Chair DeLauro Statement at Ready or Not: U.S. Public Health Infrastructure
House Appropriations Committee Chair and Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee Chair Rosa DeLauro (CT-03), delivered the following remarks at the Subcommittee's Ready or Not: U.S. Public Health Infrastructure Hearing:
If there is one thing we have learned from the COVID-19 pandemic that has raged across our nation over the past year, it is that our nation’s public health infrastructure is extremely fragile. Simply put: we are not adequately prepared to respond to public health emergencies of this scale.
Dr. Schuchat from the CDC observed in our COVID-19 Member roundtable yesterday, "emergency resources are very different than sustainable longitudinal capacity" and what health departments really need is help "improving the data, improving the workforce skillsets, and improving the lab capacity."
Even now, a full year into this pandemic, the virus continues to move faster than our ability to collect, share, and analyze the data. Decisions are being made based on stale information.
During our public witness day in 2019, this subcommittee heard about health departments and labs that still use fax machines to communicate. In many cases, data has to be reentered by hand. Health agencies analyze data retrospectively, rather than with an eye to the future.
Effectively that means that even data as basic as a patient’s demographic information, race, ethnicity, or pregnancy status is not being electronically transmitted across health providers and agencies. And that lack of communication can have serious consequences. For example, to answer the question of how COVID-19 affects pregnant women, researchers must first figure out who is pregnant, as there is not sufficient data on who is pregnant!
In response to this health data transmission problem, we championed the public health data modernization initiative at the Centers for Disease Control and Prevention. This Subcommittee has provided a total of $100 million for the CDC to start the data modernization initiative in fiscal year 2020 and 2021. The Labor appropriations bills on a bipartisan basis, as well in 2020, included an additional $500 million to be directed to data modernization in the CARES Act. Unfortunately, when the coronavirus hit, this multi-year data modernization initiative was barely getting off the ground.
Turning more broadly to health departments across America. Let me just make this point, which was made by one of our witnesses this morning. State and local public health officials are the foundation of every public health response. A year into the pandemic they are still understaffed. Our health departments are still understaffed. Following the Great Recession, local and state health departments have lost more than 20% of their workforce since 2008, shedding over 50,000 jobs across the country.
This staff shortage is worsened because as much as one quarter of our health workforce is eligible to retire. In fact, 22% of the workforce plans to retire in the next five years. 25% plan to leave public health for reasons other than retirement. Overall, this means nearly half of the health department workforce is leaving their organization in the next five years. And the COVID-19 pandemic certainly hasn’t improved matters. We need to look at our workforce, we need to make sure that there is diversity and equity. We need to incentivize and hire a whole new generation of public health staff and we need to do it now. Our public health departments and laboratories must be equipped with the capacity, the equipment, and again, a diverse and trained workforce that they so desperately need.
I think this is a very, very interesting statistic which was brought out in Dr. Bibbs-Freeman’s testimony. Public health laboratories are essential for the public health practice. COVID-19 has shined a light on the capability, the work force, and data modernization needs in our nation’s 110 public health laboratories. Dr. Freeman’s testimony states, "In March of 2020, 3% of all public health laboratories and only 3% in the country were capable of performing the advance molecular detectcion tests needed to combat COVID-19." Just 3%. This is an example of the virus being able to move faster than our public health capabilities. Dr. Freeman’s testimony highlights the challenges of recruitement and retaining a diverse, qualified laboratory workforce.
We need to invest in not only the equipment that public health laborites need, but the people. These are not one time budget requests.
Though Congress has provided more funding to local, tribal, and territorial public health organizations to respond to the pandemic over the past year, we have much to do to in order to make this a lasting difference.
We are here today to learn more about how these supplemental funds have been used and how much more we must provide to adequately meet the challenges of the ongoing COVID-19 response. Which is why we will need our witnesses and others in the public health arena to tell us what you need, especially in terms of the long-term challenges of the public health workforce. And what we need to do to build that architecture for the future.
But while the national attention has been laser focused on the impacts and challenges of the COVID-19 pandemic, it is important for us to keep in mind that this is just one of the many battles our public health system is facing.
I want to mention one or two other pieces here. This pandemic is only compounded by the already existing public health crises of the youth vaping epidemic, the anti-vaxxer movement, and the rise in food safety challenges following the past Administration’s deregulation of the food industry.
These are challenges and are reasons to invest in our public health agencies, which in turn keep our communities healthy and functioning. Historically as a nation we appreciate the need for a strong public health system when we are in the middle of a public health crisis, but never before. We think about it in the midst of, but never before. If we want to have a public health system that is prepared, we need to invest now in personnel, labs, equipment, and data systems not just this year, but every year. And not forget about this when the pandemic subsides.
I will reintroduce the Public Health Emergency Fund Act, which would provide $5 billion to the existing public health emergency fund, which was created in 1983, but is currently empty. By dedicating funding ahead of time, this bill would enable our public health agencies to respond quickly to these emergencies.
We have provided billions for the airline industry, billions more for small businesses through the Paycheck Protection Program (PPP). We needed to do that. It is only logical that we would need to invest as much, if not more, in the very systems designed to keep us healthy and safe from disease. We saved the airlines. We saved small businesses. We now need to be in the business of saving lives. This is not about throwing money at a problem, this is about really creating a stable, solid, sustainable public health infrastructure system for the future.
The witnesses we have joining us today represent key partners in public health. We will gain perspectives from a state health department, a local health department, and a public health laboratory system. We will learn about these institutions and their roles in the COVID-19 pandemic response, what the needs are in the field, and their recommendations for strengthening our public health infrastructure.
To meet the moment, we must transform our public health infrastructure. The health of our families and our communities depend on it.