The Costs of Cutting Disease Surveillance Programs
In a decade where the term ‘every penny counts’ could not be more appropriate, our governments, at local, state and federal levels, are faced with making tough decisions. Legislators walk a fine line between balancing the budget and acting in the best interest of their constituents. The difficult task for legislators is to make deep cuts and changes in the tax system without causing serious detriment to society. When making the tough decisions in this current funding climate, it becomes difficult to look beyond immediate needs and continue supporting projects that do not have significant short-term impacts, but that provide a long term benefit; however, tough decisions must be made even when the average person does not always understand this long-term benefit. This includes securing funding for disease surveillance programs.
Case-in-point: In balancing the federal budget, law-makers are cutting funding to essential services that monitor the spread of both food-borne diseases (the Microbiological Data Program) and insect-borne diseases (CDC Vector Borne Disease Division). While an ocean apart from the United States, this summer Europe was painfully reminded that disease outbreaks are a clear and present danger; not a memory of past centuries, nor an unfortunate phenomenon of developing countries. Disease surveillance services are essential and life-saving for our communities by monitoring and controlling disease outbreaks of both known pathogens and emerging infectious diseases. These programs are most effective in their ability to quickly identify disease origins, which results in successfully mitigating disease spread (and associated morbidity and mortality). As interwoven as the world is, it stands to reason that, as with Europe, the United States will continue to be susceptible to disease epidemics from both food-borne and insect-borne origins. This again was illustrated by the fact that the origin of the E.coli outbreak in Europe was linked to Egyptian seeds.
Importantly, we must realize that epidemics, such as the recent one in Europe, inevitably and regrettably can lead to a loss in life. What we sometimes fail to consider are the additional costs of uncontrolled epidemics: (1) The public health burden of treating the survivors who have been irreparably scarred. While there were 50 deaths linked to the recent E. coli outbreak in Germany, hundreds more have suffered complete kidney failure and other long-term disabilities. These survivors, who could have been otherwise healthy individuals, will require a lifetime of care and medical treatment. Maintaining this continuous care can unequivocally stress federal, state, and local governments. (2) The economic strain of responding to and managing epidemics. Governments and companies, as well as the average person, can suffer financially from the results of poorly mitigated outbreaks when last resort efforts lead to destroying all suspected contaminated foods and/or infected livestock. These economic costs are especially critical in light of the current global economic crisis, when few funds are set aside to recover lost revenue or provide assistance for long-term health care. Past epidemics within the United States are a good example of the potential economic and public health burden levied upon society. One such example: the West Nile virus outbreaks of the past decade.
The West Nile virus first appeared in the United States in 1999. In the following years, West Nile virus spread with great speed throughout the continental United States. The majority of people infected with West Nile virus (80%) did not present any significant symptoms other than fever, headache, or a mild skin rash on the trunk of the body. Documented deaths linked to West Nile virus infection were relatively low compared to other epidemics. Contrary to its low public health impact, the economic burden of West Nile virus was significant. Take the example in 2005 when Sacramento County (California) was hit by a resurgent outbreak of West Nile virus. The economic burden for mitigating the spread of West Nile virus (i.e. mosquito control, public announcements and monitoring disease spread) for this county at this time was estimated to be at $2.98 million, representing ~4% of the 2005 fiscal year budget, while another $2.28 million were spent on medical costs. This was the financial impact when disease surveillance programs were in place, so we could imagine that, in their absence, the costs will be much worse.
What makes cutting funding for the surveillance programs (i.e., the Microbiological Data Program and the CDC Vector Borne Disease Division) such a poor decision is that, for many new emerging infectious diseases, there are no available drug treatments. This is even true for many already known infectious agents. Additional resources to develop effective medications for treating an infected person are required, but are severely lacking. One of our best tools today to deal with infectious disease outbreaks are the very surveillance programs that some members of Congress are suggesting should be cut. There are many serious issues we are forced to deal with (e.g., climate change, terrorism, and infectious disease epidemics) that require our immediate attention. For all of these examples, we must adapt our tactics to accommodate ever changing situations; however, to prevent infectious disease outbreaks, we already have a solid and functional foundation in place represented by the aforementioned surveillance programs. Germany’s response to the E.coli outbreak could be best described as disorganized due to the lack of coordinated surveillance services. Here in the United States, eliminating the surveillance programs would similarly weaken our capabilities to protect our population from known and emerging infectious disease epidemics, as well as weakening our ability to detect and minimize the threat of a topic not discussed here: bioterrorism attacks that employ weaponized infectious diseases to cause maximum damage. Current surveillance programs would already be prepared to distinguish a natural from a man-made infectious disease epidemic, and would therefore be extremely beneficial as tools in our war on terror.
Legislators in government must deal with balancing a tight budget and the needs of our society. National security has always been on the forefront of our minds, but in addition to terrorism and other issues, this also includes protecting our society from in fectious diseases.