Public health needs funding

The following editorial appeared in the St. Louis Post-Dispatch on Wednesday:

The three most alarming words in medicine are these: "We don't know." They've been invoked frequently in connection with an outbreak of swine flu over the past few days.

It began in Mexico, where thousands of people have been sickened and reportedly more than 150 people are dead. The virus spread with alarming speed to the United States, Canada, New Zealand, the United Kingdom, Israel and Spain.

Still, there is no reason to panic. Public health officials already have activated emergency plans. Doctors report the virus responds to anti-flu drugs that are available widely.

Still, many questions remain about the new influenza strain, which is a combination of swine, bird and human viruses. The challenge for public health officials is to avoid both overreaction and complacency.

Swine flu is famous in the annals of public health. A small outbreak on an Army base in 1976 led to a national vaccination campaign, but the feared epidemic never materialized. For years afterward, swine flu was synonymous with a threat that was more theoretical than real.

It's still unclear how great a threat the 2009 version poses. But in the United States, at least, it occurs against an ominous backdrop of budget cuts and soaring numbers of uninsured people.

The public health network we rely on to protect us from disease outbreaks is a fraying fabric of more than 3,000 federal, state and local health departments. Falling tax revenues from the recession have caused many governments to cut funding. Ironically, one area that has been hit particularly hard is pandemic influenza preparedness. Federal funding for those state programs ended last August.

In Mexico, which has a limited ability to detect and track community disease outbreaks, most swine flu cases have been reported among patients hospitalized for pneumonia. Infectious disease experts have suggested that explains why the death rate in Mexico appears to be much higher than in the rest of North America.

It also may be, however, the virus has mutated to become less lethal. Or it could be that future waves of infection among more vulnerable patients will push up death rates here and around the world. We don't know.

It will take time to answer those questions. A vigorous public health response doesn't have to wait, but unless the nation invests in its public health agencies, our ability to respond to emerging infectious disease outbreaks is as fanciful as pigs that fly.

Distributed by McClatchy-Tribune Information Services.