Dwindling federal funding for public health and low booster shot participation threatens to raise the COVID-19 risk once again in Chicago, according to Public Health Commissioner Dr. Allison Arwady.
“COVID is not gone,” she said last week at an event promoting vaccinations on the Southwest Side.
This news comes at a time when the city’s risk for infection is low, with fewer hospitalizations and a dramatic decline in deaths from a year ago. Then, a new variant of the virus, omicron, was gaining steam and a deadly surge in cases loomed. More than 10,000 city residents were being diagnosed with COVID daily. More than 300 Chicagoans were being hospitalized daily last December and January, on average, and dozens were dying every day. Today, on average, around 400 Chicagoans are diagnosed with COVID – and around 30 are hospitalized – each day, with a death rate of less than one per day.
But two factors risk undoing some of that progress.
Chicagoans have become lax about getting their latest booster shots — only about 15% of those eligible have received the newest shot aimed at strains of the omicron variant, the culprit behind mass hospitalizations and deaths last winter.
And federal money is beginning to dry up, leaving health departments locally and across the country — many having already been gutted over the past 20 years — back to fending for themselves with insufficient resources.
In 2002, Chicago had a public health workforce of 1,600 employees. That number dropped to under 600 by 2019, largely because of federal cuts, a city spokesman said, before growing to just over 800 in response to the pandemic.
In recent interviews with the Sun-Times, Arwady said the pandemic has exposed what she describes as a flaw in funding public health departments. Health departments are on a lifeline from Washington, and that funding tends to spike during crises and then fade.
That’s a problem because other health crises pop up, she said, whether it’s an unexpected outbreak, such as monkeypox, or a particularly bad flu season. And for each crisis, local health officials have to build programs knowing that they will ultimately end them once the current health threat subsides.
Chicago has received an unprecedented amount of federal taxpayer funding since the pandemic hit in 2020. The city’s health department, which is almost entirely funded with federal tax dollars, rose from around $220 million annually to around $1 billion for the current year.
That money has gone toward staffing, community vaccination centers, home visits for COVID shots, education, outreach and marketing, testing, disease tracking and contract tracing in addition to many other programs. Newer tracking efforts, such as wastewater surveillance to help detect community spread early, is a product of pandemic funding.
Now that money is set to disappear. Almost all of it — nearly 90% — will be gone within the next two years, Arwady said.
It’s a cycle that repeats itself after each crisis, she said, and it doesn’t have to be this way. Congress could commit to a more steady stream of funding for public health rather than piling on a lot of money — much of it with restrictions — all at once to address a single event, such as a once-in-a-century pandemic, she said.
Of course, the current pandemic is historic and required massive resources. But with tens of millions of dollars in federal funding drying up just in the first half of next year, the city is losing dozens of employees funded by a nonprofit tied to the U.S. Centers for Disease Control and Prevention.
Restrictions on COVID funding are also putting a strain on efforts to get out the word on the need for booster shots, Arwady said. Without added protection from the new boosters, cases will likely increase.
“Our booster rates, not just here but across the country, are not where they should be,” Arwady said. “I need to run the kind of vaccine outreach that we were doing at the beginning of COVID but I am unable to do that.”
Arwady is alarmed about the low uptake of the new COVID booster, especially in communities — such as the Southwest Side where she recently visited — that are still at high risk of infections, hospitalizations and death.
Progress over the last three years has required ongoing education, often convincing people without adequate access to health care that they should suddenly trust a broken system. Many people still aren’t fully vaccinated, much less boosted.
Arwady gets a sympathetic ear from the state’s two U.S. senators, though no quick solutions are forthcoming.
“While Congress has worked to fund our local COVID-19 response, our public health officials need more resources and flexible tools to meet evolving disease threats,” Sen. Dick Durbin said in a statement to the Sun-Times.
He said money in a bill he is co-sponsoring would “provide steady, predictable funding increases” to health agencies.
Sen. Tammy Duckworth “knows Congress should be doing more to ensure that we provide our public health departments with the support and flexibility they need to protect the overall health and wellbeing of our communities,” according to a statement.
A recent report published in Public Health Management and Practice last month underlines the need for beefed up local health agencies to protect public health on an ongoing basis.
“A strong public health infrastructure is essential to ensuring that communities are capable of delivering core public health functions,” said authors of the report, published in Public Health Management and Practice last month. “Even before the COVID-19 pandemic, many state and local health agencies operated with minimally sufficient levels of staff to address health needs and protect and promote health in the communities they serve.”
Acknowledging that reductions in funding are to be expected, Arwady argues that a sudden and significant drop should be avoided.
“We have an emerging issue at least once a year,” Arwady adds. “Because all of the funding comes short term, you can’t maintain the preparedness for whatever comes next.”
Brett Chase’s reporting on the environment and public health is made possible by a grant from The Chicago Community Trust.