Since 1994, funding for the CDC’s Division of Tuberculosis Elimination has declined by about 60% when adjusted for inflation, according to a division analysis provided to Wegener.
An analysis by the Association of State and Territorial Health Officials noted that public health spending rose significantly in 2020 and 2021 in response to the COVID-19 pandemic, but the analysis also pointed to a sharp increase in vacancies in public health departments since 2016 and warned of a post-pandemic drop-off in funding.
A recent report by Trust for America’s Health, a nonprofit research and advocacy group, concluded that “many long-standing deficiencies remain unaddressed as state and local health departments could not use pandemic response funding to address other public health programming and infrastructure needs.”
“[Tuberculosis] programs are expected to do more with decreasing funding,” Wegener said. “I have heard several programs say to me that we are basically in a crisis mode right now.”
State and local efforts
In Alaska, which has the highest TB rate, the number of cases per 100,000 residents surged from 7.9 in 2021 to 13.0 in 2022. Hawaii has the second-highest rate, but its rate decreased slightly during the same period, from 7.4 to 7.0. California’s rate increased from 4.5 to 4.7, while the rate in both Texas and New York increased from 3.4 to 3.7 and 3.6, respectively, according to the CDC data.
In Texas, local health departments conduct their own investigations and follow-up, a spokesperson said.
Tommy Camden, tuberculosis prevention and control program manager of the San Antonio Metropolitan Health District, said the department runs a clinic and has partnerships with the local hospital and Texas Biomedical Research Institute. San Antonio is one of a handful of U.S. sites that received a 10-year research funding grant from the CDC.
But funding for prevention, treatment and control — including for public health staffing — falls short for San Antonio, Camden said. The city helped fund six more positions at the department to make up for the lack of state and federal dollars, he noted.
“It’s a huge challenge. … The state and federal grants have been capped,” he said. “As the needs and the necessities have increased, and the challenges have increased, the funding has remained pretty level and it’s put a strain on all the TB programs.”
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