Infectious disease is all around us — whooping cough is on the rise in Maine, widespread influenza is reported, MRSA and C-difficile cases persist in hospitals.

Last winter, hundreds of people were exposed to tuberculosis at a Maine community college. And a major outbreak of measles has been reported at Disneyland.

We are in a modern world of disease threats, where an infectious disease outbreak is only one airplane ride away. Severe new microbes, including SARS, Ebola and H1N1 influenza, have found their way to the United States from distant countries. Maine can no longer be complacent in its seeming isolation.

The good news is there is no mystery about how to identify and control infectious disease threats. Maine needs a well-developed system of disease surveillance (structured scanning of health data to look for threatening trends), laboratory detection and epidemiological investigation (studying, even tracking down, the occurrence of disease in populations).

Hospitals, doctors and nurses complement this population-based work with medical care for at-risk and affected individuals, with vaccines, medicines, emergency preparedness measures, treatment and hospitalizations. Community organizations even have a role in mounting public education and vaccination programs. There are many partners in a widespread emergency, but government plays a central role in coordinating responses.

However, a political climate exists in Maine and in this country where the role of government is challenged at every turn. Even though protection of health and safety is an accepted governmental function, 33 states have seen cuts in their public health budgets from 2011 to 2013, as reported by the Trust for America’s Health.

Maine had one of the highest cumulative budget cuts among those states, and the trend continues. The governor’s budget calls for eliminating upward of 40 positions in the Maine Center for Disease Control. The budget also redirects funds used for public health purposes into other functions.

Worried about Maine’s preparedness, the Legislature’s Health and Human Services Committee posed a number of questions to the commissioner of the department last fall. Commissioner Mary Mayhew assured the committee that Maine is well-prepared for emergencies such as Ebola, citing the highly trained, dedicated and experienced team of state and regional epidemiologists, public health nurses and emergency preparedness professionals.

A look at current staffing levels, however, shows we are down at least two key epidemiologists within the Maine CDC, and three of the seven regional field epidemiologist positions are vacant. In the Public Health Nursing division, close to a third of the positions are vacant throughout the state. These are the professionals who would coordinate and conduct outbreak investigations in our communities.

Will all of these expert positions vacant, the commitment to maintaining that highly trained, expert team is certainly not evident. Is the goal of the vacancies to satisfy a lower head count of state employees? Even when some of these positions are entirely federally funded?

As government health structures decline, it is tempting to think that our system of community hospitals and medical professionals can step up to the plate even further. They certainly play a key role in assuring that hospital beds and appropriate treatment are available to infected patients, and some even have infectious disease specialists on staff. They are not, however, prepared to perform key public health functions, such as disease investigation, tracing of contacts or even school-based vaccination programs, as seen in the flu outbreak in 2009.

It has never been more important for public health and clinical care to collaborate. But public health has to be a viable partner. The Trust for America’s Health recently scored the states on 10 indicators of preparedness for infectious disease outbreaks. Thirty-four states scored better than Maine, and we are likely to drop even further with the proposed budget cuts.

If you are starting to feel uneasy about microbial threats, you should be. We all need to ask hard questions about the adequacy of public health protections for our citizens. Maine has not yet reached a red-alert stage, but our response system is showing serious signs of erosion.

Lisa Miller, of Somerville, is a former legislator who served on the Health and Human Services and Appropriations and Financial Affairs committees.


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