The Ebola threat is calling attention to a problem years in the making: cuts to the programs and staff intended to prepare for just such a public health emergency.
Gov. Rick Scott, who has demanded federal aid to prepare for Ebola, announced Monday that the Florida National Guard is establishing two "rapid response teams" to help hospitals. But he has also overseen major cuts in the state's own Department of Health. The department had 15,170 staff positions this year — a 13 percent drop from 2010, according to legislative documents.
Nationally, funding for the Centers for Disease Control's public health preparedness and response activities was $1 billion lower in 2013 than in 2002. That decline in funding fueled the loss of more than 45,700 jobs at state and local health departments between 2008 and 2012, a CDC report found.
In emergencies, it's crucial to have trained experts ready to work in laboratories, investigate outbreaks and track down people who may be most at risk of contracting a disease, said Jack Herrmann, senior adviser for public health programs at the National Association of County and City Health Officials. But when there's no crisis, officials often question the investment.
"Unfortunately, public health preparedness appeared to be one of those areas considered low-hanging fruit," he said.
Not now. With Ebola putting the nation on alert, officials are scrambling. On Monday, at the insistence of the governor, the CDC spoke with Florida hospital leaders in a one-hour phone meeting closed to the press. The governor also met in St. Augustine with Maj. Gen. Emmett Titshaw of the Florida National Guard about the two 16-member response teams, which will include physicians and nurses.
Though Ebola has sent worried people to hospitals and even prompted the cancellation of a planned visit by African journalists to St. Petersburg (see related story), no confirmed case has been reported in Florida.
State officials overseeing Ebola preparedness did not respond to repeated requests for information on how they are paying for the arrangements. It took a Department of Health spokesman three business days to provide basic budget totals for the past five years.
The Health Department's budget stood at $2.97 billion in the 2010-2011 year, approved in the final legislative session before Scott took office, according to department figures. It declined to as low as $2.79 billion in 2012-2013, but now is back up at $2.99 billion.
But staffing has not recovered similarly. The department lost roughly 200 positions in Hillsborough and 50 in the Pinellas office since 2011.
Ebola is not the first potential emergency to draw attention to public health funding in Florida. A.G. Holley State Hospital in Palm Beach County, the last tuberculosis sanitarium in the country, was closed in 2012.
Scott and the Legislature signed off on that decision as news of an outbreak of tuberculosis among Jacksonville's homeless population surfaced.
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Dr. Leslie Beitsch, a former deputy health secretary in Gov. Jeb Bush's administration and now a professor at Florida State University College of Medicine, said the isolation rooms in the Holley facility might have been useful for other infectious diseases, including Ebola.
"It was a perfect place to have available to us," Beitsch said. "But, no. We wanted to save a small amount of money."
U.S. Rep. Kathy Castor, a Tampa Democrat, said the Republican-led Legislature's changes to the Health Department went deep. In 2012, its mission was shifted from "an active disease-prevention role to a passive surveillance role."
Staff cuts, she said, left local health departments less agile at handling emergencies.
"The changes in law were quite drastic back in 2012," she said. "The local officials say they are less prepared to address outbreaks and disasters."
Beitsch said he expects health agencies to stretch themselves to respond to emergencies. But other tasks — from providing the uninsured with preventive health care to running anti-smoking campaigns and encouraging people to get flu shots — could suffer, he said.
"We also have an emergency for diabetes and weight problems in this country," he said.
No one can say whether the funding cuts will the affect Ebola response. Still, Herrmann said, it should be heeded as a warning.
"This should shed a spotlight on how important it is for the government to provide sustainable funding so we can keep a public health care system ready to respond," he said.
Contact Jodie Tillman at firstname.lastname@example.org or (813) 226-3374. Follow @jtillmantimes.