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2010 Report: Public Health Preparedness

Funding Supporting Public Health Preparedness and Response

Congress has supported CDC public health preparedness and response activities by appropriating approximately $1.5 billion per year since 2002. This Terrorism Preparedness and Emergency Response funding supports a wide variety of activities at CDC and at state and local levels.

CDC’s Office of Public Health Preparedness and Response (OPHPR; formerly the Coordinating Office for Terrorism Preparedness and Emergency Response)25 is responsible for managing these funds. Congress appropriates over three-quarters of this funding for two CDC programs, the PHEP cooperative agreement and the Strategic National Stockpile. OPHPR allocates the remainder of this funding to preparedness programs across CDC. (See appendices 3 and 4 for more details on funding levels.)

Congress has also provided emergency supplemental funding to address preparedness needs related to specific health threats such as pandemic influenza.

PHEP cooperative agreement. CDC’s PHEP cooperative agreement funds 62 state, locality, and U.S. insular area public health departments to build and strengthen their abilities to respond effectively to public health emergencies.26 PHEP funding has declined from $970 million in FY 2003 to $689 million in FY 2009. (See box below and appendix 4 for historical PHEP funding levels.)

PHEP-funded emergency preparedness and response efforts support the National Response Framework and are targeted specifically for the development of emergencyready public health departments that are flexible and adaptable. The Division of State and Local Readiness within OPHPR manages the PHEP cooperative agreement, provides direction on preparedness activities, and coordinates technical assistance.

Included in the PHEP cooperative agreement funding is support for the Cities Readiness Initiative of CDC’s Strategic National Stockpile. This program focuses on enhancing preparedness for responding to a largescale bioterrorist event within 48 hours in the nation’s largest cities and metropolitan statistical areas, where more than half of the U.S. population resides.27

PHEP funding has declined from $970 million in
FY 2003 to $689 million in FY 2009.
PHEP funding has declined from $970 million in
FY 2003 to $689 million in FY 2009.
*Includes $100 million Smallpox Supplement

Source: HHS and CDC

Strategic National Stockpile. CDC’s Strategic National Stockpile is a national repository of critical medical supplies designed to supplement state and local public health departments in the event of a large-scale public health emergency. Funds are also used to support technical assistance at state and local levels to receive, distribute, and dispense the supplies. Stockpile assets help ensure that key medical supplies are available to prepare for and respond to emergencies. Stockpile funding averaged approximately $495 million for FY 2002-2009. (See appendix 3 for Stockpile funding levels.)

Additional funding for pandemic influenza. Recognizing the need to prepare for a possible influenza pandemic, Congress appropriated two other sources of funding specifically for pandemic influenza preparedness activities. Beginning in 2005 and continuing through 2008, CDC awarded approximately $524 million in Pandemic Influenza Supplement funds to the 62 PHEP-funded states, localities, and U.S. insular areas for program operations to prepare for and respond to an influenza pandemic. (See appendix 4 for Pandemic Influenza Supplement funding levels.)

Subsequently, as the nation faced the 2009 H1N1 influenza pandemic, Congress provided funding through the 2009 Supplemental Appropriations Act28 for the Public Health and Social Services Emergency Fund to prepare for and respond to an influenza pandemic. Since July 2009, CDC has administered $1.4 billion from this fund through the Public Health Emergency Response (PHER) grant specifically for the 2009 H1N1 pandemic influenza response. (See appendix 5 for PHER funding levels.) PHER funds were used for assessing response capabilities and addressing remaining gaps in vaccination; antiviral drug distribution/ dispensing; and laboratory, epidemiology, and surveillance activities. Funds were also used to provide additional resources for mass vaccination planning and implementation, and to support the implementation of 2009 H1N1 vaccination campaign.

Cutbacks in state public health investments. The 2008-2009 economic crisis had a negative impact on state investments in public health programs. As states faced sharp downturns in tax revenues, many cut budgets and reduced services, including those affecting the public health system. A survey of 57 state and U.S. insular area health agencies conducted by the Association of State and Territorial Health Officials reported that 76% of health departments made cuts to the FY 2009 budget and 61% reported FY 2010 budgets smaller than FY 2009.29 Nationwide, a 2010 survey of local health departments conducted by the National Association of County and City Health Officials reported that between January 2008 and December 2009 health departments lost 23,000 jobs to layoffs and attrition, roughly 15% of their entire workforce. In 2009, an additional 25,000 local health department employees were subjected to reduced hours or mandatory furloughs.30 These cutbacks have significant implications for public health and preparedness.


Child receiving vaccine
Supplemental funding was used to provide additional resources for mass vaccination planning and implementation, and to support the 2009 H1N1 vaccination campaign. Pictured is an H1N1 vaccination clinic in Cambridge, Massachusetts.

Photo source: Cambridge Public Health Department


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