State and Local Funding Cuts Hit ID Hard

In late March, the US Department of Health and Human Services announced the cancellation of more than $11 billion in funding to local and state public health departments. The funding was initially authorized by Congress in 2021 during the COVID-19 pandemic to support testing, vaccination, and health equity efforts but has since been used for broader public health programs and infectious disease (ID) research that vary by state and community, according to the Infectious Diseases Society of America (IDSA).

A statement from the Department of Health and Human Services cited the end of the COVID-19 pandemic as the main reason for cutting the grants. The statement was originally reported by NBC News. 

The impact of the cuts will vary, as some states and communities may be able to cover the gaps better than others, but many aspects of ID will be affected, according to the IDSA.

Cuts Hit ID Tech, Clinical Care

“IDSA has heard from its members that many state and local public health programs may be affected by these funding cuts,” said Amanda Jezek, the IDSA’s senior vice president for public policy and government relations, in an interview.

In the healthcare setting, the cuts may result in dramatically reduced state and local capacity to address healthcare-associated infections and antimicrobial resistance through testing and laboratory detection, Jezek said. Other programs at risk include outbreak response and containment, data reporting, and education of healthcare providers on infection prevention and improved antibiotic use.

In addition, IDSA members have reported potential decrease in laboratory capacity for viral testing and genomic sequencing, Jezek told Medscape Medical News. Such testing speeds identification of emerging and existing viruses, which helps local healthcare professionals and public health officials understand how seasonal respiratory viruses and other viruses are spreading in their local communities and understand the potential number of persons at risk, she said.

From an epidemiology standpoint, the funding cuts will result in reduced immunization programs in some areas, which will not only affect vaccine access, but also increase the number of individuals susceptible to IDs, Jezek said. In addition, cuts may slow or halt modernization of electronic case reporting and vaccine databases that would help improve state and local public health efficiency, and also may mean fewer local epidemiologists and data analysts to interpret and disseminate data for informed decision-making at the local level, she said.

Finally, the cuts likely mean the loss of Antiviral Drug Discovery Centers for Pathogens of Pandemic Concern, Jezek told Medscape Medical News. These centers were conducting research to develop new antivirals, “especially those that can be taken in an outpatient setting, targeting specific viral families with high potential to cause a pandemic in the future,” Jezek said. “These include Ebola, enteroviruses and the viruses that cause yellow fever, dengue and Zika,” she added.

Another long-term casualty of the state/local funding cuts will likely be recruiting, training, and retaining the expert public health professionals and scientists needed to protect communities, Jezek emphasized. This loss will affect the quality of health care that can be provided to individuals of all ages, she said.

Funding Benefits Went Beyond COVID

“In my state of Colorado, and many others, the sudden loss of federal COVID-related funding will have wide-reaching consequences for the health of our communities,” said David Higgins, MD, a pediatrician and preventive medicine specialist at the University of Colorado Anschutz Medical Campus, Aurora, Colorado, in an interview. The funds, while originally for pandemic response, were extended to support future preparedness and improve upon infrastructure built during the pandemic, he said. This infrastructure includes other ID surveillance, routine immunizations, data modernization, outbreak response systems, community prevention programs, and workforce support, added Higgins, whose e-newsletter, Community Immunity, includes insights and updates on news related to vaccines and public health.

“What makes this especially challenging is the speed at which funds were revoked,” Higgins said. “Funding cliffs are a reality in public health, but there’s usually time to plan and secure new support. Historically, departments have trusted that the federal government would honor its contracts and commitments; this time the floor was pulled out without warning,” he added.

Survival or Extinction?

Some of the programs supported by the COVID funding may be able to survive in the short term through a patchwork of support from other state funds, short-term grants, or partnerships with institutions, Higgins told Medscape Medical News. However, “the scale and speed of these cuts mean many will simply disappear,” he said.

The long-term implications of this funding loss are serious, Higgins told Medscape Medical News. “With the loss of programs, communities will experience slower outbreak detection, widening immunization gaps, increased transmission risks for preventable diseases, and erosion of trust and continuity in community-based public health services,” he said. 

“Public health infrastructure isn’t a faucet you can just turn on and off. After it is dismantled in this abrupt way, it takes significant time to rebuild,” he added.

Higgins and Jezek had no financial conflicts to disclose.