Cities Gain, States Lose in Bio-Terror Funding

 

Each of the 50 states' public health programs is about to lose its grip on about $1.1 million in bioterrorism preparedness funds under a Bush administration decision to transfer the money to 21 cities believed to face a high risk of a terrorist attack.

U.S. Health and Human Services Secretary Tommy Thompson recently announced he will reprogram $54.9 million from the federal Centers for Disease Control and Prevention (CDC) that were allocated this year to help states enhance their public health resources to deal with terror attacks involving biological or chemical agents such as anthrax, smallpox or ricin.

Favoring high-risk cities over states is raising concerns among state officials and public health experts about the federal government's long-term commitment to help states improve their public health infrastructures.

The debate raises one of the hottest state policy issues in homeland security: how to allocate money to combat terrorism. Critics have been quick to point out that sparsely populated states often receive more money per capita than densely populated areas, which some say face a greater risk of terrorism.

States with the lowest populations will be hardest hit by the latest decision because they receive less CDC bioterrorism money to begin with under the current federal formula.

Compared to what each state received from the CDC last year, Wyoming would face the largest proportional decrease in funds 18 percent. Alaska, North Dakota, South Dakota and Vermont all would face 17 percent reductions.

Certain regions of the country also could suffer disproportionately. For example, little of the diverted money will go to the northern Plains states. Only one city Seattle is located in the Pacific Northwest, and one Denver - in the Rocky Mountain region.

The 21 cities receiving the funds are in 16 states, including nine of the nation's 10 most populous.

In effect, more bioterrorism money will be flowing to California, Illinois, New York, Pennsylvania and Texas, but the funds will flow directly to cities instead of state-level public health officials.

Public health officials from a handful of states have written Congress asking lawmakers to halt the reallocation, so far to no avail. Congress would have to act by next week to rescind the HHS action. No proposals yet have been made.

In Alaska, public health officials spent nearly all of their fiscal 2002 funding from the CDC to hire public health personnel such as doctors, nurses and microbiologists. Now, two years later, the diversion of funds from Washington could force them to lay off some of those people.

Officials in Idaho are concerned the cut could stymie its CHEMPACK program, which is designed to train first responders to battle exposures to chemical agents and radioactive contamination from "dirty bombs." Wisconsin officials are concerned they will not be able to support their statewide health-alert networks.

State officials and organizations including the National Governors Association, the Association of State and Territorial Health Officials, the Council of State and Territorial Epidemiologists and the Association of Public Health Laboratories - all of which have come out against the fund shift claim the move sets a dangerous precedent of reneging on public health monies promised to states.

"We don't know where this will stop," said Nolan Jones, a spokesman for the National Governors Association. "Instead of going to Congress with this new initiative, they're just taking it from states. ... It creates an instability and an uncertainty."

North Dakota Governor John Hoeven (R) and Michigan Governor Jennifer Granholm (D), the chairman and vice chairwoman of NGA's Health and Human Services Committee, sent a letter to Thompson within hours of his announcement May 19 urging him to reconsider.

"Governors are committed to ensuring that U.S. citizens are secure from bioterrorism attacks, but this can only be achieved through an equal, stable and steady commitment from the federal government to continue supporting state bioterrorism preparedness initiatives," the letter states.

HHS Spokesman Bill Hall said the move reflects an increased focus on targeting funds to high-population areas.

Since 2002, states have received a baseline appropriation of $5 million in CDC bioterrorism funds; additional funding was calculated based on population. Under that model, California received the most CDC bioterrorism money in 2003 - $55.6 million. Wyoming received the least - $6 million. But per capita, that means Wyoming received about $12.15 per person while California received about $1.64.

Starting with its fiscal 2005 budget proposal, HHS is moving even further towards a population-based model for disbursing money to states, Hall said.

Hall also reiterated sentiments Thompson expressed in a letter to key lawmakers that the nation is in need of rapid, targeted bioterrorism preparedness improvements.

The fund change will redirect $39 million to the Cities Readiness Initiative, a 21-city pilot program that includes training U.S. Postal Service workers to deliver emergency re-supplies from the Strategic National Stockpile, a repository of antibiotics, chemical antidotes, antitoxins and other medications.

"Once the stockpile gets there, it won't do anybody any good if it just sits there at that location," Hall said.

The remaining $16 million will accelerate two CDC bioterrorism preparedness programs that deal with quarantines and detection of outbreaks.

Since 2002, the federal government has provided almost $2 billion in HHS grants to states through the CDC to bolster their public health infrastructures.

Through a slightly different program, HHS last week awarded $498 million to strengthen the ability of hospitals nationwide to respond to bioterrorism events and other large-scale emergencies.

The metropolitan areas that will receive money as part of the Cities Readiness Initiative are:

  • Arizona Phoenix
  • California Los Angeles, San Diego, San Francisco
  • Colorado - Denver
  • Florida Miami
  • Georgia Atlanta
  • Illinois - Chicago
  • Massachusetts - Boston
  • Michigan - Detroit 
  • Minnesota - Minneapolis
  • Missouri - St. Louis
  • Nevada - Las Vegas
  • New York New York City
  • Ohio - Cleveland
  • Pennsylvania Philadelphia, Pittsburgh
  • Texas Houston, Dallas
  • Washington - Seattle
  • Washington, D.C.
 
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