricultural, environmental, military, and academic laboratories; (f) the continuity of operations planning needed to support critical testing; and (g) the expanded and improved engagement of state laboratory network partners – most notably during the 2009-2010 H1N1 pandemic when many states were able to effectively use the CDC networks during their own responses.

New Budget Cuts & Standoffs: The Dangerous Consequences

The nation’s public health laboratories are the backbone of the Laboratory Response Network, the nation’s premier network for responding to public health threats. Any funding reductions could seriously jeopardize the CDC’s ability, therefore, to continue its vital testing and surge-capacity responsibilities. To begin with, any reductions in laboratory capabilities and capacity would limit the ability of various laboratories to provide testing support for the Federal Bureau of Investigation and other law-enforcement agencies, and at the same time increase the testing burden on federal laboratories that are already stretched thin.

The very existence of laboratories that perform testing for biological and chemical threats also would be threatened, thereby limiting the nation’s overall ability to rapidly test for and respond to various acts of biological, chemical, or radiological terrorism. Additional reductions in federal funding would also:

  • Decrease the overall capability of the Laboratory Response Network chemical threat laboratories, which would be forced to either drop below a certain level of functionality or even close their facilities;
  • Limit the ability of laboratories to purchase the testing supplies and reagents needed to cope with large-scale events;
  • Increase the reporting times needed during public health emergencies, which in many cases would translate directly into unnecessary morbidity and mortality;
  • Strain existing partnerships and the communications with other non-laboratory entities;
  • Decrease the ability: (a) to work with international partners; and (b) to evaluate and work with the newer technologies now emerging;
  • Increase the difficulty both to maintain current instruments and to pay for service contracts;
  • Reduce the travel funds available for attendance at important meetings and training conferences; and
  • Limit the ability to rapidly transport samples to and from laboratories.

There are many other adverse consequences of new budget cutbacks that also must be taken into consideration. Some state public health laboratories, already reeling from existing budget reductions, would undoubtedly lose at least a few highly skilled staff members. As a result, these laboratories would experience: (a) longer response times for all-hazard threats ranging from foodborne outbreaks to acts of biological and chemical terrorism; (b) a reduced ability to provide training for and outreach to the thousands of sentinel clinical laboratories and first responder/hazmat organizations that would likely be the first in line to obtain samples during an emergency; and (c) fewer skilled response personnel available to run complex instrumentation and perform necessary analysis.

To briefly summarize, virtually all state and local health agencies throughout the nation were already feeling the effects of recent federal funding reductions. The prolonged federal shutdown earlier this month, however, increased and compounded the difficulties already encountered. With so many federal personnel furloughed, only limited technical support was immediately available to help laboratories maintain their vitally important surveillance programs and disease-detection missions. For instance, during the shutdown, one state was unable to access CDC subject matter experts for guidance confirming ricinine in a case of suspected ricin poisoning. In ricin events, ricinine is the biomarker looked for in urine.

In short, the federal funding shutdown placed a significant – and, it could reasonably be argued – unnecessary burden on all state and local health agencies throughout the nation. What is even more worrisome, though, is that the threat of yet another federal shutdown looms dangerously just over the horizon.

Chris Mangal

Chris N. Mangal, MPH, is the director of public health preparedness and response at the Association of Public Health Laboratories (APHL). The recipient of a bachelor’s degree in microbiology from the University of Florida, and of a master of public health degree from the University of South Florida, she is responsible for providing programmatic and scientific leadership for preparedness activities for APHL members, staff, and partner organizations, such as the U.S. Centers for Disease Control and Prevention (CDC). She has more than 12 years of experience working to improve laboratory practice in the detection of public health threats, and to expand and enhance the relationships between APHL member laboratories and CDC, other federal agencies, and private organizations involved in emergency preparedness and response, public health testing, policy, and training.



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