On March 1, the Chicago Department of Health was notified that an infant at a Chicago migrant shelter had tested positive for measles. Given the potential for measles to spread rapidly among unvaccinated populations living in crowded conditions, it was time for the Department of Health to mobilize.
Within 24 hoursThe city launched a mass vaccination campaign at the evacuation centers. Three days later, 882 evacuation center residents had received the measles vaccine, and an additional 784 had been confirmed to have previously received the measles vaccine. By March 11, measles vaccination coverage at the evacuation centers had jumped from 44 percent to 93 percent.
The campaign worked: More than two months after the first case, only 57 people living or working in the shelters had contracted measles. A recent study by the Chicago Department of Public Health and the Centers for Disease Control and Prevention found that the rapid mass vaccination response reduced the odds of 100 or more cases by 69 times and shortened the median duration of infection by six weeks.
As Commissioner of the Chicago Department of Public Health and Executive Director of the Metropolitan Health Coalition, which represents 35 of the largest local health departments in the country, we believe these results highlight the value of a strong public health infrastructure to support rapid response and emergency preparedness — and how public health saves lives.
But while this campaign was a complete success, it also serves as a lesson: As chronic disease rates rise and public health emergencies become more frequent and longer lasting, the federal government cannot afford to sit by and force local governments to do more with less. Congress must invest in a public health system that is worthy of the officials who run it and the Americans who depend on it.
Any discussion of public health funding in the United States must begin with just how little money there is.
in spite ofGenerateThere is a substantial return on investment, and public health and disease preventionLess than 5 centsEvery dollar spent on health care in our country129 millionEveryone in the United States has at least one chronic disease.90 percentDespite accounting for 10 percent of annual health care spending in the U.S., the CDC’s inflation-adjusted budget for chronic disease prevention and health promotion is lower than it was a decade ago.
Further exacerbating the funding shortfall is how limited funds are allocated: “boom and bust” cycles in public health funding result in funding surges when disasters occur, then disappears once the threat is perceived to have passed.
If health officials fail to pay the funds within any given deadline, Congress can and will claw back the funds.RetractionRecently enacted spending laws include more than $4 billion for COVID-19 relief. To make matters worse, Congress has often appropriated funds for disease-specific purposes rather than giving health officials more flexibility.
“Boom and Bust” Funding Doesn’t Make Sense. Take the Chicago Measles Case. responseThis has been a huge success: over 33,000 measles vaccinations administered, no cases reported since April 20, and only 64 total cases reported since March. But Chicago has not only had to rely on limited funding and resources, it has also been hindered from doing much more.
Specifically, the Chicago Department of Public Health was denied a request to reallocate $18 million in COVID-19 federal funds to combat measles. This decision has limited the city’s ability to create isolation and quarantine space and depleted adult vaccine stocks. No one wins when local and state health departments are unnecessarily hamstrung by federal regulations.
What is needed is a system that ensures public health has the funding to meet its day-to-day goals and, when necessary, pivot to rapid and effective emergency response. Congress can start by reauthorizing the Pandemic and All-Care Disaster Preparedness Act.
First enacted in 2006, the law’s funding and programs help health departments prepare for and respond quickly and effectively to public health emergencies of any kind before they occur, and they have also provided important stability during times of calm.
The next revision of this law will require the Metropolitan Health AssociationRecommendationsTo strengthen our nation’s public health system:
- Fully fundedCDC’s Public Health Emergency Preparedness Fund assists state and local health departments in responding to infectious disease outbreaks, natural disasters, and even terrorist attacks. However, funding for this fund has declined by 30% over the past 20 years. This fund should be reauthorized at its full amount of $1 billion. Similarly, CDC’s Hospital Preparedness Program should be restored to $500 million to help hospitals respond to patient surges in emergencies.
- Flexible approachLarge cities are often the first line of defense when a public health emergency occurs, but the time it typically takes Congress to act on emergency funding requests hinders our ability to act. Congress should upgrade the Public Health Emergency Fund, designed to supplement existing reserve funds, and allocate funds as soon as a public health emergency is declared.
- Long-term visionThe best time to prepare for an emergency is before it occurs. Congress should launch an adult vaccination program modeled on the highly effective Vaccines for Children program, making uninsured and underinsured adults eligible to receive vaccines recommended by the Advisory Committee on Immunization Practices at no cost. Congress should also grant the CDC the authority to require reporting of data essential to public health and emergency response.
While it is a testament to the hard work and dedication of public health officials that the vast majority of Chicago residents have been protected from measles, we also know that there will be more public health emergencies in the future.
These emergencies may be inevitable, but how we respond to them — before, during, and after — is in our hands, and we urge Congress to begin that important work now.
Dr. Olushimbo (“Shimbo”) Ige, MD, MPH, is the Commissioner of the Chicago Department of Public Health. Chrissy Juliano is the Executive Director of the Big Cities Health Coalition..
