Q&A: U.S. Public-Health Official Protests Federal Medical-Response Cuts

A scientist works at a medical laboratory in New York City in 2011. A senior official at the Centers for Disease Control and Prevention sharply criticized a Health and Human Services Department proposal to reduce federal grants to state and local public-health agencies in fiscal 2015.
National Journal
Diane Barnes
Add to Briefcase
Diane Barnes
April 28, 2014, 10:49 a.m.

A seni­or U.S. pub­lic-health of­fi­cial has taken a stand against his de­part­ment’s latest push to cut fed­er­al funds to an ar­ray of med­ic­al-read­i­ness ini­ti­at­ives.

More than half a dec­ade of re­duc­tions to spend­ing on state and loc­al pub­lic-health agen­cies has already been “ex­tremely dam­aging” to cap­ab­il­it­ies across the coun­try for re­spond­ing to un­con­ven­tion­al at­tacks and oth­er dis­asters, Dr. Ali Khan, dir­ect­or of the Pub­lic Health Pre­pared­ness and Re­sponse Of­fice at the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, told Glob­al Se­cur­ity News­wire in an in­ter­view.

The Health and Hu­man Ser­vices De­part­ment’s latest push would fur­ther un­der­mine ini­ti­at­ives that are now “stag­nant,” Khan ar­gued.

“We used to have a $1 bil­lion pub­lic health pre­pared­ness pro­gram, [and] that is al­most two-thirds to one-half that size at this point,” said Khan, re­fer­ring to a range of pro­grams that re­ceived an in­fu­sion of fed­er­al dol­lars after the Sept. 11 ter­ror­ist at­tacks. “With every new cut, that’s few­er people at the state and loc­al health de­part­ments, and few­er sup­ports for pub­lic health sys­tems that are keep­ing people safe from daily threats.”

Re­duc­tions sought in the health agency’s fisc­al 2015 budget pro­pos­al in­clude a $28 mil­lion cut to spend­ing on the Pub­lic Health Emer­gency Pre­pared­ness grant ini­ti­at­ive. Khan de­scribed that as a crit­ic­al fund­ing source for labor­at­or­ies and spe­cial­ists needed to con­tain dis­ease out­breaks, in­clud­ing any caused in­ten­tion­ally.

Health and Hu­man Ser­vices wants to max­im­ize agency re­sources “in the cur­rent fisc­al en­vir­on­ment,” and plans to shift the grant pro­gram’s fo­cus to “cap­ab­il­ity sus­tain­ment” after spend­ing more than $9 bil­lion since 2002 to up­grade med­ic­al re­sponse ca­pa­cit­ies across the coun­try, the de­part­ment said in its fisc­al 2015 budget jus­ti­fic­a­tion for the Cen­ters for Dis­ease Con­trol.

Khan, though, said many of those up­graded cap­ab­il­it­ies have already withered after pri­or rounds of cuts.

“This money is really sliced and diced very thinly already” among thou­sands of loc­al health agen­cies, said the vet­er­an Cen­ter ad­viser on bio­lo­gic­al ter­ror­ism threats. The grant pro­gram would re­ceive $617 mil­lion in the com­ing budget cycle un­der the Health and Hu­man Ser­vices pro­pos­al.

Oth­er tar­gets of the de­part­ment’s spend­ing re­duc­tions in­clude the Stra­tegic Na­tion­al Stock­pile, which main­tains med­ic­al treat­ments across the United States for re­spond­ing to po­ten­tial strikes in­volving weapons of mass de­struc­tion. Khan’s of­fice man­ages the pro­gram, which would see its fund­ing drop by $8 mil­lion un­der the health agency’s pro­pos­al for fisc­al 2015.

Khan as­sumed his cur­rent po­s­i­tion in Au­gust 2010, after hold­ing a range of posts that in­cluded as­sist­ant sur­geon gen­er­al and deputy dir­ect­or of the Na­tion­al Cen­ter for Emer­ging and Zo­onot­ic In­fec­tious Dis­eases. He joined the Cen­ters for Dis­ease Con­trol in 1991, after ob­tain­ing a med­ic­al de­gree from Down­state Med­ic­al Cen­ter in Brook­lyn, NY.

Khan spoke to GSN by tele­phone from the Cen­ters for Dis­ease Con­trol headquar­ters in At­lanta. Ed­ited ex­cerpts of the March 24 in­ter­view fol­low:

GSN: What chal­lenges has your of­fice faced in com­mu­nic­at­ing with the pub­lic about pre­par­ing for bio­lo­gic­al and oth­er un­con­ven­tion­al at­tacks?

Khan: “¦ Chem­ic­al and bio­lo­gic­al ter­ror­ism [is] an ex­tant threat “¦ but we try not to be that fo­cused on single threats for pre­pared­ness ef­forts. We really need to think about an all-haz­ards, all-com­munity ap­proach.

We need to make sure our com­munit­ies are pre­pared for pan­dem­ics, nat­ur­al dis­asters and ter­ror­ism, wheth­er it’s chem­ic­al, bio­lo­gic­al, [ra­di­olo­gic­al and nuc­le­ar] ter­ror­ism or oth­er forms of ter­ror­ism. And all of that [should be] laid on a found­a­tion of strong pub­lic-health and com­munity-re­si­li­ence sys­tems that can be scaled up for these dis­asters.

Our chal­lenge is to help our com­munit­ies un­der­stand “¦ that [pre­pared­ness] isn’t just the role of the feds. That’s the role of the state and loc­al health de­part­ments, that’s the role of the private in­dustry, that’s the role of the non­profits, and it in­cludes the role of an in­di­vidu­al in their pre­pared­ness. “¦

If some­body “¦ is in­di­vidu­ally pre­pared and their fam­ily [is] pre­pared, it al­lows the re­sponse com­munity to fo­cus on those people who un­for­tu­nately may not be pre­pared. “¦

GSN: Has the lack of a high-pro­file un­con­ven­tion­al at­tack in re­cent years factored in­to CDC’s com­mu­nic­a­tions strategy?

Khan: No, only if you think that our pre­pared­ness and read­i­ness pro­grams are just wait­ing around for something to hap­pen — for an im­pro­vised nuc­le­ar device or something — but we just had a pan­dem­ic in 2009 with H1N1, we just had a num­ber of na­tion­al storms, we just had a num­ber of ex­treme weath­er events.

There are nu­mer­ous routine pub­lic-health threats [such as] measles and mumps out­breaks in New York City [and] hep­at­it­is out­breaks. “¦ So it’s im­port­ant for us to re­mind our com­munity of those and use those as the ful­crum to get people to be pre­pared.

GSN: What emer­ging pub­lic health threats should the U.S. pub­lic be more aware of?

Khan: From an in­fec­tious-dis­ease stand­point “¦ a new flu strain al­ways re­mains a threat. So [do] oth­er eas­ily spread res­pir­at­ory vir­al dis­eases, such as coronavir­uses. There’s a new one cur­rently in the Middle East. And just knock­ing on our door is chikun­gun­ya vir­us out of the Carib­bean right now that po­ten­tially could be spread through the United States.

From a [de­lib­er­ate-use] stand­point, there’s a couple of patho­gens that worry us. “¦ At the top of that list [are] an­thrax and small­pox, but it also in­cludes oth­er agents such as plague and tu­lar­emia and botulism. [And] some of the vir­al hem­or­rhagic fevers are usu­ally in the top list of agents that we worry about and have taken sig­ni­fic­ant pre­pared­ness steps [against]. “¦

GSN: Is the CDC con­sid­er­ing any new op­tions for use of stock­piled an­thrax vac­cine near­ing ex­pir­a­tion, giv­en the slow pro­gress of an ini­ti­at­ive to dis­trib­ute such vac­cine to first re­spon­ders?

Khan: “¦We are work­ing with our col­leagues in [the Home­land Se­cur­ity De­part­ment] who are put­ting to­geth­er a pro­gram to think about how do they po­ten­tially vac­cin­ate an in­ter­ested first re­spon­der, but that’s in­de­pend­ent of the con­cern about ex­pired vac­cine.

They’re try­ing to do the right thing, and we’re try­ing to help them “¦ to provide vac­cine for those who may be in­ter­ested. “¦

GSN: How do you ex­pect pub­lic health pre­pared­ness to be af­fected by cuts sought in the fisc­al 2015 budget to the Pub­lic Health Emer­gency Pre­pared­ness Grant Pro­gram?

Khan: There are sig­ni­fic­ant cuts to pub­lic health pre­pared­ness mov­ing for­ward. This is not new; there have been on­go­ing cuts for the last six or sev­en years. We used to have a $1 bil­lion pub­lic health pre­pared­ness pro­gram, [and] that is al­most two-thirds to one-half that size at this point. And the data is pretty clear already, even without new cuts.

People are al­ways wor­ried what are the next set of cuts go­ing to do to you, and I would rather talk about what the cur­rent set of cuts have already done to us as a na­tion. If you look at ob­ject­ive, quant­it­at­ive meas­ures of pre­pared­ness, we can say un­equi­voc­ally that pre­pared­ness ef­forts in the United States are stag­nant, [or] are on the de­cline. “¦

The [Na­tion­al Health Se­cur­ity Pre­pared­ness In­dex] is the first nov­el meas­ure­ment scheme in the United States to give you a com­pos­ite meas­ure of what pre­pared­ness looks like at a state level. “¦

You can go look at those rat­ings between 6.9 and 8.2 [on a scale of 10] of where our vari­ous states “¦ are with­in five do­mains [health sur­veil­lance; com­munity plan­ning and en­gage­ment; in­cid­ent and in­form­a­tion man­age­ment; surge man­age­ment; and coun­ter­meas­ure man­age­ment] to make the point that we don’t think we’re fully pre­pared in the United States. “¦

The state and loc­al read­i­ness pro­gram “¦ is about mak­ing sure that states and loc­al pub­lic health de­part­ments have the tools, the people, the sys­tems, the boots on the ground that they need “¦ to re­spond to their daily pub­lic health threats and to be able to scale up for un­pre­dict­able or large threats. “¦

We have very good data on [15 pre­pared­ness cap­ab­il­it­ies] to show you that those are stag­nant also.

This is with cur­rent cuts, so don’t even be­gin to ask me [about] the im­pact [of] ad­di­tion­al cuts on our state and loc­al health de­part­ments, where we take this small amount of money, we divvy it out between the states, the cit­ies and ter­rit­or­ies, and they in turn divvy it out between any­where between 2,000 to 3,000 loc­al health de­part­ments or county health de­part­ments. This money is really sliced and diced very thinly already. “¦

At its height, we had unique things hap­pen in pub­lic health that we had nev­er seen, and I have the ad­vant­age of help­ing to put this pro­gram to­geth­er back in 1999 to see how far we’d come. You know, loc­al health de­part­ments didn’t even have com­puters, and we had this won­der­ful thing 10 years ago called the fax ma­chine that we were try­ing to pur­chase for many loc­al health de­part­ments. “¦

But county health de­part­ments all of a sud­den had epi­demi­olo­gists to in­vest­ig­ate out­breaks that they oth­er­wise wouldn’t have had. We have state health de­part­ments that built “¦ labor­at­ory sys­tems and their dis­ease-de­tec­tion sys­tems on these dol­lars.

And these dol­lars are used “¦ every day in our pub­lic health com­munit­ies to keep Amer­ic­ans safe from pub­lic health threats, so these are the routine set of re­sources they’re us­ing for their dis­ease de­tec­tion and re­sponse ef­forts and even some of our spe­cial­ized re­sources. “¦

[This in­cludes] the work we do with the Stra­tegic Na­tion­al Stock­pile to make sure that we have points of dis­pens­ing for something like an an­thrax at­tack, and they use these points of dis­pens­ing for vac­cine cam­paigns across the United States. “¦

Botulism oc­curs all the time in the United States, and when they need an­ti­tox­in it comes from the Stra­tegic Na­tion­al Stock­pile. That’s an­oth­er little ex­ample.

We’ve [also] provided fed­er­al med­ic­al sta­tions from the Stra­tegic Na­tion­al Stock­pile to vari­ous “¦ nat­ur­al dis­aster re­sponses over the years. “¦

[The cuts] have been ex­tremely dam­aging to date. “¦ With every new cut, that’s few­er people at the state and loc­al health de­part­ments, and few­er sup­ports for pub­lic health sys­tems that are keep­ing people safe from daily threats. “¦

In ad­di­tion to cuts to the state and loc­al pro­grams “¦ we’re cut­ting [fisc­al 2015 funds] to aca­dem­ic cen­ters, so we’re cut­ting a lot of the work that looks at [how] to use the lim­ited dol­lars we have to get the most out of our com­munit­ies from a pre­pared­ness stand­point and from a re­sponse-and-re­cov­ery stand­point.

GSN: Last year’s fed­er­al gov­ern­ment shut­down res­ul­ted in a sus­pen­sion of CDC in­spec­tions at Biosafety Level 3 and 4 fa­cil­it­ies. What level of risk did you see in that sus­pen­sion?  Have there been oth­er con­cern­ing im­pacts from fluc­tu­ations in fund­ing avail­ab­il­ity?

Khan: Our pro­gram was ex­tremely re­spons­ible dur­ing the fur­lough [be­cause] this was a na­tion­al-se­cur­ity is­sue. “¦ They did sus­pend a large num­ber of in­spec­tions they’ll have to make up at this point, but they were still avail­able for any act­ive con­sulta­tion that labs needed around biosafety and bi­o­se­c­ur­ity is­sues. “¦

This is the crit­ic­al pro­gram of the United States that makes sure that any­body that has, uses or trans­fers some of the most deadly patho­gens in the world is un­der reg­u­lat­ory over­sight “¦ [and it] con­tin­ues to evolve all the time. “¦

GSN: A re­cent New­s­week art­icle made the case that the pro­lif­er­a­tion of bio­lo­gic­al-de­fense labs over the last dec­ade poses a great­er pub­lic health threat than the danger of de­lib­er­ate and nat­ur­al out­breaks that such fa­cil­it­ies are in­ten­ded to counter. Speak­ing broadly, what is your ar­gu­ment against the idea that the cure is more po­ten­tially de­struct­ive than the prob­lem it was de­signed to ad­dress?

Khan: There’s prob­ably noth­ing more safe — or few things safer in the United States — than re­search on these patho­gens, thanks to the joint [U.S. Ag­ri­cul­ture De­part­ment-Cen­ters for Dis­ease Con­trol] Se­lect Agent Pro­gram that mon­it­ors these labor­at­or­ies. “¦

If you have the patho­gen — if you use it, or if you trans­fer it — that’s all cur­rently reg­u­lated by the USDA and [CDC]. These are fa­cil­it­ies that are mon­itored, in­di­vidu­als who work on these patho­gens are mon­itored, the nature of the work that they do is very closely mon­itored. Every year “¦ they have con­crete meas­ures of how well they’ve done. “¦

So there’s really great data on “¦ how ef­fect­ive these pro­grams have been in mak­ing sure that all of this re­search is done very, very re­spons­ibly. [The] New­s­week art­icle didn’t pick up … how re­spons­ible this work cur­rently is.

Cor­rec­tion: This art­icle was up­dated at the re­quest of Khan’s of­fice to cla­ri­fy his de­scrip­tion of agen­cies ad­min­is­ter­ing the U.S. Se­lect Agent Pro­gram.

What We're Following See More »
Trump to Hill Next Tuesday
40 minutes ago
Longtime Progressive Members Pushed Out at DNC
1 hours ago

"A shake-up is underway at the Democratic National Committee as several key longtime officials have lost their posts, exposing a still-raw rift in the party and igniting anger among those in its progressive wing who see retaliation for their opposition to DNC Chairman Tom Perez. The ousters come ahead of the DNC's first meeting, in Las Vegas, Nevada, since Perez took over as chairman with a pledge this year to unite a party that had become badly divided during the brutal Bernie Sanders-Hillary Clinton 2016 primary race."

FDA Approves Personalized Cancer Therapy
2 hours ago
Rep. Tiberi Confirms Resignation Report
4 hours ago

In a statement, Rep. Pat Tiberi (R-OH 12) confirmed a New York Times report that he would resign to lead the Ohio Business Roundtable. "While I have not yet determined a final resignation date, I will be leaving Congress by January 31, 2018."

Unemployment Claims Fall to Lowest in 44 Years
4 hours ago

"The number of Americans collecting unemployment benefits fell last week to the lowest level" since March 1973. According to the Labor Department Thursday, "claims for jobless aid dropped by 22,000 to 222,000." Additionally, "the less volatile four-week average slid by 9,500 to 248,250, lowest since late August."


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.