The Trump administration does not plan to request emergency funding from Congress to respond to the coronavirus, a frustration for lawmakers and experts who argue it is better to be overprepared than underprepared for a potential pandemic.
While only 12 cases of the coronavirus have been detected in the U.S., extra funding is needed now to help federal, state and local health officials prepare for the worst and monitor potential cases, they argue.
But the Department of Health and Human Services (HHS) Secretary Alex Azar said Friday it is too early to talk about requesting emergency funding from Congress.
“It’s premature to be talking about any additional needs for money at this point. There are still so many unknowns about the situation,” Azar told reporters, noting that two of the 12 patients in the U.S. have already completed treatment.
“We won’t let resources be any kind of barrier to response activities here but let’s not put the cart before the horse.”
Responding to and preparing for a public health emergency is costly and labor-intensive. At the CDC alone, 800 people are working on the coronavirus response, including 200 people who have been dispatched to airports, quarantine sites and states to assist with investigations of confirmed cases.
The CDC is operating on $105 million from an infectious disease rapid response fund, and its parent agency — the Department of Health and Human Services (HHS) — told Congress this week it may transfer up to $136 million from the National Institutes of Health and the Administration for Children and Families to boost funding for the coronavirus response.
HHS hasn’t said what programs at NIH and ACF would be affected by a funding transfer, but lawmakers would rather authorize new money than take from existing programs.
“Instead of transferring funds from other important HHS activities, including NIH research and Head Start, we strongly urge the administration to transmit a request to Congress for emergency supplemental appropriations to respond to this public health emergency,” House Democratic appropriators Nita Lowey (D-N.Y.) and Rosa DeLauro (D-Conn.) wrote in a letter HHS Secretary Alex Azar this week.
CDC and state and local health department staffers are monitoring and caring for hundreds of quarantined Americans who have been evacuated from Wuhan, China — the epicenter of the outbreak.
The CDC has also increased staffing levels at airports and ports of entry to screen for potentially ill passengers and has tested hundreds of specimens for the virus.
More than 31,000 cases have been confirmed in China and nearly 300 cases in other countries.
Emergency funding is needed now in case the U.S. fails to contain the disease so health departments and providers are prepared to treat surges of patients, said Jennifer Nuzzo, senior scholar, center for health security at Johns Hopkins Bloomberg School of Public Health.
“This very much looks like we’re in the midst of the pandemic so we very much have to count on the fact that the U.S. will experience cases and I think it would be utterly foolish to just wait for it to get bad before we start talking about planning and resources,” Nuzzo said.
“It’s very hard to scope how much of a response they’re going to be able to do without knowing what resources they have,” Nuzzo said of health departments.
Some state and local health departments, which experts argue are notoriously underfunded, are already incurring extra costs in areas where passengers are being quarantined and confirmed cases are being monitored.
In Riverside, Calif., where 195 evacuees are being quarantined, the county public health department and other local entities are incurring an extra $115,000 in costs per day, a spokesperson said.
The county has about 25 staff at the airbase where passengers have been quarantined and another 10 – 12 staff working on the response off-site. It is not clear if those costs will be reimbursed by the CDC.
There are no cases of the coronavirus in Seattle and King County in Washington state, but the health department is spending an extra $200,000 a week on preparedness, said Adriane Casalotti, chief of government and public affairs for the National Association of County & City Health Officials.
Most of that is going toward overtime and supplies, including masks and thermometers, and costs related to preparing and arranging for isolation and quarantine of people under investigation.
The department is also planning to hire new staff at an estimated cost of $880,000 over six months.
Meanwhile, departments are also dealing with other public health issues, including outbreaks of hepatitis A and food-borne illnesses.
The grant program, which helps health departments in all 50 states prepare for and respond to public health threats, has seen a 30 percent funding cut since 2003, despite an increasing number of public health emergencies. It has been flat-funded for the past two years at $675,000.
Azar did not indicate Friday that HHS would provide more funding to health departments dealing with the coronavirus.
“We already have significant funding to the state and local governments, to their public health departments, to build capacity for this and for these types of activities,” Azar said.
“We’ll certainly want to work with state and local governments to find if there is additional money needed from CDC. We’ll certainly work to try to be fair and find the available resources for them. But at the moment, we certainly have funded tremendous capacity for exactly this type of activity.”
Congress often approves extra funding for public health emergencies when it is asked to by HHS, as it did for Zika in 2016. But months of congressional infighting led to a delay in passing the funds, hampering prevention efforts in the states.
That experience led some lawmakers to feel more urgent about approving emergency funding at the first sign of a potential outbreak.
Members are thinking “what can we do both to better prepare ourselves domestically?” said Rep. Ami Bera (D-Calif.), whose Foreign Affairs subcommittee held a coronavirus hearing this week.
“Right now it looks like the relative risk of a big pandemic is low. But we’re watching what’s happening in China. And I think we have to anticipate the worst.”