Zika virusU.S. response to Zika: Fragmented and uneven

By Scott L. Greer

Published 7 September 2016

How is the United States responding to Zika? CDC is doing what it can to support efforts to halt disease transmission and support state and local government. But on 30 August CDC director Tom Frieden announced that the agency had almost run out of money to fight the virus. Congress has yet to pass a funding bill, leaving the Obama administration to redirect money earmarked for other purposes to support Zika research and response efforts. The response so far seems fragmented, and even somewhat contentious – not unlike the response to the Ebola crisis in the United States in 2014. The response to that public health crisis was shaped by the fragmented and partisan U.S. political system, not by epidemiology or medicine.

Scott Greer, University of Michigan // Source: umich.edu

On 1 September, officials in Florida reported that mosquitoes carrying the Zika virus had been found in Miami Beach. The Florida Department of Health reports forty-nine non-travel related cases of Zika. There are almost 2,700 cases of travel-associated cases in the continental United States. Things are worse in the U.S. territories, where more than 14,000 locally acquired cases have been reported.

So, how is the United States responding to Zika? The Centers for Disease Control and Prevention is doing what it can to support efforts to halt disease transmission and support state and local government. But on 30 August CDC director Tom Frieden announced that the agency had almost run out of money to fight the virus. Congress has yet to pass a funding bill, leaving the Obama administration to redirect money earmarked for other purposes to support Zika research and response efforts.

The response so far seems fragmented, and even somewhat contentious. So why is that? We can look back to the Ebola crisis in the United States in 2014 for some answers. As my colleague Phillip Singer and I found in a case study, the response to that public health crisis was shaped by the fragmented and partisan U.S. political system, not by epidemiology or medicine.

How does public health in the U.S. actually work?
The United States is a tremendously fragmented political system, with about 90,000 local governments, in addition to the fifty states and federal government. Local public health policy is mostly overseen, created, and funded at the state level.

And public health work from disease surveillance to health education to mosquito abatement is done by local governments and nonprofits that work with them. These include safety net health care facilities, mosquito abatement agencies (whose very presence is patchy), social services agencies and so on.

However, public health at the state and local level is often underfunded. If disease threats seem more distant, state and local governments may assume that there will be no threats or that the federal government will help them out if something does happen. Recessions are especially likely to lead to reduced funding in areas like clinics for the poor or mosquito abatement.