January 8, 2009
The Honorable Barack Obama
President-elect
Presidential Transition Team
Washington, DC 20270
Dear Mr. President-elect:
Maintaining and improving the public health laboratory workforce at governmental
laboratories that conduct testing of public health significance is the top issue for the
Association of Public Health Laboratories (APHL). The economic decline has reduced
funding levels for state and local governments, and it is causing them to reduce the amount
of funding they direct to public health and the laboratories that support it.
Governmental laboratories performing testing of public health significance are barely
staffed to meet their obligations and are likely to be severely stressed if they lose even one
position. APHL has learned that almost 80% of its member laboratories are being required
to cut their spending, and APHL estimates that, nationwide, state and local governmental
laboratories have seen their state funding cut by almost $34 million, with an average
reduction of more than $400,000, because of the economic downturn. More than half of
these respondents are laying off their highly-trained and qualified staff, which APHL
estimates has resulted in 429 positions being cut nationally. Another cut of 246 positions is
planned or likely in the very-near future. This is diametrically opposite from the direction
that must be pursued to not only strengthen public health laboratories but also to improve
health outcomes.
Based on survey results, governmental laboratories performing testing of public health
significance have also been required to reduce their purchases of needed materials and
supplies by an estimated $14 million, or an average of almost $142,000. These reduced
expenditures further exacerbate the economic downturn. APHL is joining with the many
voices in the public health community to urge increased funding through the Preventive
Health and Health Services block grant, managed by the Centers for Disease Control and
Prevention (CDC), to quickly and easily provide federal funding to state and local
governments. Funding of $300 million will enable laboratories to staunch the layoffs,
purchase needed materials and supplies and continue to provide good health outcomes.
Second only to workforce, there is an urgent public health need to improve electronic
laboratory messaging. Creating an electronic network for medical laboratory results will
constitute the cornerstone of early detection and rapid control for disease outbreaks, as
documented in a recent report from Analytic Services Inc (ANSER). Electronic laboratory
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January 8, 2009
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reporting (ELR) would also serve as the country’s key indicator for significant outbreaks
of disease.
Without timely and accurate information, those responsible for managing and controlling
an event cannot respond in time to prevent needless casualties. ELR would promote rapid
identification and mitigation of exposure. Test orders and results can no longer be
inefficiently reported by telephone, fax and email. Improvements in health information
technology must include laboratories performing testing of public health significance. The
ANSER panel of subject matter experts identified a funding level of $200 million annually
as essential to moving forward in a significant way.
The economic downturn is also aggravating the underlying long-term workforce shortage
in public health laboratories. The nation’s state and local public health laboratories
currently face high levels of turnover and likely shortages in senior leadership over the
next several years. During 2005 alone, 16 new state public health laboratory directors took
office, representing a 30% turnover rate; for 2006, the vacancy rate in these senior
leadership positions is expected to exceed 25%. Moreover, many current laboratory
directors indicate that the pipeline of candidates available to serve as their successors is
thin and comprised of individuals who lack the knowledge and skills needed to lead
laboratories successfully through periods of change in the evolving public health
environment. APHL has been addressing the future workforce needs of its member
laboratories through its public health laboratory fellowship program, which has 60 active
fellows. A doubling of the program to 100 fellows could be accomplished with $6 million.
At a minimum, funding for CDC’s existing programs in infectious diseases and
environmental health must be maintained. Specifically, state and local funding for
preparedness, biomonitoring, tuberculosis, food safety, influenza and newborn screening
must receive funding at least at the previous fiscal year levels.
Continued federal funding for preparedness will preserve the state and local capacity that
has been built and allow laboratories to respond rapidly and effectively to a terrorist
event or public health emergency; purchase new instrumentation, adopt new
technologies and develop electronic laboratory reporting; recruit and retain highly-skilled
laboratory personnel; maintain outreach programs to hospital and clinical laboratories and
first responders; and assure a coordinated response effort with federal partners.
Biomonitoring funding will allow states to build laboratory capacity and capability to
monitor chemicals in people and will allow CDC to manage state programs, conduct
studies and issue reports on monitoring disease and chemical exposures in people.
Increased tuberculosis funding for laboratories will enable them to implement new and
existing diagnostic tests that can identify tuberculosis and screen for drug resistance;
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January 8, 2009
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standardize drug susceptibility testing methods in the US for first- and second-line drugs
used to treat TB patients to improve clinical outcome; enable CDC to conduct an
assessment of laboratory tuberculosis testing capacity; develop a plan of action that will
address extensively drug resistant tuberculosis (XDR-TB) to prevent it from invading the
US; develop recommended testing methods for different patient populations, as well as
guidelines to help jurisdictions select the appropriate level of service; and improve
laboratory staff proficiency in complex tuberculosis testing procedures.
Funding increases in food safety would allow states to hire additional staff and train new
and existing staff to meet food testing demands; provide for the purchase of necessary
reagents and laboratory equipment; allow for the development of food chemistry testing;
fully fund PulseNet to allow immediate testing of samples and expand PulseNet to detect
additional pathogens; evaluate and implement next-generation laboratory testing methods
and support national foodborne disease surveillance; and make improvements in sample
shipping to assure timely submission of samples from healthcare providers and clinical
laboratories.
Continuing influenza funding will enhance influenza pandemic preparedness and expand
early warning laboratory surveillance with year-round testing to rapidly detect variations of
influenza viruses, especially the emerging deadly avian influenza viruses, in accordance
with the Department of Health and Human Services’ “Federal Guidance to
Assist States In Improving State-Level Influenza Operating Plans” and enhance molecular
detection capacity, provide needed reagents, allow for staff recruitment and provide
training.
Newborn screening funding increases will support the implementation of the Newborn
Screening Saves Lives Act of 2007 (Public Law No: 110-204) to increase funding of
newborn screening grant programs in education, outreach, follow-up care, quality
assurance and contingency planning and expand the efforts of CDC’s Environmental
Health Laboratory’s Newborn Screening Quality Assurance Program.
Finally, the revitalization of the Commissioned Corps of the Public Health Service — under
the excellent leadership of Rear Admiral Sam Shekar, has made much progress. APHL
believes that the changes underway in the Corps reflect exactly the right approach the
program has needed. Particularly strong is the notion of promoting Corps assignments to
state and local agencies, including public health laboratories, which helps to fill gaps and
provide qualified and interested Corps members with on-the-ground public health practice
– representing a win-win for the Corps and for public health practice.
The nation’s state and local governmental laboratories performing testing of public health
significance pride themselves on performing the best possible diagnostic work and
transmitting the data from that work in a timely fashion to improve the public’s health.
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January 8, 2009
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They deserve funding that will allow them to continue their operations and provide this
critical service. Sadly, the economic downturn is now threatening their ability to meet
these goals, and they must be included in any economic recovery package. These public
health benefits cannot be delayed or deferred.
Sincerely,
Frances Pouch Downes, DrPH
President, APHL
Director, Public Health Laboratory, Michigan Department of Health
The Association of Public Health Laboratories is a national nonprofit dedicated to
working with its members to strengthen governmental laboratories with a public health
mandate. By promoting effective programs and public policy, APHL strives to provide
public health laboratories with the resources and infrastructure needed to protect the
health of US residents and to prevent and control disease globally.