Last year’s emergency Zika funding is about to run out and there’s no new money in the pipeline. It’s emblematic of the kind of short-term, reactive policymaking that public health officials have been warning us about for years. Now, as we head into summer, public health again faces a dangerous, highly complex threat along with an enormous funding gap.
“The Zika threat will get worse,” said Claude Jacob, chief public health officer at the Cambridge Public Health Department in Massachusetts and president of the National Association of County & City Health Officials (NACCHO). “And the consequences for women and their babies are very serious.”
Jacob spoke during a May 31 press briefing on the 2017 Zika threat organized by NACCHO, March of Dimes, and the Big Cities Health Coalition (a forum for the nation’s largest metropolitan health departments). Speakers discussed the state of the Zika outbreak — there are now nearly 5,300 Zika cases reported in the U.S., including more than 1,800 pregnant women — as well as evolving research on the virus’ health effects. But the overarching message was clear: keeping the Zika virus at relative bay will require continued and sustained investment. Gaps in funding, they said, will have an especially acute impact at the community level, where local public health agencies serve as a frontline defense against the mosquito-borne virus.
“Local health departments need that sustained investment — they can’t wait for Congress to take months to act,” said Oscar Alleyne, senior advisor for public health programs at NACCHO, referring to Congress’ months-long delay in authorizing the 2016 Zika funding. “We can’t wait until there’s a fire to want to go out and buy a fire truck.”
Last year, after months of political games, Congress approved $1.1 billion in emergency Zika funding (the Obama administration had originally requested $1.9 billion on the recommendations of scientists and public health officials). That emergency money runs out this summer. At the same time, the Centers for Disease Control and Prevention faces a Trump budget that proposes cutting the agency’s fiscal year 2018 budget by $1.2 billion, including a proposed cut of $136 million to public health preparedness and response. More than half of local health departments depend solely on federal funds to support their emergency preparedness activities.
Zachary Thompson, director of Dallas County Health and Human Services, said “any cuts to public health preparedness are unacceptable.”
During the briefing, Thompson emphasized that public health funding cuts at the federal level have a direct impact on surge capacity at the local level. In Dallas, Thompson’s agency is leading a broad range of Zika-related activities, all of which continuously learn from and build on each another to form a comprehensive local defense to Zika. Just to name a few: diagnostic testing for at-risk pregnant women; Zika case surveillance; follow up on travel-related Zika cases; organizing with mosquito control municipalities; teaching residents how to reduce mosquito breeding habitats near their homes; distributing mosquito repellent; and participating in tabletop exercises that simulate the effects of a local outbreak.
Texas is particularly vulnerable to Zika. As of June 2, the Texas Department of State Health Services reported 12 Zika cases so far in 2017 and 323 cases in 2015 and 2016, including six cases of locally acquired Zika in the southern part of the state. The state has also reported 342 cases to CDC’s Zika Pregnancy Registry. A local Zika outbreak could prove overwhelming, Thompson said, pointing to last summer’s Zika outbreak in Florida, where public health agencies were inundated with Zika testing demands.
The Zika Pregnancy Registry is also in jeopardy, said Paul Jarris, chief medical officer and senior vice president for mission impact at the March of Dimes, during the briefing. The registry, which works with state, local and tribal public health to gather data on Zika’s effects on pregnancy and newborn health, is administered via CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) and supported with the emergency Zika funds set to run out this July. (Trump’s budget proposal also calls for cutting the NCBDDD by $35 million.)
Jarris said the registry provides critical insights into who’s most at risk for Zika, how and when Zika infection is most dangerous to developing fetuses, and what kind of clinical protocols are needed to keep women and families safe. It’s hard to overstate just how important this kind of data is to shaping effective interventions and learning all we can about this virus. Just recently, registry data contributed to new CDC findings that 5 percent of fetuses and infants born to women with Zika in 2017 in U.S. territories had Zika-related birth defects. CDC said such birth defects were reported following Zika infections during every trimester of pregnancy. (This kind of information is why robust data collection and analysis are so essential. The more doctors, and obstetricians in particular, know about Zika virus, the better they can protect and guide their patients.)
Jarris said we’re learning more about Zika virus every day, and much of that is thanks to the federal support for Zika data collection and research that’s now in jeopardy. He not only called for adequate public health funding in the face of Zika, but “that we continue to support women’s health and the women’s health safety net in this country.” He called for supporting programs like Title X, which provide low-income women with access to family planning and preventive health services, as well as supporting gains under the Affordable Care Act (ACA) that require coverage of women’s health services and maternity and newborn care. (Those gains, along with access to timely prenatal care, could be reversed if Republicans succeed in gutting the ACA’s essential health benefits.)
“We need to make sure women’s health care is strengthened in this country, not weakened,” Jarris said.
White House cuts to Medicaid and the Children’s Health Insurance Program would impact Zika-affected families as well. Combined, the two programs cover nearly half of children with special health care needs, such as the developmental disabilities associated with Zika infection.
Right now, the Zika Coalition — a coalition of dozens of health and medical groups led, in part, by March of Dimes and NACCHO — is calling on Congress to increase funding for Zika-related CDC programs, including an increase of $45 million in public health preparedness funds to “sustain current Zika response efforts.”
“Zika funds are not where they should be if we are serious about protecting the lives of the people we serve in the community,” said Alleyne. “Failing to fund Zika efforts can and will be catastrophic.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.