A federal public health official recently advised local government officials to invest in public health programs to stem the spread of infectious disease because of the federal government’s challenges with providing a timely and flexible response. The recent example of the debate regarding a supplemental appropriation to help combat the Zika virus showed the limits of federal response due to a lack of trust between the legislative and executive branches.
When Zika first emerged as a prominent issue in summer 2016, federal officials like the director of the Centers for Disease Control and Prevention, Thomas Frieden, were already calling upon members of Congress to take the threat seriously. Public statements stressed that the situation was “urgent” and that “time matters” in terms of stemming the effects of the virus.
Members of Congress, particularly Republicans, responded with fiscal caution. They countered that the federal public health agency already had funding available to combat Zika absent the $1.9 billion in additional funds requested by President Obama. Republicans held that new funding should be offset by cuts in other areas.
Other health officials, such as Surgeon General Vivek Murthy, warned that reserve funds to address the virus were being rapidly depleted. Republicans argued that the administration had the money to combat the immediate threat and that new funding could wait for appropriations through the regular budget process rather than a supplemental appropriation.
In June, a Zika bill with $1.1 billion in new funding was passed in the House of Representatives, which proposed the money be taken from funding for Ebola response and the Affordable Care Act. The funding bill was also hampered by a dispute regarding federal funding going to Planned Parenthood, including a clinic in Puerto Rico. As time went on, Republican members of Congress from states particularly threatened by Zika joined those stressing the urgent need for increased response funding. Some began calling for a public health emergency fund which could be used in the future without congressional action.
The U.S. entered August without a deal being struck. Health and Human Services Secretary Sylvia Burwell sent a letter to Congress stating that funding was running out and that without new funding efforts to develop a Zika vaccine and promote mosquito control would be significantly hampered. Burwell also countered charges from Republican senators that the administration still had $400 million in unspent funds, noting that much of the money was already being used and the rest would be spent soon.
When the $1.1 billion was finally appropriated in late September, federal health officials wasted little time describing how the funds would be used but cautioned that it would take time to move the money to the efforts for which it would be needed. In a recent speech, Director Frieden cautioned a meeting of mayors and city officials in Miami that it was too late to stop Zika from spreading nationwide. He encouraged local leaders to be forward thinking in supporting public health programs because of the challenges of responding to a public health emergency at the federal level. County and city governments could hone their capabilities through participation in programs like Project Public Health Ready.
The long debate over Zika funding has led to calls for the creation of a public health emergency fund that could be used at the discretion of federal officials. While this may be a perfectly reasonable proposal, it raises the question: if we can agree that the CDC and other agencies should have the money to respond to threats like Zika, why didn’t Congress provide funds earlier and why wouldn’t Congress be expected to provide funding in the future?
These unanswered questions may be indicative of the larger lack of trust between the Congress and the executive branch. These branches have shown they can cooperate in the face of an undeniable catastrophe, such as a terrorist attack or natural disaster. However, public health threats are slower and less visible, allowing for different perceptions of the level of risk and allowing more time for suspicion and partisanship to hinder the response. However, recent research indicates that a delay in the response to Ebola led to a mutation that allows the virus to more easily infect humans. Therefore, a delay runs the risk of not only having more people become infected but also providing viruses with the opportunity to become dangerous.
The next president must make it a priority to rebuild trust between federal public health officials and the legislature. One approach is to have congressional staffers work on the staffs of executive public health agencies for a period of time to better understand how they work. Similarly, public health policy analysts could collaborate more closely with members of Congress and their staffs.
The most visible effects of Zika are the births of children with microcephaly, many of which will require a lifetime of intensive care. Federal government leaders in the executive and legislative branches must be prepared to act to prevent such tragedies, not in response to them.
Author: Nathan Myers is an associate professor of Political Science at Indiana State University. He primarily teaches courses in the Master of Public Administration program. Myers is also a member of the ISU Center for Genomic Advocacy. His teaching and research interests include organizational behavior, public health policy, and biotechnology policy associated with genomic research.
Public health issues will not be a priority for the next administration. Across the board reductions in public health funding along with elimination of the ACA can be expected. Proposals will be made to shift Medicaid to block grants, add new eligibility restrictions and require co-payments from some recipients. In addition, the limited emergency health benefits for persons not lawfully present will be eliminated entirely.