St. Louis has been hit by two tornadoes in the past two months. The fire forced residents to evacuate a new nursing home last month in Enterprises, Alabama. Cleveland tackled the blackout while visitors to the NCAA Women's Basketball Final Four flooded.
In each case, local health officials held down fallout, supported hospitals, found new homes for displaced people, and played a key role in coordination with fires, police and other urban sectors.
The work totaled around $735 million and comes from the Centers for Disease Control and Prevention. The budget proposed by President Trump is zero.
The proposed cuts have made health officials more uneasy, particularly as they traced a $12 billion cut to state and local health sectors in March. 19 countries and the District of Columbia have sued to prevent cuts.
“Artificial and natural disasters do not depend on federal funds, but the response to saving lives is,” said Dr. Matifha Fratova Davis, Health Director at St. Louis. (Dr. Davis has resigned, but continues until the city finds a replacement.)
The city is dealing with huge sinkholes, and sits on fault lines that are routinely facing floods and are at risk of earthquakes. “We really rely on this fundraising,” Dr. Davis said. Without it, “the entire population of St. Louis and its visitors will remain vulnerable.”
The Department of Health and Human Services directed questions regarding budget proposals to the Office of Management and Budget, which did not respond to requests for comment.
The funding has attracted attention from local health sectors through the Public Health Emergency Preparedness Cooperation Agreement. The program was created after the September 11, 2001 terrorist attacks and helped prepare for biological threats and other emergencies.
The funding will help authorities manage the public health impacts of natural and artificial disasters and contain the outbreak of infectious diseases. They also pay salaries of experienced officials who help prepare and mitigate public health.
The amount varies depending on the jurisdiction. St. Louis and Cleveland each receive around $250,000. This covers the salaries of three staff members. In contrast, Dallas receives nearly $2 million and pays salaries for 17 employees.
“There's not much buffer for these funds, especially at the local level,” said Dr. Philip Fan, director of the Dallas County Health and Human Services Department in Texas.
If funds disappear, even big cities like Dallas will step in in emergencies. “The smaller the health department, the more likely the impact will be,” he said.
Dr. Davis said her department receives less than 1% of the St. Louis city budget. If public health emergency funds are cut from the CDC, Missouri and cities are likely to make up for the shortage, as the budget currently suggests.
“These people will soon lose their jobs,” Dr. Davis said of the employees funded by the grant.
In Alabama, emergency response programs are funded entirely through federal grants. Winter tornadoes, hurricanes and ice can all cause havoc and require intervention from health authorities.
“We're accused of the Alabama Department of Public Health,” said Dr. Scott Harris, state health officer for the Alabama Department of Public Health.
In many jurisdictions, staff relied on hundreds of volunteers to help vaccinate Covid and MPOX. But they still needed paid staff to coordinate those activities and train volunteers, Dr. Huang said.
“You can't show up to everyone and say, 'Yeah, I'm a doctor,'” he said. City officials will verify their volunteer qualifications and mobilize for emergencies if necessary.
In Cleveland, health officials charged with prep charges are receiving calls from hospitals in the middle of the night with the possibility of charcoal thr bacterial or other infectious threats.
“We've seen a lot of trouble with our efforts,” said Dr. David Margolius, Director of Public Health at Cleveland. “But it's better to prepare than to get arrested at your feet.”
Some officials have been worried since the election that the Trump administration may not update the program when they end. But they said they weren't prepared for the money to be suddenly cut off, as was the case with other CDC funding streams.
If Congress enacted a cut, he said, “We'll have to scramble to get a sense of their situation.” “For these teams and Cleveland residents, it's completely unfair to resort to these services.”
