In a report issued a year ago, the Centers for Disease Control pointed out that its budget for public health preparedness -- an effort that "improves the ability of federal, state, and local public health authorities to prepare for and respond to all types of public health threats," including Ebola -- had been cut by $1 billion since its height in 2002, not accounting for inflation.
Furthermore, the part of that budget that supports emergency preparedness at the state and local level -- the front lines of public-health efforts to monitor and contain disease -- has been cut by almost half since 2006. Citing the chart below, the report warned that "CDC continues to work with reduced financial resources, which similarly affects state, local, and insular area public health departments. These and other funding decreases have resulted in more than 45,700 job losses at state and local health departments since 2008."
The impact of federal cuts has been especially significant in states such as Georgia, which don't fund their own public health programs very well.
A similar story has played out at the National Institutes of Health. A year ago, NIH Director
that the additional $1.7 billion in budget cuts imposed on his agency could have profound implications, especially in research into areas such as influenza, which in recent years has killed anywhere from 3,000 to 49,000 Americans annually.
"If you want to convert this into real meaningful numbers, that means people are going to die of influenza five years from now because we don't yet have the universal vaccine," he told Sam Stein at Huffington Post. "And God help us if we get a worldwide pandemic that emerges in the next five years, which takes a long time to prepare a vaccine for. If we had the universal vaccine, it would work for that too."
Among other programs slashed over the years was research into a vaccine against the Ebola virus. Private industry isn't going to fund that work; there didn't seem to be enough of a market for it. Even Z-Mapp, the experimental drug regimen that shows some promise in treating Ebola, is the product of NIH-funded research, and according to Collins, that effort would be much further along if budget cuts hadn't interfered.
"NIH has been working on Ebola vaccines since 2001," Collins said last week. "It's not like we suddenly woke up and thought, 'Oh my gosh, we should have something ready here'. Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would've gone through clinical trials and would have been ready."
That's a sobering thought, or at least it ought to be. Unfortunately, substantive, fact-based discussions of the current situation continue to be drowned out by the panic-mongers in the media and in politics. For example, the self-appointed experts on public health at Fox News continue to insist that they know how to approach Ebola better than the men and women who have spent their entire adult lives studying and dealing with disease outbreaks.
Just last night, Bill O'Reilly made it explicit, informing America that "It's MY job to keep (the outbreak) small; It's my job to look out for the folks," and insisting that the man who has officially given that task, CDC Director Tom Frieden, ought to resign. Why? Because he dares to disagree with O'Reilly.
"Resign!" O'Reilly yelled indignantly into the camera. "Have a little dignity, Frieden! Have a little dignity! You're misleading the American public!"
O'Reilly also complained that Frieden refuses to appear on his show. "He will not because he is afraid," O'Reilly said. "He knows that I know that he's not being candid, that he is spinning the situation and is not being forthcoming about how the disease is being spread." Dr. O'Reilly was not specific about the special insight that he possesses about Ebola's transmission methods.
Frieden, on the other hand, has a medical degree from Columbia University and as a post-graduate studied infectious diseases at Yale. He has led highly successful efforts to control outbreaks of tuberculosis in New York City and later in India, where programs that he helped to institute are credited with saving more than a million lives. He has also led successful efforts to reduce smoking and HIV transmission. So given the task that he faces, I suspect that Frieden has better things to do than go on Fox News to be lectured to about public health by a preening, self-aggrandizing blowhard whose primary concern is his own self-importance.
The problem is that through such histrionics, O'Reilly and others may succeed in hijacking control of a public-health challenge and giving it instead to politicians who underinvested in prevention and are now eager to play to public panic and fear. That kind of political interference, with government officials overriding or ignoring the advice of the experts, has already undermined efforts to control the disease in Liberia and other West African nations. Containment has been further hampered by amateur experts who spread disinformation about the disease and how it can best be fought, undermining public faith in steps that have been proved to work if implemented.
And once that faith is lost, controlling the disease becomes immensely more complicated.
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