Threat to Prevention and Public Health Fund Defeated

By Peter Kyriacopoulos, Senior Director of Public Policy, APHL

On September 14, the U.S. Senate defeated an attempt to eliminate the funding for the Prevention and Public Health Fund -- created in the Affordable Care Act (ACA), the federal health reform law.

Voting on a procedural matter, the Senate rejected an amendment offered by Senator Mike Johanns of Nebraska that would have used the resources in the Fund as an off-set for a new federal income tax reporting requirement that will be implemented by the Internal Revenue Service in 2012. The vote was especially significant because of the eight vote margin by which it was defeated, even though there was an extremely strong push by the business community that encouraged the Senate to pass the amendment.

The final vote tally can be found here; a letter of support from Secretary Sebelius (Health and Human Services) and Secretary Geithner (Treasury) is here.

The public health community has never come together so quickly and worked together as cohesively as it did in the effort to preserve the Prevention and Public Health Fund. This accomplishment will be easily replicated for any future attempts to reduce or eliminate the Fund and should send a very clear message to those who seek other uses for it: “Hands Off!”

Experts Cite Lack of Resources for Public Health Laboratories as Impediment to Response in Foodborne Outbreaks

A lack of resources at state and local public health laboratories slows response to foodborne outbreaks, according to experts at a national meeting of food safety professionals. Participants in a panel at the International Association for Food Protection identified adequate laboratory staffing and provision of testing materials as critical to rapid response in a hypothetical multi-state outbreak of E. coli O111.

This statement will come as no revelation to those in public health. Disease control measures are based on a definitive laboratory-confirmed diagnosis. If you don’t have the test results, you can’t track down the pathogen that’s contaminated the food in your community. It’s that simple.

But this simple message seems to be lost on the funders of the governmental laboratories that conduct testing for E. coli O111 and other foodborne diseases. Laboratories continue to reel from cuts in state and local budgets. Yes, dedicated staff will work long hours during a crisis—as they did during the Salmonella outbreak in peanut products and the novel Influenza A/H1N1 outbreak—but this only goes so far. In a prolonged outbreak, staff has to be rotated or the quality of test results will be compromised. You just can’t make two people out of one, no matter how hard you try.

The same principle applies to lab instrumentation and supplies. Too often the assumption seems to be that lab testing is like cooking: if you have more specimens, you just put more pots on the stove. Unfortunately it doesn’t work that way. Laboratory “through-put”—the number of specimens that a laboratory can test in a day—depends upon the capacity of its instrumentation: If a lab has bigger and faster equipment, it can test more specimens faster. If it doesn’t, then laboratory diagnosis, and response time, will lag. And, of course, no testing can be conducted without test kits, reagents and other essential supplies. But with recent budget cuts, inventories are low, and resources to purchase additional supplies limited.

One wonders what will happen in the event of a sustained, foodborne disease outbreak – or the next wave of novel H1N1.

Flu Appropriation Update

Great news! The Senate Appropriations Committee has recommended approving $900 million in emergency flu funding. Even more importantly, the Committee has recognized the importance of hiring PHL staff. Taken from the report itself:

“The Committee notes that the economic downturn has forced States and local governments to lay off public health laboratories and other public health professionals.”

The House Appropriations Committee has already taken similar action by adding $350 million for State and local government capacity building in its version of the emergency flu funding bill. Their report also references the impact of the lay offs.

You can see the full text of the Senate report here and the full text of the House report here.

Flu Appropriation

The House of Representatives pushed through a $350 million appropriation for desperately-needed federal funding for state and local government public health organizations.

This funding will help combat many of the cuts government public health labs have had to make during the current recession. A recent APHL survey found that in 2008 alone, labs laid off or left unfilled almost 430 full-time positions, and expected to see another 230 positions empty in 2009. This proposed budget appropriation will go a long way to restoring vital lab capacity—it is critically important that labs retain and reclaim their highly trained workforce.

Despite severe workforce gaps, in the past few weeks, government labs still managed to test thousands of samples and keep the H1N1 outbreak just that—an outbreak—and not a pandemic. However, we’re not out of the woods yet. While things have certainly quieted down in the media, the H1N1 outbreak underscores the need to strengthen public health surveillance and detection of any novel flu strains that may appear.

Yet, that proposed $350 million in funding may still die—unless the Senate acts quickly and decisively. As it stands now, the full Senate will not begin actively debating the proposed appropriation until next week. If the Senate does not match the House with this funding, public health infrastructure will continue to erode in the wake of continued budget cuts.