"We've documented how preparedness has been on an upward trajectory" over the past 10 years, said Trust for America's Health director Jeff Levi. "But the economic crisis has changed the story. Now we're seeing a decade's worth of preparedness eroding in front of our eyes."
Funding reductions could affect preparedness gains made since 9/11, Levi said. The cuts could impede communities' ability to distribute vaccines, test for chemical and biological agents, and coordinate disaster response.
Trust for America's Health and the Robert Wood Johnson Foundation assessed the nation's emergency infrastructure, and looked both at funding cuts so far and projections of future cuts. Future cuts include the mandatory reductions that could result from the failure of the deficit-reduction super committee to reach an agreement.
The report found that 40 states and D.C. have cut their public health funds this year, and 49,310 state and local public health department jobs have been lost since 2008. For some states, this was the second or even third straight year of funding reductions for public health emergency preparedness programs.
And deep federal cuts are looming: Fifty-one cities stand to lose bioterrorism preparedness funding, the 10 highest-level chemical testing labs in the country could lose their top-level status, and 24 states could lose the support of Centers for Disease Control and Prevention epidemiology experts, the report found.
"Really, our health security is dependent on this funding from the federal government," said Mel Kohn, director of the Oregon Public Health division. In Oregon, federal grant dollars have supported everything from tracking biological threats to training a reserve corps of emergency responders, Kohn said.
Projected federal budget cuts will impact every state in the nation, Levi said, although he noted that budget negotiations are ongoing and the details of sequestration may change. Public health departments can expect as much as 10 percent reductions in federal funding under sequestration, he said.
Levi named the National Center for Environmental Health and the Federal Emergency Management Agency as likely targets for cuts. He noted that the reauthorization of the Pandemic and All-Hazards Preparedness Act caps spending at 2011 levels, which means that funding won't keep pace with inflation. "Without sufficient resources, many provisions amount to empty gestures," Levi said of the reauthorization.
Despite the gains made since 9/11, the nation's public health emergency response system still needs improving, the report found. The report's recommendations include improving electronic surveillance capability, boosting vaccine research and development, making sure hospitals have the capacity to deal with mass casualties, and coordinating with the Food and Drug Administration to protect the food supply.
The report's No. 1 recommendation: consistent funding for public health preparedness. Otherwise, states and communities can't develop the infrastructure and expertise they need to handle emergencies when they occur, Levi said. Levi pointed to Hurricane Katrina as an example of a botched government response that could happen again if public health programs don't get the support they need. "When the next disaster strikes, we may not be ready," he said.