Yesterday the New York Times editorial board highlighted an urgent homeland security threat. I am not pointing to their second piece, Chemical Plants Could be More Safe. While undoubtedly a real risk, as far as we know there is no actionable intelligence on plans to attack US chemical facilities.
Tuesday’s lead editorial in the Times is entitled, “States in Distress.” It outlines consequences of $143 billion in state budget cuts. In twenty-one States public health funding has been among the biggest losers.
There is actionable intelligence, known vulnerabilities, a specific threat sequence, and potentially ominous consequences for an Autumn pandemic. Despite this we are accelerating a process of public health disarmament.
The Illinois public health budget has been cut 25 percent and further cuts are threatened. At one point in late July the Illinois budget had zeroed out funding for infectious disease surveillance. Heroic last minute efforts restored the money, but there is still a huge budget deficit to close and the public health budget is still at risk.
In Sacramento County, California the public health department’s budget has been reduced from $9.8 million in 2007-2008 to $5.1 million this year. The number of county public health positions has been reduced by one-fourth. More cuts are possible as the County attempts to adjust to reduced State funding.
On July 27 the Chief Justice of the West Virginia Supreme Court noted in a judgment against the State’s Department of Health and Human Resources, “I conclude that DHHR’s ability to adequately comply herein with its legal obligation was caused not by any desire of a DHHR employee or administrator to do so, nor by the best efforts of DHHR employees and administrators, but rather by the continuing lack of requisite resources which DHHR receives to meet its mission. There is only so much that dedicated DHHR personnel can accomplish without adequate resources. I am deeply troubled and concerned about this continuing resource problem _ a problem which I sense may be worsening and may be becoming systemic.”
The same could be said for a whole host of public health departments and functions across the United States. Committed professionals are doing their best with less and less. But budget reductions, staff cuts, and distraction undermine the fundamental capacity of even the most dedicated professional organization.
Yesterday Secretary Napolitano highlighted the lag-time and increased vulnerability between the beginning of school — late this month — and the hoped-for availability of an H1N1 vaccine in mid-October. Yesterday news reports suggested a possible pattern of H1N1 resistance to Tamiflu in Southern Texas. (See possible correction from CIDRAP). Yesterday other news reports seemed to confirm that H1N1 had evolved a resistance to Relenza.
Perhaps H1N1 will ultimately prove to be no more than a tweak of the seasonal flu. It could also be considerably worse. We don’t know. There is no way to be certain. But H1N1 is not the only threat requiring ongoing care by public health professionals.
Precisely because of the uncertainty, this is the time to reinforce our front lines of surveillance and defense. Instead we are reducing our troop levels, withdrawing our artillery, grounding our planes, and moving our ships into drydock.
Public Health and Medical Responses to the 1957-58 Influenza Pandemic (UPMC-Center for Biosecurity)