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U.S. Must Prepare for New Dangers

As a high school senior in 1969 in Mansfield, Ohio, I saw the last tuberculosis sanitarium in our area close its doors. My father, a family doctor who still made house calls, told me that TB was no longer a problem in the United States.

No longer considered an emerging health threat, TB funding was reduced. This drop in funding seemed to make sense at the time since TB was no longer on the threat list.

Between 1985 and 1992, less than 20 years after that sanitarium closed, reports of TB cases in the United States jumped 20 percent.

This outbreak, coupled with the steady increase of TB globally, forced the World Health Organization to declare TB a global health emergency. New York City alone spent $1 billion fighting an epidemic of multidrug-resistant TB that had emerged in jails and spread to area hospitals. At the height of the epidemic in 1992, the city had 3,811 cases of TB.

The end of the New York crisis didn’t end the TB epidemic. The New Jersey Medical School’s National Tuberculosis Center reports that TB kills 2 million people worldwide each year — roughly 228 casualties an hour, 1,100 a day in India alone. The United States reports roughly 15,000 cases of TB each year.

Although most Americans are not aware of these numbers, they are becoming more informed about the essential role public health agencies play in protecting us from emerging threats, communicable diseases and bioterrorist attacks. Severe Acute Respiratory Syndrome, monkeypox, anthrax, Ebola and the West Nile Virus are all wake-up calls for the public. [IMGCAP(1)]

Americans need to understand the important role public health systems play in both protecting them from these threats and the unknown threats used in an act of terrorism.

The Centers for Disease Control and Prevention and local public health agencies cannot just focus on the issue or disease attracting the most media attention. These professionals have to balance the demands of protecting the public against known diseases that can and do emerge in communities, schools or hospitals with threats that could strike in an act of terrorism. A health department’s success in responding to an outbreak of smallpox depends largely on its ability to respond to an outbreak, or a case, of TB. We must adequately fund both basic public health functions and efforts specific to bioterrorism and other public health emergencies. One initiative should not be neglected to fund another.

The CDC has rightfully earned praise for responding to and containing potential SARS and monkeypox cases. To date, there are 35 suspected cases of SARS in the United States and zero deaths. Medications aren’t credited for a zero mortality rate; our public health infrastructure is.

In 2003, the CDC will protect the public’s health for the bargain price of just more than $4 billion. The $4 billion spent to protect the country from disease, poor health and potential bioterrorist attacks represents one-fifth of 1 percent of our entire federal budget. We expect a great deal of our public health system. We expect our public health infrastructure to prevent an uncontrollable outbreak of TB, maintain a low infant-mortality rate, and respond to the needs of populations at risk of and burdened by HIV/AIDS (many of whom fall among the ranks of the 41 million uninsured). It’s a tall order. Congress and the president must ensure that public health professionals have the resources they need to identify threats, report findings and take the necessary actions to prevent further outbreaks.

The Public Health Security and Bioterrorism Preparedness and Response Act, signed into law a year ago, featured enhancements to public health. This historic legislation authorized $2.72 billion for national, state and local efforts to increase preparedness for bioterrorism and other public health emergencies. The bill gave our first responders — our first line of defense — more resources to help them better respond to health threats, and it strengthened our food and water supply.

This legislation made a long-overdue investment in our public health infrastructure and signifies a renewed commitment to these programs. Emerging health threats warrant investments consistent with these agencies’ responsibilities. We cannot just sign legislation into law. We have to fulfill our obligation to fund the programs that protect us against these threats.

National public health labs are ill-equipped to handle a chemical attack. In an effort to prioritize funding toward bioterrorism preparedness, basic public health care preparedness has been starved. State and local public health departments, charged with preparing for a possible smallpox attack and other bioterrorist threats, have been forced to drain resources from areas such as childhood vaccines and TB prevention to fulfill that obligation. These resource shifts have concrete effects on public health. The recent diversion from TB prevention has left a local health department in Seattle ill-equipped to handle an outbreak. As a result, Seattle is facing the worst outbreak of TB in 30 years.

The nation’s public health system operates in a new world where an act of terrorism is no longer theoretical. In this new environment, public health departments have received additional resources to help prepare for a possible bioterrorist attack. They have not received the funding necessary to maintain TB control, protect against SARS or deliver on other promises to protect the public’s health. We must provide the resources necessary to strengthen a system that can and will protect the nation’s health every day.

Rep. Sherrod Brown (D-Ohio) is ranking member of the Energy and Commerce subcommittee on health.

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