Yesterday, Ebola. Today, Zika. Tomorrow...?

Special to Medical Journal – Houston BY TED SHAW, President/CEO, Texas Hospital Association

At a time in the calendar when the flu usually dominates our health news, this year we have a new scene stealer. The Zika virus.

Mosquito-borne, the Zika virus has grabbed international attention primarily because of its devastating effects on developing fetuses. An estimated 4,000 babies in Brazil alone are thought to have been afflicted with the Zika virus, which is suspected to be linked to the fetal deformation known as microcephaly, in which infants are born with smaller-than-usual brains. Depending on the severity, microcephaly can cause developmental delays, dwarfism, mental retardation, and seizures. Infectious disease experts are hard at work investigating the full impact of the Zika virus on pregnant women and developing fetuses. No treatment or vaccine for the virus is available.

At the time of this writing, mosquitos carrying the Zika virus have not yet crossed the border into the United States. Cold comfort though when the infection has already been found in 21 countries in the Caribbean as well as and North, Central, and South America, and the World Health Organization predicts the virus will eventually spread to all but two countries (Canada and Chile) in the region.

Dealing with new and emerging infections is not unchartered territory for Texas hospitals. In 2014, Texas hospitals were at the epicenter of the Ebola virus in the U.S. The disease had ravaged several countries in Africa, but until a patient traveling from Liberia entered a Dallas hospital in September 2014, there had never before been a single case of Ebola diagnosed in the U.S. In the intervening months, the Centers for Disease Control and Prevention issued updated and revised diagnosis and treatment guidelines; new protocols governing screening and the use of personal protective equipment for health care workers are being followed; and specialized Ebola treatment centers are designated. In just 16 short months, the entire health care community in Texas and the nation is exponentially more prepared and equipped to handle a patient with the Ebola virus.

But Texas hospitals know that it is not enough just to react to known threats. Identifying potential dangers and developing response plans before a crisis occurs is part of hospitals’ vital role as the first line of defense against threats to the public’s health. This is particularly true with respect to infectious diseases because viruses do not respect geographic boundaries.

Just as roads and bridges are the essential physical infrastructure for a thriving economy, hospitals are the essential infrastructure for safeguarding the public’s health. This infrastructure requires support, maintenance, and investment. Equipment, staff, emergency medical supplies, training, and education are just a few of hospitals’ nuts and bolts that create a sound public health infrastructure.

Yet, funding to support such an infrastructure hasn’t kept up with the need. Federal funding specifically for hospital emergency preparedness has dropped by more than half since its inception following the September 11, 2001 terrorist attacks. From $515 million per year in 2003, funding for the Hospital Preparedness Program was down to less than $230 million in the fiscal year 2015. And this is funding for all of the nation’s hospitals.

At the same time, Texas hospitals have fewer discretionary funds to dedicate to emergency preparedness and public health activities. Repeated Medicare and Medicaid funding cuts combined with a persistently high uncompensated care burden resulting from the state’s large number of uninsured residents have left Texas hospitals with fewer funds to invest in emergency preparedness.

The emergence of Ebola in the U.S. and the imminent threat of the Zika virus are known. We can plan and prepare accordingly. But a clear and present danger exists from what is not known. Now is not the time to ask hospitals to be on the front lines of protecting the nation’s public health without equipping them with the necessary resources. Texas hospitals need lawmakers to reject further cuts to Medicare and Medicaid funding for hospital services, reduce the number of uninsured, and increase federal Hospital Preparedness Program funding. Our nation’s health depends on it.