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Recent budget cuts have health agencies in bind for pandemic

Recession could hurt response if virus spreads

By Kevin Sack
New York Times / April 30, 2009
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NEW YORK - The recession has drained hundreds of millions of dollars and thousands of workers from the state and local health departments that are now the frontline in the country's defense against a possible swine flu pandemic.

Health officials in affected states said they had thus far been able to manage the testing and treatment of infected residents and mount vigorous public education campaigns. But many said they had been able to do so only by shifting workers from other public health priorities, and some questioned how their depleted departments might handle a full-fledged pandemic.

"I'm very concerned," said Robert M. Pestronk, executive director of the National Association of County and City Health Officials. "Local health departments are barely staffed to do the work they do on a day-to-day basis. A large increase in workload will mean that much of the other work that is being done now won't be done. And depending on the scale of an epidemic, capacity may be exceeded."

At a news conference on Monday, Dr. Richard E. Besser, the acting director of the federal Centers for Disease Control and Prevention, said the public health system was in a tough situation.

"We hear about tens of thousands of state public health workers who are going to be losing their jobs because of state budgets," he said. "It is very important that we look at that resource because this outbreak was identified because of a lot of work going on around preparedness."

Pestronk's group estimates that local health departments lost about $300 million in financing and 7,000 workers in 2008, a year when more than half of all agencies shed employees. There were about 160,000 health department workers in 2005, according to the group.

Pestronk said he expected to lose at least another 7,000 jobs this year.

State public health agencies lost an additional 1,500 workers through layoffs and attrition from July 2008 to January 2009, according to the Association of State and Territorial Health Officials.

The group anticipates 2,600 job losses in the coming fiscal year.

Public health officials said Congress had missed an opportunity by excising nearly $900 million in proposed financing for pandemic flu preparation from this year's stimulus bill. It was to be the final installment of President George W. Bush's request for $7 billion in federal spending on vaccines, medical equipment, and planning.

Congress last allocated money for pandemic planning by state and local governments in 2006 - about $600 million over two years, said Dr. Paul E. Jarris, executive director of the Association of State and Territorial Health Officials.

"The entire system is lining up to decrease resources at the time we need them most," Jarris said. "We have to realize that we're at the starting line. The stress will come if this escalates."

Jeffrey Levi, executive director of the Trust for America's Health, said the financial strain made "it more important that we luck out" with a mild outbreak.

Dr. Alvin D. Jackson, the state health director in Ohio, which has one confirmed case of swine flu, said his agency's state appropriation had declined by about $10 million over the last two years.

He said his budget to prepare communities and hospitals for an influenza pandemic had dropped from $55 million in 2004 to $34 million.

"Right now we're OK," he said. "We feel that we can do an excellent job protecting our citizens. But looking forward, we do understand that some additional resources would be appreciated."

But in Cleveland, Dr. Terry Allan, the Cuyahoga County health commissioner, said the decline in state and federal money had prompted a 25 percent cut in spending on pandemic preparedness over the last two years. That had cost the department at least 10 workers, he said, and further cuts are anticipated.

"Those are people we would have had available to expand and build on our plans for social distancing, for mobilizing antivirals," he said.

"Our plan is not adequate. It's barely started."

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