Recent presidential administrations confronted infectious disease emergencies that threatened both human lives and the U.S. economy, and with the likelihood high that the Trump administration will be no exception, the U.S. government should strengthen its public health emergency preparedness now, warns an expert on health security.
“The occurrence of a severe epidemic or pandemic infectious disease is the kind of event that can come out of left field and force our government into emergency response mode,” said Matthew Watson, senior managing analyst at the Johns Hopkins Center for Health Security, in emailed comments to Homeland Preparedness News. “In that way, they are not unlike acts of terrorism (and, on occasion, can be acts of terrorism).”
While past administrations have invested in technical programs and systems that can detect, mitigate, and in some cases eliminate those threats, Watson said he is concerned that the next time the United States is faced with a public health emergency as serious as Ebola or pandemic influenza, that the nation will not be as prepared as it should be to manage it.
Already this year, a spike in human infections of avian influenza (H7N9) in China has public health authorities closely monitoring the situation. The Centers for Disease Control and Prevention reported that human infections during this fifth epidemic in China represents a significant increase compared with the first four epidemics, the earliest of which was detected in 2013.
The World Health Organization said between Jan. 19 and Feb. 14, a total of 304 cases of human infection of bird flu virus in China had been confirmed, leading to 36 deaths at the time of the report. Most of the cases involved people being exposed to live poultry or contaminated environments. The virus does not appear to transmit easily from person to person, authorities said.
Watson, whose research has focused on health sector response to high-impact epidemics, notes that each of the last two administrations has contended with multiple emergencies stemming from infectious diseases.
Biological threats to the public can originate from a variety of circumstances. They can be naturally occurring infectious diseases, intentionally introduced biological agents through acts of terrorism, and result from the accidental release of pathogens from research laboratories.
Former President George W. Bush oversaw the response to an anthrax attack that resulted in five deaths soon following the Sept. 11, 2001 attacks. Responses to the SARS virus epidemic and concerns about H5N1 influenza followed suit. Under the Obama administration, the MERS virus emerged in 2012, followed by a major outbreak of Ebola in West Africa, and most recently the emergence of Zika virus.
The Johns Hopkins Center for Health Security recently produced more than a dozen memos on public health security for the new administration and Congress, which in part, argued for additional funding in order to shore up the nation’s preparedness efforts.
“Unfortunately, it seems as though resources are going to become increasingly scarce across the federal government, a trend that could leave the nation worse off from a preparedness perspective,” Watson said.
Trump is slated to release his budget plan on Thursday, when he is expected to unveil steep cuts to domestic programs.
Federal support through the CDC’s Public Health Emergency Preparedness Program is essential, but funding for that program and the closely linked Hospital Preparedness Program, have been in decline since 2006, he noted.
The U.S. government also funds multiple international biosurveillance programs that focus on quickly identifying threats. Those programs are important to global health security, but are also at risk of budget cuts.
Additionally, state and local public health systems are on the front lines of emergencies, and ensuring adequate funding for those entities is viewed as a priority. Those are the agencies responsible for surveillance and investigations of disease outbreaks, managing vaccination clinics and laboratory operations.
“Despite their importance though, state and local budgets for public health emergency preparedness are resource constrained,” Watson said.
In order to respond to a fast-moving infectious disease emergency, the proper expertise and policies should be put in place within the Executive Office of the President. Having well-placed experts with access to the best available science, particularly at the National Security Council and the Office of Science and Technology Policy, would be key to mounting an early response to a threat, Watson said.
The responsibility of U.S. health security is now spread across numerous federal agencies and programs. As a result of the complexities, an argument can be made to name a senior White House official who is charged with coordinating federal health security programs and policies.
“Past administrations have had such a position, and I think this administration should as well,” Watson said.
Also critical is having access to large sources of funding during a health crisis. As the struggle in Congress last year over funding the nation’s response to the Zika virus showed, a prolonged debate over appropriations potentially puts lives at risk. As a result, Watson is calling for the creation of a public health emergency fund to aid in the federal response to potential emergencies, similar to a FEMA disaster relief fund.
Threats from infectious diseases can impact national security, and the last two administrations have acknowledged that link and formalized strategies around it. For example, the 2015 National Security Strategy lays out the need to develop a global capacity to prevent, detect and respond to biological threats through the Global Health Security Agenda.
“Now is not the time for complacency with regard to infectious diseases threats; what’s called for is the same creativity, cooperation, and vigilance that we devote to other threats to our collective security,” Watson said.