BY INACTION, Congress has left federal, state and local public health agencies scrambling to find resources to cope with the Zika virus carried by mosquitoes, for which there is no vaccine or effective cure. The virus is a serious threat to pregnant women, because it can lead to birth defects. It was irresponsible of Congress to leave town for the summer with President Obama’s $1.9 billion request up in the air. It also underscores a larger problem: The system for financing public health emergencies is flawed.
When it comes to other high-consequence threats, politicians open the funding spigot. Might there someday be a ballistic missile fired at the continental United States? Billions are lavished on missile defense systems. Might there be a massive hurricane or storm? A federal disaster relief fund stands ready. After the anthrax letters, billions were spent to stockpile biomedical countermeasures. But when a virus such as Ebola or Zika comes along, public health officials are reduced to rattling a tin cup. The huge advantage of rapid response — being able to warn people and change behavior, to create diagnostics and surveillance, to launch vaccine and drug therapy research, among other things — is lost to political uncertainty and bickering.
This is not only a problem in the United States, but afflicts other nations and the World Health Organization, as the Ebola postmortems showed. Matt Watson, writing for the Center for Health Security at the University of Pittsburgh Medical Center, notes that severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), H1N1 influenza, Ebola and Zika “all caught us flat footed.” Haven’t we learned anything?
As Congress dithered this spring over whether to provide emergency funding for Zika, the administration responded by reprogramming about $589 million in existing funds to deal with the threat. This wasn’t a freebie. It robbed resources set aside to help other nations improve their disease surveillance and response systems, an important lacuna exposed by Ebola’s spread in West Africa. Also, some of the money had been set aside to help state and local health departments in this country prepare for emergencies — training, exercises, laboratory testing, communications, surveillance and epidemiological investigation. In effect, by inaction, Congress forced the administration to rob the future to pay for today. State and local public health departments, often at the front lines of fighting disease, have suffered budget and staffing cuts since the Great Recession. The National Health Security Preparedness Index found that many states in the South — where the Zika threat is greatest — fall below the national average in readiness for health incidents or emergencies.
Funding disputes in Washington will always be intense. But it is time to take infectious disease outbreaks seriously and establish a more stable financing mechanism for fighting them, such as a proposal by Rep. Rosa L. DeLauro (D-Conn.) to create a $5 billion public health emergency fund that would be ready for a rapid and flexible response when viruses and bacteria suddenly run rampant.