| The high cost and heavy demands of being ready
for a possible smallpox attack are squeezing basic public
health services, state health officials say, forcing cutbacks
in such areas as childhood vaccinations and tuberculosis prevention.
"It has forced trade-offs in everything we do,"
said Dr. Alonzo Plough, public health director for Seattle
and King County, which is battling its worst tuberculosis
outbreak in 30 years.
But federal health officials have some advice: Get used to
it.
"We are never going to get back to the days when we
did 'regular' public health," said Dr. Ed Thompson, of
the Centers for Disease Control and Prevention. "For
the rest of all our careers in public health, we're going
to do the emergency crises and the daily work side by side."
Some state and local health agencies warn that the result
could be more outbreaks of preventable diseases like TB and
hepatitis. Seattle officials blame a shrinking budget and
the emphasis on smallpox for contributing to the TB outbreak.
Federal officials say local health workers simply need to
get better at juggling daily duties with emergency demands.
"That's the nature of public health — things come
up," said Thompson, deputy director for public health
services at the CDC. Public health workers need to adapt to
emergency interruptions in their routines, he said.
He agrees, though, that more money is needed for all the
demands. "Support of protection of the public health
is going to have to become a priority," Thompson said.
While Seattle's TB outbreak may be the most dramatic example,
many state and local health departments say they are cutting
bread-and-butter services.
In Memphis, Tenn., some childhood immunizations and diabetes
screenings have been put on hold. Health officials in Camden
County, N.J., near Philadelphia, have canceled family planning
clinics. In Wake County, N.C., home of Raleigh, workers have
delayed some programs and canceled client visits to meet the
demands of smallpox planning.
"This situation has led to questionable preparedness,
poor response to community requests for service and an overextended
staff — not a good combination," said Gibbie Harris,
community health director for Wake County, N.C.
The smallpox campaign began last December, when President
Bush ordered the voluntary vaccination of 450,000 civilian
health workers.
Most of the burden for carrying out the plan fell to state
and local health departments. County health officials in Washington
state said they had to shelve preparations for other bioterrorism
threats, such as anthrax, to meet federal expectations for
smallpox.
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