Congress took nearly eight months to send money to help fight a dire public health threat. Now that lawmakers have approved $1.1 billion, health officials say the funds can't arrive quickly enough to make up for lost time.
"The point is to make sure that it reaches the local health department," said Dallas County Health Director Zach Thompson. "When it gets down to it, all public health is local when you are responding to an outbreak."
Since late January, when the Centers for Disease Control and Prevention began ramping up its emergency response, the number of reported Zika cases has exploded, from about 50 to more than 25,600 in the United States, most of which are in Puerto Rico. That includes more than 2,300 pregnant women. The true number of cases is likely much higher, perhaps as high as 128,000, because 80 percent of people infected with the virus don't have symptoms and don't realize they're infected.
Most of the newly approved Zika funding, almost $935 million, is for efforts to control Zika's spread in the United States. The money will go for mosquito control and surveillance, vaccine development and studies to understand the virus's impact on the fetus, children and adults. The CDC will receive $394 million, much of which will likely go to localities on the front line.
The money will also allow the CDC to continue to send emergency teams to individual states, as the agency has done in Utah, which reported the only Zika-related adult death in the continental United States, and Florida, where active transmission is taking place in Miami Beach.
The agency also plans to invest in new technologies to better detect Zika and set up regional centers to track the growing problem of diseases spread by insects.
Perhaps one of the most critical issues that hasn't been addressed because there has been no money are studies about Zika's impact on pregnancy and to babies who are born apparently healthy.
Pregnant women infected with Zika risk having a baby with severe birth defects, including microcephaly, or an abnormally small head. But increasing evidence now points to a host of long-term health problems — from vision and hearing loss to seizures and other neurological abnormalities — in babies who appear to be unaffected at birth.
State and local public health departments are likely to receive a substantial amount of the funds. Cities and states have lost millions of federal dollars as resources were shifted to fight Zika. Officials were forced to take money and personnel from emergency response training, lab and communications equipment, and from monitoring other diseases, said James Blumenstock, who oversees health security for the Association of State and Territorial Health Officials.
"We've been fighting this fight since February," he said. Referring to Thursday's commuter train crash in Hoboken, N.J., that killed one person and injured scores more, he added: "Virtually every day there's an emergency in some community that local health officials have to respond to."
In Alabama, which has the mosquitoes that can transmit Zika, state epidemiologists have spent significant time monitoring Zika cases and less on monitoring tuberculosis or flu.
"We've shifted money from other activities into Zika tracking," said Jim McVay, who oversees health promotion and chronic disease for the state health department. "You only have so many man-hours in the day. If you're working on a new problem . . . obviously you're doing less on other, existing problems."
In Florida, which has the only outbreak in the continental United States where Zika is spreading locally, Gov. Rick Scott has authorized $61 million in state funds for Zika. He has repeatedly called on the federal government for more aid, even though Florida has yet to access about $8 million in Zika response money awarded to the state by CDC.
Since the Zika emergency began in the United States, researchers have learned the virus can be transmitted in more ways than they originally thought. Both men and women can transmit the virus through sex. The virus can linger in semen for up to 69 days. A severely infected person may be able to spread the disease through sweat or tears.
Public health laboratories, in particular, have had to juggle an overwhelming workload as demand for Zika tests has ramped up. Now with the start of flu season, those same personnel must also perform influenza testing, monitoring for new or especially nasty strains, said Peter Kyriacopolous, senior director of public policy at the American Public Health Laboratories, which represents public health laboratories in states, counties and cities.
"We were incredibly lucky not to have a simultaneous national foodborne outbreak, or mumps or measles, or an uptick in the flu," he said. "Any sort of those things would have really put us in a very difficult position."
The funding also means the National Institute of Allergy and Infectious Diseases will be getting $152 million for vaccine development. Most of that money will be spent on vaccine candidates under development, said NIAID Director Anthony Fauci.
But the Zika research has had to borrow funds from other research areas, including cancer, heart and lung, and work on other vaccines, he said. The emergency Zika funding does not give any of that money back, he said.
"We had to rob Peter to pay Paul, and Peter is not going to get paid," he said.
An additional $245 million will also to another agency within the Department of Health and Human Services, known as BARDA, or Biomedical Advanced Research and Development Authority, for research related to vaccine development and commercialization of diagnostic tests.
The funds also include:
• $75 million to reimburse health care provided in states and U.S. territories with active transmission for individuals without health insurance.
• $40 million for community health centers in Puerto Rico and other U.S. territories
• $20 million for maternal and child health programs in Puerto Rico and other territories.