I’ve worked in public health preparedness for 20 years, through disasters such as Hurricanes Katrina, Sandy, and Maria and epidemics like Zika, Legionnaire’s Disease, and, of course, COVID-19.
In April, I attended the annual gathering in San Antonio of public health workers devoted to emergency preparedness and response. Not one of the 2,500 people in attendance — from those employed by nonprofits in tiny rural counties to those working in big city and state health systems — could reasonably predict whether they would be employed this time next year. Nor could they say with certainty that the health systems they had built over decades to protect their communities and the nation would even exist.
That’s because President Trump’s proposed budget cuts all health preparedness support to local governments, cancels all resources that allow health-care systems to prepare for emergencies, and eliminates most research that guides such preparedness and response. If this reduction of more than $1 billion in direct local and state support proceeds, thousands of highly skilled, modestly paid community heroes across the country will join federal workers on the unemployment line.
This is all happening at a time when public health crises are escalating. A large outbreak of measles in Texas, fueled by declining vaccination rates, has spread to New Mexico, Oklahoma, Kansas and beyond. Avian influenza has affected more than 150 million birds and almost 1,000 cattle herds in this country, making significant spillover to humans ever more likely. And climate-driven events such as heat emergencies, wildfires, and coastal storms are setting new records for death and destruction every year.
In this context, the proposed budget cuts — coming on top of slashes to foreign aid and the recall of congressionally allocated COVID-19 funding for governments and nonprofits — would be catastrophic. To counter this crisis, many will want to turn to philanthropy for help, but foundations lack the capacity to make up the shortfall. Consider that in fiscal years 2020 and 2021, U.S. philanthropies invested a total of $3.6 billion dollars for pandemic-related relief, about 10 percent of total giving those years. Grant makers can’t be expected to maintain that level of investment on an annual basis as the government’s emergency preparedness safety net disintegrates.
A Workable Plan
So what can funders do? The simple answer: everything possible to preserve and strengthen local public health and emergency preparedness infrastructure. What does that look like in practice?
Based on recommendations to be released this fall by the New York City Preparedness & Recovery Institute, or PRI, where I serve as director, philanthropy will get the biggest bang for its buck by guiding the development of permanent public-private Preparedness and Emergency Funding Councils in every state and major city. The councils would be made up of funders, local and state officials, community nonprofits, major businesses, and academic centers, which would collaborate to prepare for and quickly address public health crises.
Similar efforts during the pandemic, such as the Partnership for New York City and California’s Together Toward Health Initiative, demonstrate that if done right these councils could effectively coordinate the securing and disbursement of emergency resources even if federal help evaporates.
To facilitate the creation of the councils, grant makers should serve in a convening role, working through their networks to bring together council members and local stakeholders to prepare for specific emergencies and for the likely impact of proposed federal funding cuts. The councils would need to establish a pool of funds that could be used for health preparedness efforts and rapidly deployed during emergencies. The funds would be distributed with limited red tape through a trusted local network of nonprofit service providers.
A similar approach was used after the 9/11 attacks when the New York Community Trust and the United Way of New York City came together to create the September 11th Fund. Since then, funding collaboratives have become more common, but service coordination has not. Such coordination is now critical.
Efficient and Effective
Once in place, the councils should focus their efforts on three priorities: adopting a collaborative problem-solving model; creating sustained support for mutual aid; and supporting ongoing innovation. While these approaches certainly won’t replace federal support, they can facilitate more efficient and effective responses to state and local public health emergencies.
Collaborative problem-solving. A key finding of PRI’s inquiry into community-level response during the pandemic is that the infusion of resources, while both welcome and needed, was often disjointed and duplicative and resulted in major funding gaps, especially in the most vulnerable communities.
The problem: Well-intentioned foundations, corporations, and governmental agencies were managing separate and disconnected funding streams, creating substantial inefficiencies and confusion for service providers on the ground. The Preparedness and Emergency Funding Councils could alleviate these problems by facilitating joint public-private strategies focused on getting funding where it’s needed in the shortest time possible.
Support for Mutual Aid. When COVID-19 first swept the country, Americans of all backgrounds stepped up to care for one another by providing supplies, food, and housing and conducting check-ins on vulnerable neighbors. In other countries, this mutual aid was sustained throughout the duration of the pandemic. But here much of it collapsed prematurely.
What was the difference? Cities like Tokyo had ongoing, formal neighborhood associations to coordinate this work. By contrast, domestic mutual aid groups such as Bed-Stuy Strong in Brooklyn relied on day-to-day crowdfunding. Ultimately, most disbanded as their leaders grew exhausted.
PRI recently held a reunion for the leaders of New York City’s mutual aid efforts. There were tears and hugs among participants, some of whom had never met in person before, and expressions of deep commitment to always show up for their neighbors. Yet many of their partnerships had collapsed, along with the grants that supported them.
The proposed councils could play an important role in making sure that doesn’t happen. At relatively little expense, they could help mutual aid organizations assist their communities year-round and during emergencies. For example, the city of Wellington, New Zealand, provides about $1,000 a year to residents who maintain 127 mutual aid groups, or what they call community emergency hubs, throughout the area
Innovation Focus. The councils could help fill some of the tragic knowledge gaps revealed by the pandemic, including identifying how public health interventions can be delivered with minimal negative effects on communities and businesses. One of the most startling statistics from the pandemic is that almost a quarter million deaths in the United States from COVID-19 could have been avoided if more people had been willing to get vaccinated.
The proposed councils could pair community leaders and researchers with donors to develop innovative diagnostic, preventive, and therapeutic interventions before emergencies strike. This, too, does not need to be costly.
Last year, PRI, in partnership with Firefly Innovations, a public health entrepreneurship platform, ran a challenge competition seeking new approaches to addressing public health emergencies. More than 60 were submitted, resulting in four projects receiving $90,000 each in funding. The projects were all led by teams of researchers, community leaders, and government officials.
Philanthropy alone cannot replace sustained governmental services. However, it can support the leadership and forward thinking critical to addressing public health challenges. Setting up Preparedness and Emergency Funding Councils nationwide is a concrete step grant makers can take immediately to help define what’s needed, determine what’s possible, and allocate resources in a coherent manner. The public health landscape is changing before our eyes. Let’s do all we can now to prepare for what’s coming.
