Everything you ever wanted to know about the Zika virus and its spread across North and South America. (Daron Taylor,Claritza Jimenez/The Washington Post)

State health officials were heartened in February when President Obama asked Congress for $1.8 billion to combat the spread of the Zika virus because they fear they don’t have the resources to fight the potentially debilitating disease on their own.

Budget cuts have left state and local health departments seriously understaffed and, officials say, in a precariously dangerous situation if the country has to face outbreaks of two or more infectious diseases — such as Zika, new strains of flu, or the West Nile and Ebola viruses — at the same time.

“We have been lucky,” said James Blumenstock of the Association of State and Territorial Health Officials, referring to states’ and localities’ ability to contain the flu, West Nile and Ebola threats of the past five years.

“Not only have the last major threats not been as severe as they might have been, they have also been sequential,” Blumenstock said. “The issue is: What if the next pandemic is not as mild as the last ones? What if more than one of them happens at once?”

To varying degrees, states have cut back spending on public health since the onset of the Great Recession in 2007. Overall state spending on public health fell by $1.3 billion between 2008 and 2014, the Trust for America’s Health and the Robert Wood Johnson Foundation reported last year.

Money issues

And the trend didn’t end as the economy improved. Sixteen states reduced spending between fiscal 2013 and 2015, the two research organizations said in another report. Those were the same years the nation faced Ebola, a new outbreak of West Nile and, in 2014, widespread cases of the H3N2 flu strain.

States with the biggest cuts over that time: California (13.3 percent), Massachusetts (11.6 percent) and Washington (11.1 percent). Six states — Alabama, Indiana, Kansas, North Carolina, Ohio and Washington — cut their spending all three years.

Local health departments have suffered, too. They lost nearly 52,000 staff positions as a result of hiring freezes and budget cuts between 2008 and 2014, the National Association of County and City Health Officials reported.

“The steady reduction in public health funding has resulted in a progressive erosion of manpower and the capacity to do the kind of work that would be optimal,” said Jeff Duchin, chief health officer of King County, which includes Seattle. “Quite frankly, we just don’t have the staff we need.”

Health officials are confident they could contain an outbreak of the Zika virus if Congress approves the president’s request for money, which would go to eradicating the mosquitoes that spread it, researching vaccines against it and educating the public about prevention.

The mosquito that transmits the virus, the Aedes aegypti, breeds in the United States and the rest of the Americas, and is also a carrier of dengue, chikungunya and yellow fever. Scientists say that with international travel and Zika outbreaks in more than two dozen Latin American countries, it is inevitable that mosquitoes carrying Zika will surface in the United States.

Zika poses little threat to most people, but it is potentially very dangerous for pregnant women. There is increasing evidence in Brazil — which had an outbreak of Zika last spring — that the virus causes microcephaly, a birth defect in which children are born with unusually small heads and brains. It also may be associated with the incapacitating Guillain-Barré syndrome.

That Zika is spread mainly by mosquitoes alarms health officials.

A 2014 report by the Council of State and Territorial Epidemiologists found that state and local health departments are less prepared to track and contain infections carried by mosquitoes than at any time since the early 2000s, when they ramped up to deal with the first outbreak of the West Nile virus.

Between 2004 and 2012, there was a 41 percent drop in the number of staff working at least half time in mosquito surveillance (to detect whether they are carrying disease), according to the report. Seven states no longer conduct mosquito surveillance.

Surveillance for mosquito-borne viruses other than West Nile is patchy at best, the report said. “In particular,” it said, “public health laboratory capacity for proactive surveillance is poor to nonexistent in most states.”

Even with West Nile, declining mosquito surveillance contributed to a new spike in cases in 2012, notably in the Dallas area, said Jeff Engel, executive director of the Council of State and Territorial Epidemiologists. “We let our guard down.”

More than mosquito surveillance has suffered. The Association of State and Territorial Health Officials reports that since 2008, 20 agencies have cut programs for sexually transmitted diseases, including AIDS, and 15 have cut laboratory services.

“Funding has been reduced for public-health activities at the same time that public-health threats are coming more often and more vigorously and with more intensity,” Blumenstock said.

When a new infectious disease such as Zika emerges, state and local health departments face a multitude of tasks: isolating and containing the threat; identifying people who are infected and assuring they are treated; reporting cases to the Centers for Disease Control and Prevention; coordinating responses with hospitals and other agencies; performing necessary laboratory work; and educating the public and the medical community.

To cope with an infectious-disease outbreak amid reduced budgets, state and local health departments have become adept at crisis management and deploying staff to meet the latest threat, said Joshua Sharfstein, former Baltimore health commissioner and Maryland secretary of health.

“We found responding to Ebola [in 2014] really taxed our ability to respond to other outbreaks because we needed to pull all the staff” from other tasks, said Sharfstein, now an associate dean at the Johns Hopkins Bloomberg School of Public Health.

The same thing is starting to happen again across the country, Blumenstock said.

“State and local departments today are looking at their staff and deploying them to deal with Zika,” he said. “But if you send an epidemiologist to deal with Zika full time, that’s eight hours a day less that he’s doing food-borne surveillance, or HIV surveillance or flu surveillance.”

“We’ve been lucky so far, and you don’t want to hope for a different scenario so you can prove your point,” Blumenstock said. “But there are tipping points, and there were times we were close to those tipping points.”