Protect a national treasure: The US Public Health Service

In congressional testimony in March 1999, Michael Lord, then the executive director of the Commissioned Officers Association of the U.S. Public Health Service, told the Senate Subcommittee on Public Health that “the threat of bioterrorism is a serious one and the federal government must have a clear, coherent and coordinated plan to deal with potential incidents that could impact upon the safety and health of large numbers of Americans.”

Although there is no evidence that the coronavirus pandemic was caused by a bioterror event, Lord’s testimony now seems prescient. One could easily argue that the coronavirus equates to a biological attack, since it clearly impacts the safety and health of most Americans. As our president and other leaders have said, we are at war, albeit with an invisible enemy. There have been a large number of casualties, with many more to follow.

The doctors, nurses, technicians and other medical professionals who are fighting the coronavirus have earned every bit of the recognition they have received. There is another cadre of medical professionals — a little known group of public servants — also in harm’s way, helping to wage this battle. They come from the U.S. Public Health Service Commissioned Corps (USPHS), one of the nation’s eight uniformed services. The Corps today is relatively small — 6,100 full-time, highly qualified public health professionals — just as it was in 1999 when Lord testified before Congress about the threat of bioterrorism.

Of those 6,100 professionals, nearly 1,500 have deployed in support of nationwide efforts to help mitigate the coronavirus’s spread in the U.S. Their support ranges from a clinical trial to evaluate the safety and efficacy of an investigative antiviral drug in hospitalized adults diagnosed with COVID-19 to working with the U.S. Army to augment the clinical staff at the 1,000-bed temporary hospital at the Javits Convention Center in New York.

Since its creation nearly 150 years ago, the Commissioned Corps has become a public health leader by promoting prevention initiatives, health education programs, environmental health techniques and various research forms. Members have served in every war since Woodrow Wilson made the USPHS part of the military during World War I — World War II, Korea, Vietnam, Iraq and Afghanistan. Dr. Anthony Fauci, who we have all come to know from the daily White House briefings on COVID-19, is an alumnus of the Commissioned Corps.

The USPHS role in medical research in the biological and chemical arenas is exceptionally noteworthy. Former Surgeon General C. Everett Koop said “expertise which is resident in the Corps [USPHS] to deal with biological and chemical agents is a critical resource that can be called upon in the event of a terrorist attack.”

But as the saying goes in Washington, “No good deed goes unpunished.” Over the past several years, there have been numerous attempts to cut the funding of the Corps — most recently in the administration’s 2019 budget proposal. The language in the proposal said the Corps’ mission assignments and functions have not evolved in step with the public health needs of the nation. The proposal said the Department of Health and Human Services (HHS) is committed to providing the “best public health services and emergency response at the lowest cost, and is undertaking a comprehensive look at how the Corps is structured.” 

There were no specifics as to how this analysis would be done or what the final result would be. However, Washington hands know what “response at the lowest cost” means — cut and slash.

In a subsequent document — Delivering Government Solutions in the 21st Century: Reform Plan and Reorganization Recommendations — the Office of Management and Budget (OMB) said the number of USPHS officers should be cut by 38 percent from 6,500 to 4,000, making the USPHS officer corps “leaner and more efficient.” OMB examiners told USPHS the proposed cuts were not based on any recent study or analysis. Instead, the proposals evolved from a 22-year-old GAO report rejected by HHS when it was released in 1996.

The OMB examiners told USPHS representatives there was no study that suggested 4,000 was the right number for the Corps. Would anyone with any degree of rationality suggest that cutting the Army, Navy, Air Force or Marine Corps by 38 percent would result in a force that is more efficient? Leaner, yes. But there is no organization that can do more with less, regardless of what a bumper sticker may say.

Today, 1,500 USPHS officers have left their agencies and the locales they serve to fight the coronavirus. It is certainly worth contemplating what our national situation would be if the OMB’s proposed cuts in the number of USPHS officers had been carried out. It certainly would not be better than it is today.

The USPHS has made major accomplishments in the area of disease eradication (e.g., smallpox) and identification of deadly viruses (e.g., AIDS, Ebola, Lassa and Marburg). It can deploy as well. Officers of the Commissioned Corps often serve where others choose not to go. 

Until now, perhaps, we may have taken public health for granted, paying attention only when a new disease breaks out. We owe our high standard of public health to the Surgeon General and the dedicated professionals of the USPHS — individuals such as Dr. Fauci.

Among the many lessons we should take away from our current crisis is that the USPHS Commissioned Corps is a national treasure that must be protected.

Tom Jurkowsky is a retired Navy rear admiral and a board member of the nonprofit Military Officers Association of America, which advocates for a strong national defense and for military service members. The Commissioned Corps of the U.S. Public Health Service is one of the eight services MOAA represents.