How will Austin Public Health prevent next outbreak with funding cuts

Austin Public Health Director Adrienne Sturrup is realizing that her department cannot count on federal or even state funding to make up the gaps caused by federal cuts. 

“Our best hope,” she said, is a possible city of Austin tax-rate increase vote in November. “That way we’re not reliant on federal funds to be able to staff some of the programs being cut.”

The City Council is discussing its budget and tax rate and some council members have floated a tax-rate increase election that would allow the city to surpass the state cap on property tax increases as well as to pull from reserves to overcome the city’s financial gaps. The budget being discussed includes a 4% increase to Austin Public Health’s funding, which offsets increased costs of services and does not add programs or replace federal funding, Sturrup said.

Federal cuts to Austin Public Health grants haven’t just meant a cut in services. Sturrup said they also are a cut in the institutional knowledge and the expertise to prevent serious outbreaks and to contain them. 

The Austin and Travis County health agency has had 43% of its $39 million in federal grants affected since January, including $7.7 million in grants permanently cut. The federal grants funded 51% of the health department’s 650 positions and represent about 50% of its fiscal year funding. 

Austin Public Health this year has eliminated 95 positions affected by federal funding cuts. Sturrup said 40 of them were unexpected when grants ended abruptly. 

Still other positions have experienced boomerang funding. The department receives news that funding is going away, staff changes are made accordingly and then the funding gets restored or part of it is restored. Austin Public Health then has to quickly put the program back in place.

That happened with a teen pregnancy prevention program, Sturrup said. All but one of the staffers assigned to this program had be reassigned to other projects. Then when the department learned the funding had returned, “they had to quickly ramp up,” Sturrup said. “This is not the way to do business.” 

The team that covers emergency preparedness response had been told that their funding was going away and soon their jobs, just as flood waters were devastating western Travis County over the Fourth of July weekend, killing 10 people in the county. “It didn’t stop them from showing up,” she said of the team that was on the ground there. That funding, which was part of the $32 million the state received from the federal Centers for Disease Control and Prevention, was later restored by the state. 

Sometimes the federal funding has been restored, other times the state has been able to kick in some, but not all, of the lost funds.

Unlike common belief, those grants did not begin with the COVID-19 pandemic.

“These were long-term grant funds that we had come to expect,” Sturrup said. Some of the staff that lost funding in disease prevention programs had been working at Austin Public Health for more 20 years or more, she said, and had seen the city through threats of Ebola, Zika, COVID-19, Mpox and this year measles. 

Without those outbreak positions in place to do the surveillance and then contact tracing, Sturrup said, Austin Public Health will have to train people without expertise to do emergency catch-up training when the next outbreak happens. 

If the measles outbreak that has been happening this fiscal year happened in the next fiscal year, which begins in October, Sturrup said the response would look different. “We would have a skeleton crew. The time of the response would be impacted.”

Here are the programs that Sturrup said have been affected: 

Mobile vaccination: Half of the team has been cut, which means the department will offer fewer mobile vaccine clinics. 

Emergency preparedness: This team deals with any natural disaster, outbreak or terrorism threat. Some state help has kept some of the programs alive. The air testing program, which looks for bioterrorism agents in the air, hasn’t seen its funding renewed.

HIV and sexually transmitted infections community testing: While surveillance will still be done, Austin Public Health has disbanded its mobile team to bring testing and prevention to the community. 

Refugee screening clinic: The department is slowly winding down. The medical care that refugees receive to help them transition to the U.S. and to screen for deadly diseases will now cost hundreds of dollars to the refugee, and the help they receive navigating the medical system will be gone. 

Tuberculosis clinic: The clinic tests and treats people with TB, which is very common in other parts of the world. The clinic helps prevent the spread of this deadly disease in the U.S. The clinic has had to shrink its program as its funding has decreased. 

Disease surveillance: The epidemiology and disease surveillance unit deals in infectious diseases and food-borne illnesses salmonella. The cuts in funding means a less rapid response.