The Trump administration's efforts and ambitions to reduce the size of government could hamper agencies integral to responding to the coronavirus.
Reductions at the Centers for Disease Control and Prevention and the National Security Council, two key groups needed to coordinate and respond, could make it more difficult for the federal government to combat the growing epidemic.
In 2018, the CDC stopped funding epidemic prevention activities in 39 out of 49 countries, including China, after the Trump administration refused to reallocate money to a program that began as part of the government's response to the Ebola outbreak in 2014.
At that time, Dr. Tom Frieden, director of the CDC from 2009 to 2017, said the move 'would significantly increase the chance an epidemic will spread without our knowledge and endanger lives in our country and around the world.'
Claire Standley, an assistant research professor at Georgetown University's Center for Global Health Science and Security, said the cuts 'make it much more challenging' for the CDC to provide technical assistance and sustain important partnerships, like with the Chinese National Influenza Center.
As the Trump administration continues to deal with the fallout from coronavirus, a review of recent budget proposals suggests it would be in much worse shape if some of its requested cuts had taken place.
Trump's budget proposal for fiscal year 2020 called for an approximately 13% cut to the National Institute of Health. The previous year's budget proposal called for incorporating three Health and Human Services agencies into NIH, a move that would have reduced federal staff dedicated to healthcare research.
In June 2018, the Trump administration proposed slashing the number of commissioned corps officers of the US Public Health Service by nearly 40% -- a request that could have significantly lowered the number of federal health professionals dedicated to handling disasters and disease outbreaks, including physicians and nurses in many rural parts of the country.
'If these cuts had gone into effect that would have had incredible impact on the Corps' ability to deal with the coronavirus,' said Jim Currie, executive director for the Commissioned Officers Association, who called the proposal 'dumb.'
Earlier this year, as part of its fiscal year 2021 budget request, the White House proposed cuts to the country's main public health preparedness programs, including a $25 million reduction to the CDC budget for these efforts, and a $18 million cut to the hospital preparedness program inside the Department of Health and Human Services.
'I think they are important as backbones for federal support for state and local responses,' said Josh Michaud, an associate director for Global Health Policy at the Kaiser Family Foundation.
While Michaud was clear that the budget for these programs has been declining since before the Trump administration, the recent requests for cuts could still be cause for concern. In the case of the current coronavirus outbreak, Michaud said: 'It's going to come down to state and local responses supported by the federal government.'
The White House is in the midst of negotiating with Senate Democrats over the amount of money needed to address the threat of the novel coronavirus, even as federal health officials warn that it's no longer a matter of 'if' but 'when' the US will have to grapple with a growing number of cases. Senate Minority Leader Chuck Schumer's $8.5 billion emergency funding proposal is significantly higher than the $2.5 billion request submitted by the administration.
Efforts to bolster preparedness
Some public health officials say they are working off already tight budgets and are used to shifting resources between different, competing concerns. In many communities, officials on the ground combating coronavirus will be the same ones ensuring restaurants follow health regulations, that community pools are properly chlorinated, and who coordinate vaccination programs and work with schools, said Adriane Casalotti of the National Association of County and City Health Officials.
Refocusing to respond to coronavirus, she said, 'is above and beyond local resources.'
'That's hard for our members -- they don't necessarily have a ton of extra workforce or resources to work on the new issue without taking their eyes off the public health issues that they've been working on,' Casalotti said.
The limited federal grants given to local officials are distributed using a flawed process, according to a 2018 report from the Government Accountability Office, a watchdog arm of Congress.
Grants awarded by Health and Human Services to establish and strengthen 'emergency preparedness and capacity-building' may not effectively build the 'surge capacity' needed by state and local health agencies during an infectious disease threat, the report says.
The report also said that states have used the grants for a variety of reasons, including to fund lab testing equipment and vaccination data entry. But in some cases during the responses to Ebola and Zika, that funds took too long to arrive -- prompting the CDC to develop a pre-approval system to speed up the process.
Some of the issues, including the funding delays, pre-date the Trump administration.
A separate GAO report issued earlier this month identified years-old challenges with federal agencies, such as the Department of Homeland Security and Health and Human Services, collecting and sharing data with non-governmental groups. That impacts the 'public health situational awareness,' the report said. Officials cited in the report said issue is 'still very challenging' but reported improvements.
Management of the crisis
At a wide-ranging press conference Wednesday evening President Donald Trump defended his administration's response to the coronavirus epidemic and placed Vice President Mike Pence in charge of the effort.
The news came as members of Congress have grown increasingly frustrated over the White House's approach to the outbreak, both in its level of preparedness and its mixed messages over the potential threat the outbreak poses to the US.
The White House has recently come under fire for not having a roster of top biodefense and health officials inside the National Security Council. The position was eliminated following the departure of Tim Ziemer in 2018. Ziemer's replacement, David Wade, holds a similar title, though officials previously told CNN that Wade carries less authority than his predecessor.
Trump's decision to put Pence in charge of coordinating the government's response followed a report from CNN that the President had privately expressed frustration with how Health and Human Services Secretary Alex Azar was handling the administration's response. White House officials had privately weighed appointing a czar to oversee the administration's response, sources inside the administration and advisers close to the White House said.
Trump made clear on Wednesday that Pence 'is not a czar,' denoting a difference between his role and that of Ziemer or Ron Klain, the Obama-appointed lead coordinator for the US response to the Ebola epidemic who was referred to as the Ebola czar.
Prior to Trump's announcement, Michaud from the Kaiser Family Foundation said, 'There was some concern that the lack of a senior person at the National Security Council which is responsible for coordinating across the various US government agencies in a pandemic response situation, that there is no one whose specific job it is to do that, who has sufficient seniority to see that task through.'