We are more than a year into the Zika outbreak, and the virus is spreading in the US and overseas. But Congress still hasn’t moved to fund the effort to beat it back. On Tuesday, the Senate once again failed to pass the $1.1 billion Zika funding package.
This is pathetic — but it’s also emblematic of how much the public health system depends on politics and how badly it needs financial independence from the political system.
A quick recap on the congressional response to the outbreak so far: President Obama first requested Zika money back in February for many prevention and preparedness measures. And lawmakers went on holiday in July without passing the spending bill that would have helped pay for them.
Back then, there were no documented Zika cases originating in the continental US, but nearly 3,000 people in US territories (mainly Puerto Rico) had acquired the virus locally, and there were more than 1,300 travelers who had brought Zika here from abroad.
Since then, the situation has deteriorated. More than 50 people have picked up the virus in Florida, and there are more than 14,000 locally acquired cases in the US territories and more than 2,600 travel-associated cases spread across the US.
In other words, the number of people with the virus has gone up significantly while lawmakers were summering. As Ron Klain, the former "Ebola czar," told Vox in July, "Ultimately, that will translate into more babies with microcephaly here," referring to one of the devastating birth defects the virus can cause in fetuses.
Mosquito season in the southern US doesn’t end until November, so it’s likely things will get worse. (Zika can also be spread through sex.) The virus is also spreading in Singapore, and health officials have warned that we’re likely to see outbreaks in the coming months in India, China, the Philippines, Indonesia, Nigeria, Vietnam, Pakistan, and Bangladesh.
Meanwhile, the Centers for Disease Control and Prevention has nearly run out of the money it shuffled around for Zika, and the National Institute of Allergy and Infectious Diseases will soon run out of funds, which will stall the development of a Zika vaccine — or the best chance we have at preventing more Zika-related damage in the future.
The lack of public health action on Zika isn’t surprising — it’s systemic
On the surface, the reason lawmakers have failed to fund the Zika bill had to do with partisan politics. For example, Republican lawmakers added provisions to the bill — including a bid to restrict funding for Planned Parenthood and Obamacare, and weakening environmental controls on pesticide uses — which the Democrats said they couldn’t sign off on.
But there are more systemic reasons why much-needed public health money can get lost in political infighting, even in the face of a dangerous virus that’s spreading close to home. These have to do with how fragmented the public health system is.
"There are nearly 90,000 local governments in the US, and from the 10th Amendment, much of public health [authority] is reserved to the states," Phillip Singer, a public health researcher at the University of Michigan, said. The states take many different approaches to handling public health, but one thing they have in common is that they’re chronically underfunded. The state public health workforces decreased by 4 percent between 2010 and 2013 alone.
"So we task states, counties, and cities to handle public health crises — but we don’t give them the money to be able to handle these things effectively," Singer said.
That means states and local governments are often left scrambling for a boost of federal dollars anytime there’s an emergency, like Zika.
And that’s where politics can either make things happen or slow things down. If epidemics happen at a politically opportune time, the money is more likely to flow. If they don’t, it won’t.
As Singer’s colleague, Michigan health policy researcher Scott L. Greer, explains in an excellent article at the Conversation, "When a crisis does happen, the responses within individual states tend to be driven by governors, who will often take guidance from the federal government. However, we found that national political ambitions can influence how governors react."
Just contrast the current Zika response with the response to the 2014-2015 Ebola epidemic. Remember New Jersey Gov. Chris Christie, who later set his sights set on the presidency, defying the federal government and calling for Ebola quarantines on health workers returning from West Africa on the eve of the 2014 general elections? Remember how he used the outbreak to draw attention to how they could get a grasp on the problem, and how the Obama administration was allegedly failing to do as much?
While much of the rhetoric around Ebola was more politicized than science-based, it did put the epidemic in the national spotlight and force action.
As absurd as it may sound, the timing of this Zika outbreak hasn’t been quite as opportune for mounting a public health response.
"We’re in the middle of an unpredictable election season," Singer observed, "so there’s little incentive for many Republicans who control the House and Senate to associate themselves with the spending measures at this time." This is especially true for politicians from states in the northern part of the country, where the mosquitoes that carry the virus are uncommon or nonexistent and the threat of Zika is lower.
"The states lack the funding, they lack the expertise to be able to handle disease control," Singer added. "And when you have a Congress like the one you have right now, where most of their focus is on other issues, it doesn’t bode well for disease control in the country going forward."
That lack of focus on Zika means state and local governments that needed money to mount Zika responses didn't get it, which has driven up the risk of people getting infections, the costs of treatment, and expanded the opportunities for long-lasting human suffering (remember, Zika can cause birth defects).
Another consequence of the lack of Zika action is "the normalization of how we handle future infectious disease outbreaks," Singer said. "Does Congress sit on their hands when we are faced with a different outbreak of a different disease two years from now? Does Congress use the emergence of an infectious disease as a means to achieve some desired political outcome?"
There’s no emergency stockpile for health crises
The perennial looming-health-disaster money scramble can also be chalked up to the fact that there is no emergency money stockpile for health crises.
"Up until recently, we have not really considered infectious diseases a critical component of public health preparedness and emergency response at the federal level," explained Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
While that's changed somewhat since the White House implemented the Global Health Security Agenda — a commitment to working with other countries for better detection and control of disease outbreaks — that mandate hasn’t translated into allocations of funding from Congress to actually do the work.
What makes allocating money to looming health disasters even more difficult is how we typically perceive risk. Humans tend to be crisis-oriented. Yet a lot of public health money has to go toward prevention efforts. In the case of Zika, this means things like mosquito control efforts and financing for a vaccine that can prevent future cases.
Short of overhauling the fragmented political and public health system in this country, one interim step a number of health experts have called for is the establishment of an emergency fund for health crises — similar to the Federal Emergency Management Agency (FEMA) for natural disasters.
Klain, the former "Ebola czar," has pointed out that right now there's no equivalent to FEMA for health. So he's been advocating for a new federal response agency to help us organize for and rapidly deploy in the event of a major epidemic.
"We should have an agency doing for epidemics what FEMA does for hurricanes — and then, yes, we would have some common response items prepositioned and some immediate funds for action and contracting in the response," he said. But, like FEMA, even if a health fund existed, it might need to be supplemented with emergency funding if a particularly bad epidemic were to hit.
Hotez also favors the creation of a new funding agency to manage infectious disease emergencies. While each epidemic looks a little different, having some sort of mechanism in place that could trigger an immediate release of money would be extremely useful and probably lifesaving.
"You could even make those funds time-sensitive — use them for the first 30 days, then go back to Congress to continue funding," said Hotez. "But at least the first tranche of money is there to begin [responding to the outbreak]."
Until then, as Zika cases mount here, health officials are left waiting for Congress to come around. And Zika won’t be the last outbreak. Researchers have been finding that the frequency with which infectious disease outbreaks happen here and abroad is likely to go up. We better find some solutions, and quickly.