Thursday, January 12, 2017

mapHealth emergencies disrupt the lives of millions of Americans and cost the country billions of dollars each year.

While emergencies are inevitable, the country is often caught “off-guard” when a new threat arises, whether it is a disease outbreak like Zika or Ebola, a natural disaster, or a bioterrorist threat. 

Emergencies are not a question of “if” but “when.” Yet, resources to prepare for and train to mitigate the effects of disasters have continually been cut.

In the Trust for America’s Health’s (TFAH) most recent Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism report on public health preparedness, we found the current public health preparedness system is not actually built for “readiness”—to be able to consistently respond in an effective and efficient way when new crises occur. Rather, when emergencies happen, the response diverts time, attention, and resources away from other ongoing needs. And, in some instances, emergency resources take months, forcing state and local public health agencies to do even more with even less.

We’ve made some important strides over the last 15 years—after the 9/11 and anthrax tragedies—with the tireless work of the Centers for Disease Control and Prevention (CDC), the Office of the Assistant Secretary for Preparedness and Response (ASPR), and state and local public health departments and workers deserving a lot of the credit. For instance, we improved emergency operations, communication, and coordination; increased support for the Strategic National Stockpile and the ability to distribute medicines and vaccines during crises; made major upgrades in public health labs and foodborne illness detection capabilities; and made improvements in legal and liability protections during emergencies.

But there are still real and serious gaps—including some areas that have never been well addressed and some areas where progress has eroded due to lack of sustained funding. Some notable gaps include: lack a coordinated, interoperable, near real-time biosurveillance system; insufficient support for research and development of new medicines, vaccines, and medical equipment; not enough support to the health care sector to prepare for a mass influx of patients during a major outbreak or attack; and cuts to the public health workforce across states.

To fill these gaps, our report identified a set of concerns and recommendations, and I’ll touch on six below. They and additional recommendations are covered in more depth in our full report.

  1. We must build strong, consistent baseline public health Foundational Capabilities in regions, states, and communities—so that everyone is protected. Leading institutions and experts recommend establishing and maintaining a clear, consistent set of capabilities that focus on performance outcomes in exchange for increased flexibility and reduced bureaucracy. These foundational capabilities would help support preparedness and readiness by providing a stronger, more consistent foundation for public health activities.
  2. To foster foundational capabilities, we need stable, sufficient health emergency preparedness funding alongside a robust complimentary Public Health Emergency Fund, which would provide immediate surge funding during an emergency. Over the past 15 years, federal funds to support and maintain state and local preparedness have been cut by about one-third (from $940 million in FY 2002 to $660 million in FY 2016), and hospital emergency preparedness funds have been cut in half ($515 million in FY 2004 to $255 million in FY 2016).
  3. We also need improved federal leadership before, during and after disasters—including at the White House level. Recent emergencies that cross federal agencies’ jurisdictions and/or have both an international and domestic component, such as the Ebola and Zika outbreaks, have demonstrated the lack of clear roles and responsibilities and the need for cross-cutting national leadership.
  4. Additionally, we must focus on recruiting and training a next generation public health workforce—with expert scientific abilities and critical thinking and management skills—to serve as Chief Health Strategists for communities. Many leading experts and initiatives—including the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), the Association of Public Health Laboratories (APHL), the de Beaumont Foundation, schools of public health, and other groups—are working to recruit and retain trained and experienced public health professionals. These efforts must be bolstered and supported.
  5. Vaccines save lives. Vaccines are one of the greatest public health successes. Yet, vaccination rates are, at best, stagnant across multiple measures. We must improve rates for children and adults by: minimizing exemptions; boosting demand; making adult vaccinations routine; increasing provider education; bolstering immunization registries and tracking; ensuring first dollar coverage and access to all recommended vaccines under Medicaid, Medicare and private insurance; and others.
  6. Lastly, we must get serious about Superbugs and antibiotic resistance and prioritize efforts to address one of the most serious threats to human health. The nation must: fully fund and implement the Combating Antimicrobial Resistant Bacteria strategy, including CDC’s Antibiotic Resistance Solutions Initiative; incentivize the development of new antibiotics and diagnostic tests for resistant bacteria; reduce overuse and unnecessary prescribing of antibiotics in agriculture and for people; among other endeavors.

Health emergencies can quickly disrupt, derail, and divert resources from other ongoing priorities and efforts. It is beyond time to recognize the importance of preparing and putting resources in place before an emergency occurs. TFAH calls on policymakers, practitioners, and the general public to help put the Ready or Not? recommendations into action.

All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.



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