Terror Fears Bring New Health Funding Priorities, Budget Gaps into Question

Spurred by Bush administration warnings against biological and nuclear terrorism -- and by more than $1 billion in federal preparedness funding -- health agencies around the country are vaccinating staff against smallpox, upgrading labs to test for anthrax, stockpiling radiation antidotes and augmenting communication networks.

Some health agencies say the new funds -- provided by the 2003 Labor, Health and Human Services and Education appropriations bill -- can be put to "dual use," simultaneously fighting terrorism and shoring up a crumbling public health infrastructure.

But critics say the preparedness drive distracts from day-to-day public health concerns like diabetes, stroke, tuberculosis, HIV and sexually transmitted diseases.

Onondaga County, N.Y., received a grant for $458,000 for bioterrorism preparedness, but spent $485,635 more than it received. "We had to shortchange other public health programs," including tuberculosis, breast and cervical cancer programs, and home visits to women with high-risk pregnancies, said Dr. Lloyd F. Novick, the county health commissioner.

The McLean County, Ill., public health department also spent more on its terrorism preparedness than the $115,000 it was allocated. Funds went to computer upgrades, pharmaceutical stockpiles and smallpox vaccinations.

Bob Keller, director of the McLean County Health Department, measures some of the costs as staff time lost to more mundane health programs. He estimates that his staff spends about 40 hours per month -- valued at $25,000 to $30,000 per year -- on terrorism preparedness.

These health care workers otherwise would have spent their time on tuberculosis surveillance and sexually transmitted disease prevention, he said.

Preparedness costs

Nationally, Bush's ongoing smallpox vaccination program -- aimed at roughly 400,000 healthcare workers who would inoculate others in case of a terrorist attack -- has cut into local agency budgets and staff time.

The Washington, D.C.-based National Association of County and City Health Officials (NACCHO) found that -- when considering staff training, facilities expenses and crucial follow-up with patients -- each vaccination costs between $154 and $284.

According to Karen Nikolai, supervisor of immunization services in Hennepin County, Minn., the program was a burden to her department. "I and several of our staff had to drop much of our regular work to do this," she said, but noted that the immunization program was "partially worthwhile" because it improved overall preparedness in case of a real emergency.

A NACCHO survey of local health agencies across the country indicated that Nikolai's experience was not unique: 53 percent of responding agencies said implementing bioterrorism preparedness made it difficult for them to maintain routine public health services.