Billions spent on coronavirus fight, but what is next?
Congress has poured tens of billions of dollars into state and local public health departments in response to the coronavirus pandemic, paying for masks, contact tracers and education campaigns to persuade people to get vaccinated.
Public health officials who have juggled bare-bones budgets for years are happy to have the additional money. Yet they worry it will soon dry up as the pandemic recedes, continuing a boom-bust funding cycle that has plagued the U.S. public health system for decades. If budgets are slashed again, they warn, that could leave the nation where it was before the coronavirus: unprepared for a health crisis.
"We need funds that we can depend on year after year," said Dr. Mysheika Roberts, the health commissioner of Columbus, Ohio.
When Roberts started in Columbus in 2006, an emergency preparedness grant paid for more than 20 staffers. By the time the coronavirus pandemic hit, it paid for about 10. Relief money that came through last year helped the department staff up its coronavirus response teams. While the funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.
After the pandemic is over, public health officials across the U.S. fear, they'll be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after the Sept. 11 attacks and the SARS and Ebola outbreaks.
When the mosquito-borne Zika virus tore through South America in 2016, causing serious birth defects in newborn babies, members of Congress couldn't agree how, and how much, to spend in the U.S. for prevention efforts, such as education and mosquito abatement. The Centers for Disease Control and Prevention took money from its Ebola efforts, and from state and local health department funding, to pay for the initial Zika response. Congress eventually allocated $1.1 billion for Zika, but by then, mosquito season had passed in much of the U.S.
"Something happens, we throw a ton of money at it, and then in a year or two we go back to our shrunken budgets and we can't do the minimum things we have to do day in and day out, let alone be prepared for the next emergency," said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders of more than two dozen public health departments.
Funding for Public Health Emergency Preparedness, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America's Health, a public health research and advocacy organization.
Even the federal Prevention and Public Health Fund, which was established with the Affordable Care Act to provide $2 billion a year for public health, was raided for cash over the past decade. If the money hadn't been touched, eventually local and state health departments would have gotten an additional $12.4 billion.
Several lawmakers, led by Democratic U.S. Sen. Patty Murray of Washington, are looking to end the boom-bust cycle with legislation that would eventually provide $4.5 billion annually in core public health funding. Health departments carry out essential government functions — such as managing water safety, issuing death certificates, tracking sexually transmitted diseases and preparing for infectious outbreaks.
Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, KHN and The Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments' ability to retain people with expertise.
Compounding those losses, the coronavirus pandemic has prompted an exodus of public health officials because of harassment, political pressure and exhaustion. A yearlong analysis by the AP and KHN found at least 248 leaders of state and local health departments resigned, retired or were fired between April 1, 2020, and March 31, 2021. Nearly 1 in 6 Americans lost a local public health leader during the pandemic. Experts say it is the largest exodus of public health leaders in American history.
Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health, calls Congress' giant influx of cash in response to the crisis "wallpaper and drapes" because it doesn't restore public health's crumbling foundation.
"I worry at the end of this we're going to hire up a bunch of contact tracers — and then lay them off soon thereafter," Castrucci said. "We are continuing to kind of go from disaster to disaster without ever talking about the actual infrastructure."