“It’s going to take us longer to discover that people are becoming ill, longer to realize the connection between them, and longer to figure out how to treat them,” says Peter Kyriacopoulos, senior director of public policy at the Association of Public Health Laboratories. “We’ll have more people sick.”
Every U.S. state has at least one public health laboratory, whose job it is to monitor for infectious diseases and other health threats. These facilities are the local eyes and ears of federal agencies like the Centers for Disease Control. On any given day, they might test blood samples for Zika, captured bats for rabies, water for harmful algae, mysterious powder for bioterror threats, newborn babies for genetic disorders, milk or meat for foodborne diseases. They look at which flu strains are sweeping the country, which drug-resistant microbes are rearing their heads, which new diseases are invading American shores. When Ebola arrived in Dallas in September 2014, it was the Texas state public health lab that confirmed its presence by testing a patient’s blood for the virus.
Created in 1995, the ELC program gives the public health laboratories funds for training their staff and buying equipment. It’s not sexy, but it is essential. And until recently, it was relatively small—between 2004 and 2008, it doled out $50-60 million a year, across all 50 states.
“Public health is never well-funded, which means that in the lab, things get very, very tight,” says Kyriacopoulos. “I often say that in this country, we’re lucky we don’t have more than one public health emergency at a time. If we had Zika and a serious foodborne disease outbreak, we would have been in very bad shape.”
The program’s fortunes changed in 2010, when the Affordable Care Act was passed. The act’s Prevention and Public Health Fund (PPHF) infused an extra $40 million into the ELC, almost doubling its budget. Better still, those funds were flexible. Until then, most ELC money was tied to specific diseases, grouped into a few dozen categories. You couldn’t use, say, flu money for tick-borne diseases, or prion money for fungal infections. The new funds came with no such restrictions.
“It gives me the flexibility to do whatever I need to do and to build capacity for what we don’t know about already—like Zika,” says Sara Vetter, who manages the Infectious Disease Lab at Minnesota’s Public Health Laboratory. When the Zika epidemic hit last year, it took seven months for Congress to approve extra funds to fight the disease. In the meantime, Vetter used ELC money to buy everything she needed to start testing for the virus. Without it, thousands of samples would have arrived at the labs and gathered dust. Thousands of women would have waited months for answers.
Similarly, the people who were hired using the extra ELC money weren’t tied to one particular disease, but could be cross-trained to deal with any of them. The funds literally bought flexibility. Some states used them to deal with Zika, while others expanded testing for re-emerging diseases like measles and mumps. They paid for electronic systems for sharing data, and courier services to safely transport hazardous specimens between facilities. “They allow you to perform constant surveillance in the community and identify when you need to respond,” says Kelly Wroblewski, Director of Infectious Disease Programs at the Association of Public Health Laboratories.