Los Angeles County, for example, says it won’t be able to fill 17 vacancies at its public health laboratory or buy equipment to upgrade its capability for Zika testing. Michigan is concerned about providing resources to help Flint contend with its ongoing water-contamination crisis. Minnesota plans to reduce its stockpile of certain medications needed to treat first responders during emergencies.
The across-the-board funding cuts are part of a complicated shift of resources that the Obama administration blames on Congress and its refusal to approve the White House’s $1.9 billion emergency request to combat Zika. In early April, officials announced a stopgap measure that moved money originally intended for the government’s Ebola response.
But in that scramble, the administration also redirected about $44 million in emergency preparedness grants that state and local public health departments expected to receive starting in July. They use the grants for a broad range of events, including natural and human disasters and terrorist attacks. Some agencies lost up to 9 percent of their awards.
“It’s the first time I recall something like this, where the [emergency preparedness] funds were repurposed for another crisis or emergency,” said James Blumenstock, chief health security officer at the Association of State and Territorial Health Officials, which represents U.S. public health agencies.
Federal officials maintain that they had few alternatives given the steadily increasing prevalence of Zika. The continental United States has at least 388 confirmed cases. Nearly all cases involve travelers who were infected abroad; sexual transmission is implicated in a few others. Thirty-three cases involve pregnant women.
“In the absence of congressional action, this is an example of the tough choices we’re faced with,” said Kevin Griffis, a spokesman for the Department of Health and Human Services.
The shifts come at a time when state and local public health emergencies already are strained because of years of dwindling resources. Federal funding to help them prepare for hurricanes, infectious-disease outbreaks and other disasters has been cut by more than a third in the past 11 years. According to the National Association of County and City Health Officials, which represents 2,800 local health departments, federal allocations in fiscal 2005 totaled $863 million nationally. This fiscal year, the total is $568 million.
Although they wouldn’t have received the next grants for several months, state and local health departments say they’re being forced to redo budgets now.
“You can’t plan that way for disease or flooding,” said Umair Shah, who in Houston heads the Harris County public health and environmental services department. Emergencies don’t follow government schedules. “They happen today. They happen tomorrow.”
And the public’s expectations don’t change despite funding cuts.
“When you lose 10 percent of your funding,” Shah said, “the expectations of the community are not that you are 10 percent less responsive to their needs. They expect you to be just as capable today as tomorrow.”
Although New York City announced a three-year, $21 million Zika response plan last week, the expected loss of more than $1 million would “severely diminish the city’s overall capability to respond to public health emergencies,” including Zika, according to a statement by Health Commissioner Mary Bassett. That could delay surveillance of mosquitoes carrying the virus as well as weaken the city’s ability to identify, track and prevent infectious diseases in general, a department spokeswoman said.
Los Angeles County is losing nearly $1.6 million in funding. In addition to the unfilled lab positions and equipment needs, the public health department won’t be renewing a $119,250 contract for the vendor that sends almost instantaneous alerts during public health emergencies to tens of thousands of doctors and hundreds of hospitals, medical offices and laboratories.
“We had to slim down to the bare minimum,” said interim director Cynthia Harding, even though both mosquito species that transmit Zika are well established in large parts of the county, especially in low-income areas.
In recent months, Los Angeles has confronted several other public health emergencies, including a massive gas leak from a storage facility, and lead and arsenic contamination from a battery recycling plant.
“This is stealing from Peter to pay Paul,” Harding said of the federal decision to shift a percentage of funding. “What we need to prevent Zika from becoming endemic are more funds at the local level.”
Experts say Zika outbreaks are most likely to occur in the South, particularly along the Gulf Coast, because warm, moist weather and higher-than-average temperatures forecast for late spring into early summer provide ideal breeding conditions for Aedes aegypti, the primary virus vector.
In those high-risk regions, officials expect the Centers for Disease Control and Prevention to provide targeted funding for Zika preparedness and response activities, Blumenstock said. But states don't know how much money will be made available or what activities they will cover.
Texas is losing nearly $3.6 million, or more than 9 percent of its funding. State officials said some public health emergency funding from previous years will soften the immediate impact. That will allow Harris County’s health and environmental services department to keep three staff positions that otherwise would have been at risk, said Shah, the executive director.
Even in places with few worries about Zika, officials are grappling with what activities they can delay, cancel or reduce.
In Minnesota, that means a 7 percent across-the-board cut to local public health departments, many in rural communities, that will affect the replacement of critical laboratory equipment. The state will no longer conduct certain types of emergency-response drills, state Health Commissioner Edward Ehlinger wrote in a recent letter to the Minnesota congressional delegation, and training to support survivors of post-disaster stress has also been scrubbed.
Responding to Zika is important, said Ehlinger, a pediatrician who is also president of the Association of State and Territorial Health Officials. Yet, he added, “it is shortsighted to fund that response by weakening all states’ ability to respond to future public health crises.”