U.S. ill-prepared to handle widespread disease outbreak

WASHINGTON – Having defeated the scourges of smallpox, tuberculosis and polio, U.S. Surgeon General William Stewart confidently told Congress in 1969 that it was time to “close the books on infectious diseases.”

Within a few years, U.S. public health research, funding and manpower, especially at the National Institutes of Health, shifted largely from infectious diseases to chronic ones such as cancer, heart disease and stroke. Federal public hospitals that specialized in infectious diseases closed as the number of infectious disease courses at public health schools were slowly scaled back.

Decades later, as the nation prepares for a potential avian flu outbreak, those policy changes and complacency in the fight against public health threats have helped to make the United States even more vulnerable to a pandemic.

The 3,000-plus state and local health agencies that would be charged with monitoring and containing a bird flu outbreak aren’t up to the challenge because of poor funding, poor staffing and a decades-long retreat from infectious disease prevention and control.

“We’re not even staffed at even half the level we need to manage our day-to-day outbreaks and events in this country, let alone a challenge like pandemic flu,” said Dr. Rex Archer, the director of health for Kansas City, Mo., and the president of the National Association of County Health Officials.

And despite Stewart’s belief that infectious diseases were no longer a public concern, the emergence of 34 new infectious microbes since 1973 says otherwise.

“Today we face a double jeopardy from both chronic and infectious diseases, but because we forgot the public health lessons of the past, we tore down the infrastructure” that could help counter the avian flu, said Dr. Susan Blumenthal, a former U.S. assistant surgeon general.

President’s Bush’s call for $7.1 billion to prepare for the bird flu is a good start, but doesn’t go far enough, health experts say.

“What we’re failing to understand is that we need consistent long-term funding that maintains a flexible, adaptable (public health system) that can respond to all health threats,” said Laurie Garrett, the Pulitzer Prize-winning author of “The Coming Plague.” “We just haven’t been able to hold a thought in our head long enough to look at this the right way.”

With a nation on edge and lawmakers trying to avert a flu pandemic that could claim millions of U.S. lives, experts say it’s time to push for that investment.

“There’s a wave here and we should ride it,” said Georges Benjamin, executive director of the American Public Health Association. “It’s a terrible tragedy that’s potentially there, but we should use it as an opportunity to address what we believe are long-standing areas of neglect in rebuilding the public health infrastructure.”

The U.S. public health system is made up of state, federal and local government employees as well as private-sector professionals. Their main goal is preventing disease and disability in entire populations, rather than in individuals. States are primarily responsible for public health services, but federal funding plays an important role as well.

A 2003 report, “The Future of the Public’s Health,” by the Institute of Medicine found that the nation’s “governmental public health agencies, the backbone of any public health system, suffer from grave underfunding, political neglect and continued exclusion from the very forums in which their expertise and leadership are most needed to assure an effective public health system. This calls for urgent action.”