Under mounting pressure to provide additional funding to combat an anticipated Zika virus outbreak in the U.S., congressional Republicans have begun to move legislation to approve more money.
But public health experts called the response insufficient and warned that congressional moves to shift money away from existing public health initiatives, including Ebola prevention, will undermine national and local efforts to prevent other disease outbreaks.
The Senate voted, 68-29, Tuesday to spend $1.1 billion to fight Zika, short of the $1.9 billion requested by President Obama in February.
Senior House Republicans this week proposed even less in a new emergency appropriations bill, which the White House on Tuesday called “woefully inadequate” and said Obama would veto.
Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, also criticized Congress for its response to the Zika threat.
“We will pay a steep price for this particular shortsightedness,” he said. "The politicization of public health challenges is one of the more disheartening consequences of a dysfunctional political system.”
Last month, officials from the federal Centers for Disease Control and Prevention warned that Zika outbreaks could be expected this summer across much of the United States, including Central and Southern California and as far north and east as New Jersey.
In Puerto Rico, where hundreds of cases have been reported, “hundreds of thousands” could end up infected, agency officials said.
The disease is spread primarily by mosquitoes, although it can also be transmitted sexually, according to health officials. Many people who contract the virus will not get sick, but the virus is more dangerous to pregnant women as it has been linked to brain abnormalities in newborns, including a small head, known as microcephaly.
When it asked for emergency funding in February, the Obama administration said the money was needed to control mosquitoes, research the disease and speed development of a vaccine.
The compromise approved by the Senate, which was negotiated by the administration and Sens. Roy Blunt (R-Mo.) and Patty Murray (D-Wash.), the senior members of the Senate appropriations subcommittee that oversees health funding, provides some of what the administration says is necessary.
But House Republicans continue to balk at so much emergency aid, arguing that the Obama administration hasn’t justified the larger request.
On Monday, House Appropriations Committee Chairman Harold Rogers (R-Ky.) unveiled a $622-million package, funded with money currently earmarked for the Ebola response and for administrative tasks at the U.S. Department of Health and Human Services.
“We have made our own funding determinations, using what information is available and through discussions with federal agencies, to craft a proposal to fight the spread of this damaging disease,” Rogers said.
In its veto threat Tuesday, the White House warned that taking more money from the Ebola response “would harm the nation’s ability to address a range of urgent, emerging and ongoing health challenges.”
The administration has already begun shifting about $600 million in Ebola funding. But federal health officials and public health experts say this strategy is very risky.
“It’s like saying we haven’t had a fire in town for the last year, so let’s disband the fire department,” said Jennifer Nuzzo, an epidemiologist at the UPMC Center for Health Security in Baltimore.
“Public health officials are already dealing with an inadequate infrastructure. I don’t see how we can hope to be effective if we just continue to fund this on an ad hoc basis,” she said.
Among other problems, Ebola remains active in parts of West Africa and thus still threatens the rest of the world.
Closer to home, state and local public health offices are juggling numerous other tasks. These include containing existing infectious diseases such as measles and tuberculosis; preparing for tropical illnesses such as dengue fever that may become a larger threat as the climate warms; and supporting prevention efforts aimed at tobacco and chronic diseases such as diabetes, which many experts see as the nation’s biggest health threats.
“We just can’t keep robbing Peter to pay Paul,” CDC Director Dr. Thomas Frieden told journalists in Boston recently, noting that the country must be better prepared to deal with health emergencies without raiding existing programs.
Unlike agencies that respond to earthquakes or floods, Frieden said, the CDC can stop disasters from occurring if public health officials can prevent a disease outbreak from becoming an epidemic.
“You can make the earthquake not happen,” he said.
That is becoming more difficult as resources dwindle, according to public health officials across the country.
Government investment in public health has been declining for years. Between 2005 and 2013, the CDC’s inflation-adjusted budget declined from $7.07 billion to $5.98 billion, according to an analysis by the Trust for America’s Health.
So, too, has the nation’s public health workforce, which is almost 20% smaller than it was in 2008, a report by the National Assn. of County and City Health Officials found.
Chronic underfunding of public health initiatives has forced Congress to repeatedly pass emergency measures in the face of crises, as lawmakers did in 2014 to respond to Ebola and in 2005 and 2006 to respond to a pandemic flu outbreak.
The unpredictable funding has left local officials around the country scrambling to plug holes in their budgets and shelve vital initiatives.
In Los Angeles County, home of the nation’s largest local government, the public health department has been stretching to prepare for Zika and deal with two major environmental disasters, including the Porter Ranch gas leak and the potential contamination of as many 10,000 homes from the former Exide Technologies battery recycling plant.
At the same time, the county is losing more than $1.5 million of federal emergency aid from the CDC as the federal agency redirects money for the Zika response.
To respond, the county will cut, among other things, planning for natural disasters, including programs to train volunteers and prepare community leaders in case government services are unavailable, as they were in New Orleans after Hurricane Katrina.
“People may not appreciate this, but in a devastating earthquake, the government may not be there,” said Cynthia Harding, the county’s interim public health director. “We need to prepare for that.”
Staff writer Soumya Karlamangla contributed to this report.