H1N1 warns of public-health deficiencies

Aug. 1, 2009

Novel influenza A H1N1 (swine flu) is a new flu virus
that was first detected in April 2009. On June 11, 2009, the World
Health Organization (WHO) raised the worldwide pandemic alert level to
Phase 6 in response to the ongoing global spread of the H1N1 virus. It
is uncertain at this time how serious or severe this pandemic will be in
terms of how many infected people will develop serious complications or
die from H1N1 infection.

Laboratories in public health serve as first
responders, protecting the public from diseases and environmental health
hazards and, as such, recognized the importance of planning for a
possible pandemic long ago. The H1N1 outbreak provided a test of the
ability for public health to respond. Proactive preparations and help
from the non-profit Association of Public Health Laboratories (APHL) and
the U.S. Centers for Disease Control and Prevention (CDC), enabled
public laboratories to respond efficiently and effectively to the
current H1N1 outbreak.

Good planning has also enabled communication and
action around the emerging epidemic in a manner that has been rational,
predictable, and productive. These plans, which only came into being in
the past few years, enabled an unprecedented level of timely cooperation
and communication for assessing and responding to H1N1 virus. The
systems for communication and disease mitigation worked as they were
designed to work.

While the current outbreak of H1N1 has been
considered mild, the H1N1 pandemic has highlighted many of the
continuing and unparalleled challenges faced by the nation’s state and
local public-health laboratories. Our nation struggles with escalating
healthcare costs, continuing budget cuts, and a growing shortage of
public healthcare and laboratory workers. These cuts in funding and
staff levels threaten to erase much of the progress that has been made
in preparedness and response capabilities, which limit the public-health
system’s ability to effectively prepare for a sustainable pandemic

Linda Rosenstock, dean of UCLA’s School of Public
Health, says the public-health workforce is a vital infrastructure to
effectively respond to any health emergency, yet it currently faces a
shortage of workers — which is likely to increase in the years to come.
She says an additional 250,000 public healthcare professionals will be
needed in the United States by 2020.

The H1N1 pandemic has highlighted many of the continuing and unparalleled challenges faced by the nation’s state and local public-health laboratories.

Results of a first quarter 2009 APHL survey indicate
that the public-health laboratory workforce, which numbers 6,500
nationwide, has been reduced by at least 500. Survey results also show
deep cuts to laboratory budgets, mandatory furloughs, and reductions in
funding for essential equipment and supplies.

The unfortunate confluence of years of minimal
funding from all levels of government, an aging scientific workforce
with minimal replacements in the pipeline, and the burden of dramatic
funding reductions because of the impact of the economy on governmental
revenues could have dealt a crippling blow to public-health laboratory
operations and the public’s health. Fortunately, that was avoided in
this instance — but the response of public-health laboratories to the
H1N1 outbreak was unsustainable and was greatly aided by the fact that
there was no other major event, such as a foodborne illness or other
disease outbreak, occurring at the same time.

Funding issues, however, have not been significantly
improved, even with the $350 million recently provided for state and
local pandemic preparedness in the emergency supplemental appropriations
bill signed by the President on June 26, 2009. The $350 million is
intended to help public-health departments hire and train staff, buy
equipment to improve diagnostic capabilities, distribute antivirals and
personal protective equipment, improve communication, and maintain
disease-reporting hot lines.

APHL estimates that the nation’s public-health
laboratories are likely to receive $20 million at most, but they could
receive as little as $10 million. At these levels, the additional
federal funding will barely get public-health laboratories out of the
financial hole created by the H1N1 response and certainly will not
provide funds for any of the needed improvements that would ensure a
sustainable response for the upcoming fall flu season.

Scientists are still investigating the novel
influenza A (H1N1) virus and how it is different from seasonal flu, but
government officials are concerned it may mutate into a more dangerous
form and have suggested the possibility of a new wave of illnesses this
fall and winter.

The H1N1 pandemic reveals that there are simply not enough people in
our nation’s health departments to ensure an adequate response to a
larger, more virulent outbreak, warns Robert Pestronk, executive
director of National Association of County and City Health Officials.
Local health departments, he explains, require sustained funding to
protect public health.

Scott J. Becker, MS, is the executive director for the Association of Public Health Laboratories, and is responsible for the programmatic and fiscal operations of APHL, as well as for policy development and strategy.