Stop-and-go federal funding floods public health agencies with cash during crises but starves them of funds afterward.

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Stop-and-go federal funding floods public health agencies with cash during crises but starves them of funds afterward.

Mon, 2023-02-13 09:08 — mike kraft

JACKSON, Miss. — When the coronavirus first scythed through the nation in early 2020, few places needed help fighting it more than Scott County, Miss., a rural patch of chicken processing plants and pine forests an hour east of the state capital, Jackson.

The poverty rate for the county’s 28,000 residents was far above the nation’s. So, too, were rates of diabetes and other chronic illnesses that worsen the risk of severe Covid-19. Yet Mississippi’s health department, struggling under huge budget cuts ordered by the state’s Legislature, had deployed just two nurse practitioners to cover a quarter-million residents in Scott and eight other counties.

So when the Biden administration gave Mississippi $18.4 million in mid-2021 to hire public health workers — part of $2 billion in grants to bolster the Covid work force at state and local health agencies nationwide — it appeared that help had, at long last, arrived.

But as of January, 18 months later, Mississippi had spent just $3.6 million of its grant — less than a fifth. Its attempts to hire epidemiologists, nurses and other soldiers in the war against Covid had largely fallen flat. The state has lost one in 224 residents to Covid-19, one of the nation’s worst death rates, including 122 people in tiny Scott County alone.

Mississippi’s woes are an acute example of a larger public health failure that is reprised nearly every time a major health threat grabs headlines. The problem, experts say, is that Congress starves state and local health agencies of cash for even basic needs in quiet times. Then, when a crisis hits, it floods them with millions or even billions of dollars earmarked to battle the disease of the moment. And the sluggish machinery of Capitol Hill often ensures that most of the aid arrives only after the worst of the crisis has passed.

The $2 billion in Covid hiring grants is the latest example. Nationwide, states and localities had spent only $371 million of the money by December, or about 19 percent, according to the Centers for Disease Control and Prevention, the conduit for the funds.

Health departments found it nearly impossible to bulk up their skeletal staffs from a standing start. Seasoned workers, in high demand throughout the health care system, balked at taking jobs that were guaranteed only until the federal funds ran out. Health departments now face a July deadline to use the money, but uptake has been so slow that the C.D.C. is letting them ask for a one-year extension.

The record is replete with other such fumbles.

Six months after the World Health Organization declared the H1N1 influenza pandemic over in mid-2010, states and localities had used just a third of the $1.4 billion in federal funds they had received to combat it. The outbreaks of the Ebola virus in 2014 and the Zika virus in 2016 also led to funding windfalls, but health experts say most of the money arrived late.

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