CDC Official Protests Federal Medical Response Cuts

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 dispensingfor 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-Food and Drug Administration] 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 FDA. 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.