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 heath 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 response.
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.
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 hill 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 S10 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.
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By Scott J. Becker, MS
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.
