CDC Faces Financing Challenges, Impacting Local Health Departments
A disease intervention specialist, a crucial player in the public health system, currently working on contact tracing, screening, education, and treatment for individuals battling health issues, recently found themselves in the thick of things. They successfully located a woman, guided her back into reproductive health care, and initiated her syphilis treatment to ensure her health and prevent serious complications for the fetus.
The director of a public health agency spoke to CNN, stating, "These are individuals who take the time and have the motivation to come home and offer the support that their community needs. It's hard to quantify that value. That's the crux of the public health crisis." Funding for programs like these isn't provided by doctors, insurance companies, or other parties.
Recently, the Centers for Disease Control and Prevention (CDC) shared with CNN that it anticipated a loss of approximately 1.3 billion US dollars following negotiations on the national debt ceiling. The Congressional Budget Office previously estimated the CDC would suffer losses close to 1.5 billion US dollars, but the specifics of the savings are under current analysis.
As the five-year financing period stretched out, the Texas Department of Health Services had no choice but to recently employ four new disease intervention specialists – the first such hires in decades.
"These contracts have already been signed. I believe that every impact (from the Fiscal Responsibility Act) will have an effect on future budgets," the health commissioner said, requesting anonymity as none of their employees were informed about the cuts. "It takes a long time to train a DIS (Disease Intervention Specialist). They're just starting to make a difference once they've cleared the backlog of cases in their district. The thought of losing them is really frustrating."
Further cuts centered on a federal grant for state-wide funding of disease intervention specialists throughout the country. These grants were among the first to be eliminated, resulting in a loss of more than 400 million US dollars.
The 50-year-old Texas health system is already dealing with anemic finances and has incurred considerable losses during the COVID-19 pandemic.
"These funds are actually used to fill in the gaps, and we simply take them out or create larger gaps," Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, commented.
Preliminary data from the CDC reveals that routine immunization rates for incoming kindergarteners have dropped from 95% in the school year 2019–2020 to 93% in 2021–2022. This strands approximately 275,000 American children without complete immunizations, increasing their risk of disease outbreaks such as measles.
The CDC reported more than 2.5 million cases of sexually transmitted infections in the United States during 2021, representing an 7% year-over-year increase. Syphilis cases have skyrocketed by 32%, with alarming rates of congenital syphilis infections, transmitted from mother to child while the baby is developing in the womb, affecting 220 pregnant women and their newborns in 2021.
"It's as if the ground has been wiped out from under our feet," Elizabeth Finley, communications director for the National Alliance of STD Directors, stated.
The rising incidence of congenital syphilis is a major concern in the field of sexually transmitted infections. "We will be focusing on preserving medication and biomedical tools to carry out our mission," Finley said, referring to Bicillin – an antibiotic in short supply for syphilis treatment.
"Then we'll be thinking about losing our on-site jobs, and if we see those price tags go up, we really feel like our hands are tied," she added.
In late June, CDC representatives sent a letter to recipients announcing the loss of funding for sexually transmitted infection prevention programs.
"We are aware of how important this funding is for the programmatic response of our nation to infectious diseases, including sexually transmitted infections (STIs), and the impact of losing these funds during this critical time will only intensify," reads the letter. "As a resilient field, we know that our resilience will allow us to continue driving scientific and technological innovation."
The letter mentions that the nation's infrastructure for combating sexually transmitted infections has eroded in the past two decades, and the pro-capita purchasing power has decreased by 46%.
As a result of the recent funding cuts, Illinois will be forced to eliminate 94 positions for disease intervention specialists, with 58 cuts coming from local health departments. In Delaware, federal funding support for three HIV prevention contractors who conduct outbreak investigations and provide follow-up care, as well as a state laboratory director, was lost. Utah faces millions in lost federal funding, with nearly all the money allocated for the payment of public health workers.
"This is a devastating blow for the STI community, the workforce, and the public," the Utah Department of Health told CNN regarding the cuts. "It's expected that STIs will continue to rise, if these funds are eliminated, potentially leading to uncontrollable caseloads and disease burden."
Last month, the CDC sent another letter notifying parties of reductions in the immunization program. This week, state health agencies and other grantees are expected to receive further details. The funds aid personnel in improving the accuracy of immunization data submitted by healthcare providers and system maintenance.
In 2020, the CDC kicked off a multi-year, billion-dollar project focused on data modernization. Enhanced data exchange is a significant part of the agency's restructuring initiative, proposed by former CDC director Dr. Rochelle Walensky in 2021.
Some interest groups remain optimistic about the possibility of reallocating funds or finding alternative resources to maintain crucial public health programs.
"The local health department leaders in Texas have not yet informed all the department's staff about the layoffs," CNN reported. The hope is that other grants and state support can be combined without layoffs or cuts.
Almost 50 public health organizations called on CDC Director Dr. Mandy Cohen to repurpose unallocated funds at the end of the fiscal year to restore some of the funding lost for disease intervention specialists. "This team played a life-saving role during COVID-19, helping affected communities respond quickly to the monkeypox outbreak last year and continue to address rising rates of congenital syphilis," the letter states. "Without success for the DIS workforce, without investment, our nation will not be prepared to respond to current outbreaks of infectious diseases and deal with future unknown threats."
The CDC highlighted other funding sources that continue to exist and are well-financed, including the Public Health Infrastructure Grant, which provides nearly 4 billion US dollars for supporting personnel development, data modernization, and foundational skills.
"Covid-19 supplemental funding is not the only source of funding for state immunization systems and workforce development," CDC spokesperson Kathleen Conley told CNN.
Despite the optimism among some, many are disheartened by the cuts in public health funding, especially those of such a significant magnitude.
"We haven't been successful in planning the money to support our local health departments at their best moments, not to mention during a crisis this historic that has cost over a million lives," Freeman commented. "During the COVID-19 crisis, it feels like making things worse."
"The health department is working hard on recovery, but it now faces challenges due to some of these decisions," Freeman added. "It's frustrating, and it really feels like it's spearing us in the back."
Experts stress collaboration as the foundation of public health, and funding cuts exert pressure on the heart of the operation.
"We unfortunately have to witness the erosion of community trust in public health and, at this point, it's more important than ever to restore it," Hamilton said. "Public health often serves as a safety net that communities see and need to see. With financial resources, we provide a service that people can trust."
