California delays funding to handle public health emergencies in new state budget

Before COVID-19 hit California, public health funding in California largely plateaued for a decade.

One in four public health labs also closed their doors in the two decades leading up to the pandemic, leaving local jurisdictions without robust resources to mitigate an infectious disease outbreak in their communities.

As lawmakers and Gov. Gavin Newsom approve a new state budget this week that spends a multibillion dollar budget surplus, public health officials who wanted immediate cash to help rebuild their infrastructure were left disappointed.

Advocates this year lobbied legislators and the administration for $200 million in annual dollars to keep California safe from another public health emergency like COVID-19. They wanted the funds to hire and train workers and combat health disparities in certain communities, and pushed for investments in epidemiology, infectious disease monitoring and outbreak mitigation.

The money was necessary, they argued, to prop up the 61 local public health departments in California that serve as watchdogs for any illnesses or contamination that could make their communities sick.

But the 2021-2022 spending plan doesn’t include money local health departments asked for to update equipment and hire more skilled workers. Instead, Newsom and the Legislature agreed to include ongoing funds starting in next year’s fiscal plan.

Michelle Gibbons, executive director of the County Health Executives Association of California, said next year’s money will prove critical to boost a struggling public health system. Gibbons said years of disinvestment in trained workers, specifically, made it challenging to battle the pandemic as it ascended in California in spring 2020.

“If you think about the early days of COVID, the delays in terms of contact tracing, testing, all of those things, those are due to lack of infrastructure at the local level,” Gibbons said.

Erika Li, a chief deputy at the California Department of Finance, said during a Monday Senate Budget Committee hearing that federal funds were were enough to support local public health offices this year.

“This would also provide a planning year for the administration, Legislature, stakeholders to get together to look at ways to really reform the public health system,” Li said. And that’s why you see the ongoing funding for the out years.”

The federal money largely finances COVID-related initiatives, including two $357 million grants for immunizations efforts and $888 million to help schools test students and staff as they reopen, according to Department of Finance spokesman H.D. Palmer. Another grant worth $508 million will help the state fund epidemiology and lab capacity initiatives.

Gibbons said that money is helpful, but public health departments can’t use the dollars for non-COVID issues.

“Those funds are for COVID and COVID-response activities,” Gibbons said. “It’s not like we can apply those funds to STD outbreaks that are happening, or to staff up our environmental health departments so they can go do visits in the community for water testing. We’re not allowed to use funds in that way.”

During the Monday hearing, Sen. Richard Pan, a Sacramento Democrat and pediatrician, urged the administration to provide more details on how and where to spend the $300 million next year. Pan said public health departments need to beef up their workforce and invest in new lab equipment and technology.

“There’s more to public health than just COVID,” Pan said. “I look forward to seeing further descriptions of the administration’s commitment to using federal funds this coming year to begin that work on infrastructure funding. That we’re not just simply saying that we’re going to spend a whole year doing planning. We already know from the pandemic some of our weaknesses.”

Despite the one-year deferment, some public health leaders say the $300 million commitment that is coming was more than they asked for and should be cause for celebration.

Bruce Pomer, a current consultant and former executive of the Health Officers Association of California, said securing the $300 million was a “monumental accomplishment.”

He said the funding will help local agencies hire community workers, microbiologists, public health lab directors, public health nurses, epidemiologists and data professionals.

“I’ve been in public health for nearly half a century, and the bottom line is there have not been many instances with such a major ... deal,” Pomer said. “We needed it right away and delaying it wasn’t what we would have liked. But we have to recognize how significant this is and how positive it’s going to be.”

This story was originally published June 30, 2021 at 5:00 AM.