Connecting state and local government leaders
Hepatitis A and tax reform are more intertwined than you might think.
Local health officials are sounding the alarm about the ways in which the GOP tax reform plan, which was passed by the U.S. House on Tuesday, might jeopardize our country’s response to outbreaks of infectious disease—like the hepatitis A outbreaks happening at this very moment around the country.
The National Association of County and City Health Officials, which represents nearly 3,000 local governmental health departments, warned during a call on Tuesday with reporters that proposed tax cuts have the potential to result in the near elimination of the Prevention and Public Health Fund—a source of money that was created by the Affordable Care Act—due to automatic spending reductions triggered by the Statutory Pay-As-You-Go Act of 2010. Aside from making up 12 percent of the U.S. Centers for Disease Control and Prevention’s total funding, the PPHF makes local infectious disease response possible in several crucial ways.
The Section 317 Vaccination Program gets 53 percent of its funding from the PPHF. In fiscal year 2016, the fund made more than $611 million available to health departments to maintain immunization programs and outbreak response and control mechanisms—$324 million of that funding came directly from the PPHF.
The role these vaccine doses play when it comes time to deal with an actual outbreak is impossible to overstate.
In San Diego, vaccinations have been the centerpiece of a multi-pronged hepatitis A response. Since the outbreak was first identified in March of this year—and traced back to cases from November 2016—as many as 571 people have been diagnosed with the disease. In total, 113,230 vaccinations have been given, with 85 percent of those doses going to the people determined to be the most at-risk.
“Not having the vaccines would be a tremendous burden and limit our ability to respond to an outbreak of this nature,” said Dr. Wilma Wooten, the public health officer and director of Public Health Services for San Diego County.
“The 317 Vaccine funding is just irreplaceable,” said Dr. Jeffrey D. Gunzenhauser, the interim health officer and chief medical officer for the Los Angeles County Department of Public Health.
When L.A. County detected local transmission of hepatitis A, related to the much larger San Diego outbreak, public health officials sprang into action to put together a response. So far, the county has pulled in nearly 50,000 vaccination doses. As many as 40,000 of those were paid for through the Section 317 program. If the county had had to pay for those doses with money from its own coffers, Gunzenhauser estimates it would have cost as much as $3 million.
“Getting those local dollars in a timely manner can be very difficult,” said Gunzenhauser, “particularly when it’s competing with other priorities.” Timeliness is critical in the case of an outbreak like the one in California.
Gunzenhauser said that with the 317 Vaccine Program in place, “if I declare an outbreak … the state hears us and if they have that vaccine available, it can be with us within a day or two and I can immediately start vaccinating. But if we have to go through red tape, and it takes us two weeks or a month or more, suddenly the outbreak is at a point where we couldn’t control it.”
Beyond, vaccinations, the Prevention and Public Health Fund also supports the Epidemiology and Laboratory Capacity program, a little-known and relatively small fund that local officials say is critical to keeping on top of diseases that could do great harm. The ELC gets $40 million—as much as half of its budget—from the PPHF. Looking beyond the impact of a single disease like hepatitis A, local officials attest that having a well-staffed, well-funded local public health laboratory is vital for the safety and wellbeing of our country.
“We have so many communicable diseases in L.A. County, if I lose even a few people that are funded through that federal program it could have a serious impact on our ability to respond to outbreaks,” said Gunzenhauser. “While these dollars may seem few, from the broader scope of things, the way they play out and enable us to respond quickly to outbreaks is really what our communities need and deserve.”
Quinn Libson is a Staff Correspondent for Government Executive’s Route Fifty, based in Washington, D.C.