With the recent revelation that Sen. Rand Paul — “TrumpCare’s” hardest critic — felt, after a round of golf with the president, that his wing of the Republican Party is edging closer to a deal on dismantling the Affordable Care Act (ACA), it’s important to take a look at what the nation’s medicine will lose if the effort remains alive and the wrong deal is struck.
The Department of Health and Human Service’s Prevention and Public Health Fund supports prevention programs managed by the Centers for Disease Control and Prevention (CDC) that keep people and communities healthy, safe, and secure. It was created under the Affordable Care Act (ACA) and will likely be eliminated by the next version of the Republican repeal and replace bill. It now accounts for significant 12 percent of CDC budget.
{mosads}The fund was slated for elimination by the Republican bill, and if actually cut, the programs it supports would be subject to the uncertainty of the annual appropriations process, putting every American at risk of losing its essential benefits.
This year, the prevention fund provides $931 million to public health programs. The largest share, $324 million, supports the CDC’s 317 Immunization Program, which ensures vaccines get where they are needed and are properly handled, stored and administered so they don’t lose effectiveness. It also makes vaccines available to address disease outbreaks.
Immunizations work. In the 1900s, the average number of measles cases in the U.S. each year was 530,217. In 2015, that number was 188. And immunizations save money: the CDC reports that every $1 dollar invested in vaccines saves $3 in health care costs and $10 in total costs, including lost wages and productivity.
The prevention fund also helps state and local governments develop the epidemiology and laboratory capacity to detect and respond to emerging public health threats. In Alabama public health officials are investigating avian flu outbreaks at several chicken farms.
Although H7N9 avian flu has not yet spread to humans in the U.S., the World Health Organization announced 460 cases and 78 deaths in China and Hong Kong between September 2016 and February 2017. Of great concern, the information prompted the CDC to issue a travel watch.
In 2016, public health officials in Virginia issued a warning regarding a cluster of Hepatitis A cases traced to strawberries served at a local cafe. Cases of Hepatitis A associated with this source were discovered in eight states, including as far away as California.
A focus on prevention also helps us prepare for unknown threats to our health, safety and security. As I wrote in an earlier column, “as our small planet’s population grows it increases [human] contact with animal reservoirs for serious infectious diseases, both those you heard of — HIV, Ebola, malaria, dengue fever — and those you probably haven’t — Marburg, hantavirus and hendra virus.”
We do not know from where the next public health threat will come. Two years ago, Zika was just a four-letter word. Today, with the approach of mosquito season, public health officials are preparing for a second round of Zika virus exposure.
Having the capacity to not only develop, but also deliver vaccines and other medicines in response to a public health emergency, will save countless lives. CDC dollars support communities in 50 states to detect, track and respond to infectious disease threats. In California, local public health officials used CDC funds to buy 5,000 doses of vaccine to prevent the spread of measles during the 2015 outbreak at Disneyland.
Congressman Tom Cole (R-Okla.) put it best when referring to President Trump’s budget proposal, which cuts science and health programs: “Look, CDC is as important to defending the average American as the Department of Defense. You are a lot more likely to die in a pandemic than you are in a terrorist attack. Having a robustly funded CDC, I think, is very much in the national interest.”
The CDC supports more than just detection, response and immunization programs. Funds are available to prevent and reduce harm from diabetes, heart disease and stroke, and for lead poisoning prevention. These dollars support programs in 29 states and six major cities to identify children at risk of lead exposure by inspecting homes and removing environmental threats.
In Louisiana, a pilot program tested 1,395 high-risk children. Most — 80 percent — had never been tested for lead before. It will take many years to fully understand the public health consequences of the Flint, Michigan water crisis, but we have learned clear lessons about the importance of monitoring the water supply and blood lead levels in at-risk communities across the country. Overall, the Big Cities Health Coalition of public health directors estimates that “over half a million children have blood lead levels high enough to threaten their health.”
In a letter to Congress on the proposed American Health Care Act (AHCA), the American Medical Association (AMA) wrote that it “cannot support provisions of the legislation that repeal the Prevention and Public Health Fund.” The AMA joined other medical and public health organizations that oppose the proposal to cut a program that is vital to the nation’s health, safety, and security.
We will not have the high level of health all Americans desire if we reduce our commitment to protecting Americans — and this includes the president appointing a CDC director, a critically important role. We will never put America first if we are not prepared to address public health threats that may emerge from anywhere around the globe. For America’s health security, Congress must continue to support the Prevention and Public Health Fund.
Jonathan Fielding, MD, is a distinguished professor of public health and pediatrics at UCLA. He previously served as director of public health and health officer for Los Angeles County for more than 16 years.
The views expressed by contributors are their own and are not the views of The Hill.