The United States is not as prepared as it could be in key areas of public health disaster management, according to a recently issued report by Trust for America’s Health.
In Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, the report’s authors suggest the country is underprepared for natural disasters that can cause disease, is lacking in initiatives that prevent antibiotic resistance, and has a disease surveillance network that is underfunded and redundant. The 51-page report published in February examines on a state-by-state basis the level of public health emergency preparedness.
“The biggest cross-cutting point is that we can’t build this health infrastructure overnight after a disaster hits. We need ongoing attention,” said Dara Lieberman, director of government relations for TFAH.
One area where researchers encourage ongoing attention is in creating structural changes to flood-prone areas and reducing stormwater runoff and subsequent flooding as a result of extreme weather. Environmental safety also means providing cooling centers to keep vulnerable populations protected during heat waves, which kill more people in the United States than hurricanes, lightning, tornadoes, earthquakes, and floods combined. The report states that in 2017 alone, “15 extreme weather events across the globe were made more likely by climate change,” citing studies published by the American Meteorological Society.
Beyond the environment, the report also focuses on increasing public and private investments in efforts to combat antimicrobial resistance. The Centers for Disease Control and Prevention estimate that each year more than 2 million people get an antibiotic-resistant infection, killing at least 23,000 people in the United States. From a stewardship perspective, hospital officials have made improvements at detecting antibiotic-resistant bugs, but outpatient facilities have not done as well at containing outbreaks, Lieberman said.
“We want to detect these things before they jump from hospital to hospital and into our communities,” she said. “It’s a major ‘keep you up at night’ scenario.”
The CDC is making greater investments in detecting and containing outbreaks in hospital and other settings and investing more in laboratories through its Antibiotic Resistance Solutions Initiative. According to the CDC, this increases capabilities for state and local health departments to have rapid detection and faster response to outbreaks and emerging resistance related to healthcare-associated infections.
However, when it comes to broader surveillance systems, the report calls for a strategy that increases funding at the federal, state, and local levels to build a 21st-century system because the legacy of surveillance is operations that don’t often talk to each other and can overlap in redundant missions, Lieberman said. A broader surveillance strategy also means supporting communication systems for information-gathering purposes. As the report states: “More states should use electronic messaging for notifiable diseases and other streamlined data exchange mechanisms and should actively participate in national syndromic surveillance. Public health officials must also have a coherent strategy for incorporating nongovernmental data into surveillance.”
However, paying for these changes poses challenges. Funding mechanisms for programs utilized immediately after a disaster are typically discretionary public health dollars. This discretionary status can compromise emergency health operations, according to the report. The Zika outbreak of 2015 to 2016 serves as an example, as a decade of declining funding weakened response and recovery efforts.
“We had to build mosquito-borne surveillance systems from scratch,” Lieberman said. “We probably lost the ability to contain and delay the outbreak in a lot of places.”
In response, health advocacy groups, including the Association of Public Health Laboratories, have backed a new campaign calling for $1 billion over 10 years for CDC, state, and local public health surveillance.
Despite these financial shortfalls, the report says the United States has made serious progress in other emergency measures such as “in improving the pipeline of medical countermeasures to protect against chemical, biological, radiological, and nuclear (CBRN) threats.” That progress could be undermined if the government provides insufficient and unstable funding for medical countermeasure development initiatives created by small companies in the CBRN sector who depend on federal support, the report states. This is critical for the “last mile” of distribution and dispensing of drugs from the Strategic National Stockpile to get medicine to the patient at the right time.
“We’ve invested in capabilities to distribute and dispense, but it’s such a challenging enterprise to get it to the person,” Lieberman said.