Zika virus

NATIONAL. Congress Took 233 Days To Respond. Here’s How To Prepare For The Next Zika (Health Affairs)

Barbara Ferrer

October 27, 2016

Dr. Ferrer is a member of the Coalition's Alumni Council, as the Former Director of the Boston Public Health Commission. This blog originally appeared on HealthAffairs.com.

Congress recently passed federal funding for the nation’s response to the Zika virus, and the manner in which they provided those funds exposed a serious flaw in the way our nation handles disease outbreaks. In the time between the White House’s initial request for funding in February and the passage of the bill in September, the outbreak escalated dramatically, nearly unchecked by federal lawmakers. The entire process took a grand total of 233 days, which is simply far too long. It did not need to be this way.

Failure To Act

Over the spring and summer, the Zika virus infected more than 3,300 Americans in the states and almost 20,000 in the U.S. territories. While members of Congress effectively sat on their hands, in addition to ongoing transmission from international travel, thousands of pregnant women were infected with the Zika virus in Puerto Rico, and Miami residents were infected in their own backyards. Babies are now tragically being born with microcephaly, a birth defect that often damages a child’s brain in such a way that it creates lifelong debilitation.

As the number of infected Americans mounted and the pregnancies at risk continued to grow over nine long months, Congress still did not act. In fact, the federal government effectively cut local health department budgets by nearly 7 percent in the midst of this crisis. This approach is emblematic of Washington’s record of significantly underfunding America’s public health system. For example, funding for public health preparedness has shrunk by more than 30 percent over the last decade and hospital preparedness funds have been slashed by more than half. Dismantling critical infrastructure does not put us in a strong position to effectively fight major outbreaks like Zika, and we will continue to be at risk until state and local health departments are routinely funded.

Quite simply, we need a way to enable quicker responses to acute disease outbreaks. Due to modern travel patterns and climate change, these viruses can find a way to jump borders and oceans with greater speed than in the past. If we are not under siege in the coming months from a known foe like pandemic flu, we should expect to be hit again soon by an emerging disease, like Zika or Ebola. Relying on a legislative body that takes months to respond is not an effective plan.

A Better Funding Mechanism For Rapid Response

Members of Congress finally addressed Zika, but now they must prepare the nation for the next emergency. We could save countless lives if instead of letting each new infectious outbreak turn into a political football, we created a sound funding stream for public health that can be activated swiftly and appropriately by the executive branch, instead of a vast legislative body like Congress. This solution actually already exists, and it is an essential tool that Washington has nearly forgotten: the Public Health Emergency Fund.

This fund could give state and local health departments a crucial running start when an outbreak hits. The problem is that it’s almost empty, with a measly $57,000 remaining, and there are no concrete plans to replenish it. None of the $1.1 billion Congress set aside for Zika will be directed to restoring it, and there is no annual appropriation for this fund either.

If this fund is financed appropriately and is readily accessible to critical health decision makers in the executive branch, we would be better able to respond to public health disasters that demand quick action, without partisan politics getting in the way. Right now, using money from the fund requires Congressional action, but this authority should actually be in the hands of the executive branch, which has shown itself to be far more nimble in emergency situations, from hurricanes to terrorist attacks.

Similar to the sequence of events that occurs when a natural disaster, like a flood or tornado, strikes, a public health emergency fund would allow an immediate distribution of funds, just like the Federal Emergency Management Agency taps into an existing pot of money. In the case of a disease outbreak, a similar declaration would need to be made, and the executive branch could allocate money from the fund. We can all agree on a fiscally responsible and accountable way to restore the fund by placing appropriate restraints on these dollars so they can only be used for true public health emergencies.

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MIAMI. Zika “active transmission area” in Miami, health department says (Miami Herald)

BY DAVID J. NEAL dneal@miamiherald.com

Florida’s Department of Health announced there’s a “high likelihood” of four locally-transmitted cases of the Zika virus in Miami-Dade and Broward County, the first locally-transmitted cases in the United States, and “believes there’s an active transmission area” that includes Wynwood, Midtown and the Design District areas of Miami.

The department defined the transmission area’s boundaries as U.S. 1 (Biscayne Boulevard) to the east; Northwest Fifth Avenue to the west; 20th Street on the south; and 38th Street on the north.

“While no mosquitoes trapped tested positive for the Zika virus, the department believes these cases were likely transmitted through infected mosquitoes in this area,” the department declared in a news release.

“The department is actively conducting door-to-door outreach and urine sample collection in the impacted area and will share more details as they become available. The results from these efforts will help department determine the number of people affected. These local cases were identified by clinicians who brought them to the attention of the department. In addition, blood banks in the area are currently excluding donations from impacted areas until screening protocols are in place.”

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NATIONAL. Congress goes on vacation without a Zika funding bill, Public health organizations respond (Outbreak News Today)

Posted by Robert Herriman on July 15, 2016

As Thursday came to a close, the American public saw that no Zika funding bill, from either side of the aisle, would come to fruition as the Congress would head out for a 7-week vacation.

This drew many responses of disappointment from various medical and public health organizations:

The National Association of County and City Health Officials (NACCHO) representing the 2,800 local health departments working on the front lines to protect communities from emergencies like Zika is disappointed by our federal leaders’ inability to put health and safety above politics.

 “By not addressing the threat now, we risk squandering our nation’s opportunity to prevent the Zika virus from gaining a foothold in the United States this summer. Local health departments are rightfully concerned because they are on the front lines of responding to this crisis. Resources are still desperately needed to launch prevention efforts and to respond to any local transmission of Zika. On behalf of families across the nation, we implore federal leaders to find a solution to enable local health departments to do what they are trained to do and protect the public’s health.” said LaMar Hasbrouck, MD, MPH, NACCHO’s executive director.

In the same vein, the Big Cities Health Coalition (BCHC) expressed disappointment with the U.S. Congress Thursday. The Coalition consists of the 28 largest, most urban public health departments in the country, representing approximately 1 in 6 Americans.

“The spread of Zika virus has created a public health emergency that needs to be addressed now,” said Chrissie Juliano, MPP, Director of the Big Cities Health Coalition. “For months Congress has failed to act, which has real consequences not only for those who are already infected but for those who are at risk – expectant mothers and their children. Without federal funding, more Americans will be needlessly infected, crucial vaccine development may be stalled, and strapped public health departments will continue to scramble to keep up, doing more with less. Protecting the American people from infectious disease is a bedrock responsibility of the federal government, and right now, Congress is failing to do its job.”

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NATIONAL. Congress skips town with a long list of unfinished business (The Washington Post)

By Kelsey Snell and Karoun Demirjian

Congress started the month with a long to-do list, but it left town Thursday for seven weeks with most of it unfinished.

The House and Senate on Thursday wrapped up business for the summer without finalizing legislation to combat the Zika virus, addressing the recent string of gun violence or making significant progress toward completing this year’s budget work.

In what has become a familiar ritual, Democrats and Republicans pointed the finger at each other over who is to blame. It’s a gamble by leaders in both parties that voters will hold the other side accountable for gridlock come November.

The issue drawing the most attention is the failure to provide funding for efforts to combat the Zika virus, which causes birth defects and has spread through South America and the Caribbean.

The House and Senate both passed bills to provide the funding, but a bipartisan deal on a final package could not be struck. On Thursday, Democrats for the second time blocked a $1.1 billion funding package arguing it contains “poison pill” measures, such as restrictions on Planned Parenthood, and is paid for by ill advised cuts to other federal health programs.

The legislation passed the House last month without support from Democrats...

Public health groups chided Congress for the lack of action.

“The spread of Zika virus has created a public health emergency that needs to be addressed now,” Chrissie Juliano, director of the Big Cities Health Coalition, said in a statement. The group represents public health departments.


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DALLAS. Dallas County getting head start on fight against mosquito season (Dallas Morning News)

by Chris Siron

Officials are warning Dallas County residents of the dangers of mosquito-transmitted diseases – even though mosquito season hasn’t started yet.

Zac Thompson, the county’s director of the Health and Human Services Department, wants people to focus on preventing the spread of the Zika and West Nile viruses before mosquito season starts the first week of May.

“The impact … [Zika] could have on pregnant women is dramatic, so we think our personal mission is to ensure that we get information out to all … [Dallas County] residents,” he said. “But we don’t want to lose sight of public enemy number one: West Nile virus.”

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NATIONAL. Zika funding battle steals states’ public health emergency money (Washington Post)

Cities and states preparing for possible Zika outbreaks this spring and summer are losing millions of federal dollars that local officials say they were counting on, not only for on-the-ground efforts to track and contain the spread of the mosquito-borne virus but also to respond to other emergencies that threaten public health.

Los Angeles County, for example, says it won’t be able to fill 17 vacancies at its public health laboratory or buy equipment to upgrade its capability for Zika testing. Michigan is concerned about providing resources to help Flint contend with its ongoing water-contamination crisis. Minnesota plans to reduce its stockpile of certain medications needed to treat first responders during emergencies.

The across-the-board funding cuts are part of a complicated shift of resources that the Obama administration blames on Congress and its refusal to approve the White House's $1.9 billion emergency request to combat Zika. In early April, officials announced a stopgap measure that moved money originally intended for the government's Ebola response.

But in that scramble, the administration also redirected about $44 million in emergency preparedness grants that state and local public health departments expected to receive starting in July. They use the grants for a broad range of events, including natural and human disasters and terrorist attacks. Some agencies lost up to 9 percent of their awards.

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HOUSTON. Feds hold back state funds to fight Zika (Houston Chronicle)

Texas to lose nearly $3.6 million of slated aid to help pay for national response to virus

By Markian Hawryluk

April 4, 2016

Texas will lose nearly $3.6 million in public health emergency preparedness funding this year, after federal health officials held back $44.2 million for the national response to the emerging threat of the Zika virus.

The cut represents 9.6 percent of the $37.7 million Texas would have received. Based on percentage, the reduction is the largest of any state. However, Texas health officials say they will use federal funding left over from 2015 to minimize the effect on county and city health departments.

"You're shifting the dollars over to make health departments whole, which is good, but you still have a hole for what you were going to use those dollars from a state standpoint," said Dr. Umair Shah, executive director of the Harris County Public Health & Environmental Services.

The leftover money would have been used to pay for a series of public health programs throughout the state, but the specific projects had not yet been determined.

With the reduction, Texas will receive $34.1 million in health emergency preparedness funds in 2016 from the Centers for Disease Control and Prevention. Of that, the state plans to pass on $20.4 million to local health departments to help prepare for public health emergencies such as infectious disease outbreaks or natural disasters.

"The challenge will be if there are further reductions announced or if this reduction is ongoing," said Carrie Williams, a Department of State Health Services spokeswoman.

Per capita cuts

The money shifting started when the Obama administration asked Congress in February for $1.9 billion in emergency Zika funding. U.S. lawmakers adjourned on March 23 for their spring recess without approving the request. That left the CDC scrambling to find money for Zika preparation and response efforts that could not wait until Congress returns on April 12.

The state funding cuts were implemented according to the formula mandated by Congress, which provides a base amount to each state with additional per capita payments, a CDC spokesman said. As a result, states with larger populations absorbed a higher percentage cut.

Many state health departments still have not recovered from a 20 percent cut in public health emergency funds in 2013, which led to the elimination of more than 4,300 public health jobs nationwide that year. Many worry the latest cuts could hamper state and local health departments nationwide as they prepare for a potential Zika virus outbreak.

"It does not make much sense," said Dr. Oscar Alleyne, senior advisor for public health programs at the National Association of County & City Health Officials. "There will be a reduced ability to respond to the needs of our communities."

Congressional leaders suggested the CDC could shift funds allocated for the Ebola virus response to Zika needs. But CDC officials said the Ebola funds were allocated in part to improve the infrastructure in Africa to prevent future outbreaks. And a new case of Ebola last week in Liberia suggests the outbreak is not over.

Spending millions locally

Meanwhile, last week Houston Mayor Sylvester Turner sent a letter to the region's congressional delegation urging them to pass the $1.9 billion emergency appropriation the president requested for mosquito-transmitted Zika.

"We must not overlook the threat to Houston and other areas along the Gulf Coast," Turner said.

The mayor said the city expects to spend $3.6 million this year to clear illegal dumping and other trash that could facilitate mosquito breeding, and the Houston Health Department has implemented extra surveillance for Zika at a cost of $540,000 to $750,000. Those costs would increase significantly, he said, if the virus begins to circulate locally.

Texas has had 27 confirmed cases of Zika, although 26 of those were travelers returning from Latin America or the Caribbean where active transmission of the virus by mosquito is occurring. The remaining case was a women who was diagnosed after having sexual contact with someone infected abroad. Harris County and Houston Health Department reported a combined 12 confirmed cases.

Harris County spends more than $4 million a year on its mosquito abatement program, but 98 percent of those funds come from county tax dollars. Shah said Harris County could spend up to $3 million this year responding to Zika.


NATIONAL. Health groups pressure Congress on Zika funding (Politico Pro)

Dozens of major public health and physician organizations are calling on Congress "to immediately provide" emergency funding to gird against the threat from the Zika virus, citing a "brief window of opportunity" to "avert a wave of preventable birth defects."

The letter posted this afternoon comes amid growing pressure on Congress to act on President Barack Obama's request for $1.9 billion in funding to boost mosquito control, vaccine development and public education. Zika has swept across much of Latin America and been linked to thousands of cases of babies born with abnormally small heads and other birth defects.

The American College of Obstetricians and Gynecologists, the March of Dimes, and other health experts are hosting a press call this afternoon to demand action, after the CDC highlighted funding needs during an all-day Zika summitFriday.


BALTIMORE. Baltimore's Leana Wen: A Doctor For The City (National Public Radio)

It's only March, but Baltimore City Health Commissioner Leana Wen already has an embarrassingly full calendar.

She's put together the city's plan for dealing with the Zika virus, launched a campaign against soda and other sugary beverages and overseen an investigation into why so many people in the city are overdosing on fentanyl.

Trained in emergency medicine, Wen, 33, says running the health department in Baltimore is the fastest-paced job she's had.


SEATTLE. Zika virus: a National view from our local health officer (Enumclaw Courier-Herald, February 2016)

The following was written by Meredith Li-Vollmer for Public Health Insider:

With Zika virus dominating headlines, the Big Cities Health Coalition reached out to Dr. Jeff Duchin, Health Officer at Public Health – Seattle & King County, to discuss some of the unique challenges in the U.S. arising from the sudden emergence of this virus. We’ve excerpted it here (read the full interview on their Frontlines blog):

It seems like every year or so, there’s a new global infectious disease outbreak, like Ebola or MERS, and now Zika. Why is this, and what should we be prepared to do about it?


Part of this is due to the increased encroachment of humans on new habitats coupled with increased ease of regional and global travel, creating more opportunities for disease to spread. Humans and disease-carrying organisms are coming into more contact through urbanization and deforestation. Climate change has facilitated the movement of vectors like mosquitoes to broader habitats. And microorganisms have been adapting to be resistant to some of the treatments that have worked in the past.

To be effective in our response to infectious diseases, we must invest in a stronger public health system at the federal, state and local levels. State and local public health departments are on the front lines in our communities. We do surveillance to track and monitor diseases, update and coordinate our partners in hospitals and healthcare, provide public information and education, and operationalize federal guidance and plans on the local level.