Public health expert: budget cuts will erode response capabilities

JF: I would say the ones that worry me the most are the ones zeroing out the centers for public health preparedness in the president’s proposed 2013 budget. Then there are a few other centers in the CDC budget that are zeroed out as well. One is the education and research centers and the other is the agricultural, forestry, and fishing centers – those are two centers that are focused very strongly on occupational health and safety and by zeroing out those programs, it means you’ll see a dramatic reduction in the training of our public health workforce and occupational health and safety. You’ll also see a decline in research that’s done in that area. I’m sorry if I seem critical of the president on this, but I really do believe that the president’s professed support for the working class in this country doesn’t quite connect up very well with eliminating these two centers.

The Centers for Public Health Preparedness are also a major concern.  I know DHS is experiencing budget cuts, like so many other agencies, and I know we’re in a time where we have these budgetary issues that we have to deal with – I get that, but these programs are not consuming extraordinary amounts of money. I think the benefit that we derive from the small amount of funding that goes into these programs – the whole ends up being much bigger than just the sum of the parts here. It’s an investment in the network of prevention, especially in the area or preparedness, it’s an investment in building those connections, and it’s an investment in connecting those dots from the federal level to the local and state level. So the loss of the Center for Public Health Preparedness, for example, is a major concern to me. As I said before, in a flash you can lose preparedness that you spent a lot of time developing.

HSNW: Are there any technological developments or programs out there, in your opinion, that would be great cost savers and bolster efficacy and efficiency?

JF: One of the things that we did here in Minnesota was to really invest in e-learning infrastructure. We’ve been able to use the technology that we’ve developed through the state’s centers and grants to reach out to a three-state area. Now we don’t have to always hop in a car and drive out to rural North Dakota. We’re able to do these things online, sometimes in real-time and sometimes asynchronously.

This technology in our century really makes it possible for relatively less investment than in the analog world to reach enormous numbers of people in the public health workforce with the skills they need – not just in the long-run, but also what I call “just in time learning.” The just in time learning piece is an enormously important thing because what it means is that as new issues of preparedness emerge, the learning technology allows you to quickly respond, turn that around, and get the knowledge and training out there as rapidly as you can. This is not new, when you think of the U.S. military. They are perfectly aware of the power of just in time training and of its power to accomplish these kinds of things.

One other thing I’d like to add is here in Minnesota we’ve made some major investments at this university in a medical reserve corps. We’re probably one of the only major universities in the country that has done this. A medical reserve corps is sort of like a National Guard for public health. We basically have about 700 health science faculty, staff, and students. They range all the way from well-trained surgeons to public health students who can man phones.

The idea came about after 9/11 and we began developing it in earnest in 2003. During Katrina and Rita, we deployed four teams during the whole period of time down there. I cannot tell you how much we learned from that. Since then we’ve deployed in more localized disaster settings up in our neck in the woods. Not too long ago we deployed the medical corps for river flooding nearby as well as for the substantial flooding down in Iowa a few years ago. We actually deployed a veterinary team down there because the issue was there were quite a few farm animals threatened.

That’s the biggest problem with preparedness when you think about it is you can’t afford to maintain enormous numbers of people with nothing to do. So we’re looking for strategies where you can use existing workforces like existing faculties and students when you need to increase the public health work force in case you have some sort of major emergency or issue.

We’re here in Minneapolis, St. Paul, and a few years ago a bridge over the Mississippi collapsed. When it went down the response to that was so fast and well-coordinated –all the services here at the universities, city, and county were able to respond well. I’m absolutely convinced that the death toll from that bridge collapse would have been much higher had we not made the investment in the infrastructure in Minnesota to respond to that sort of utterly unexpected event and to respond smoothly, rapidly, and effectively. 

HSNW: Last December, the National Science Advisory Board for Biosecurity made the unprecedented move of asking journalists to censor the findings of scientists who had created an infectious new form of the H5N1 influenza virus. Was this the right move, or do you agree with critics who say this act of censorship was overly dramatic and hinders research?

JF: I have to say I agree with the original finding. Obviously this research that has been done had a very good scientific motivation — to understand from a genetic stand point what are the steps by which an organism like H5N1 can easily become easily passable from person to person. But it’s a bit of a leap of a faith for me – and I’m not a researcher in this particular area, but as a public health person, it’s a bit of a leap of faith to say, “Oh well what we were doing in the lab, even though we created the setting where this virus is much more transmissible between ferrets in an animal model, is really not lethal and not to worry.” I’m not sure I would like to take that chance at this point.

I remember in the 70s when a progressive magazine in Madison, Wisconsin published the plans to build a hydrogen bomb. It was highly controversial and everyone was afraid, but what you saw when the plan got published was you couldn’t build one in your basement. If you wanted to build a hydrogen bomb you needed an enormously expensive military-industrial complex. Initially it seemed like the nuclear genie was going to be out of the bottle and everyone would be marching into their basement to build a nuclear bomb, but you can’t do it. That is not the case with this kind of genetic work with viruses. You don’t need the same kind of very complex infrastructure to be able to do this and there are plenty of people all over the place with access to everything they need to engineer something along these lines.

Revealing the quantum level details of how to do this, I don’t see the value in that. I don’t think it would be any mystery for any good laboratory virologist for how it was done. But putting stuff like that out there does not add to our prevention knowledge per se as far as the public is concerned and probably doesn’t contribute that much to other scientists. I could be wrong. I’m not a virologist, but I did not disagree with that decision to withhold some of the key details.

HSNW: Moving forward, what do you foresee as the greatest public health challenge over the next five years?

JF: I’ve got some real concerns about the current budget proposal impacts on our ability to do public health now and in the near future. The CDC in particular has taken an enormous whack in the current budget proposals. If you look at what’s happened to it since about 2010, it’s about a 20 percent decline. That to me is really cutting past the bone – you’re getting to the point of amputation.

You can already see what the implications of that are. Some public health organizations are estimating that nationwide you are talking about the loss of 30-40,000 front line public health jobs. That means those people are not going to be there and you need them. Public health is not just about emergencies and responding to disasters, it’s about all the other aspects of chronic diseases and everything else. That helps, but it’s one of those things that an agency that is so front line engaged such as CDC will suffer a blow with the loss of people, resources, and connections with the states that it may not be able to recover for a very long time. I would say one of the huge things that confronts public health in the short term, which could have very long term consequences, is our willingness as a people to fund these important activities.

Dr. John R. Finnegan is the dean of the University of Minnesota School of Public Health