From inadequate testing to a widespread shortage of personal protective equipment, the United States government’s response to COVID-19 has been plagued by a series of critical missteps. And while it is premature to pinpoint the exact cause of all of these failures, one thing is abundantly clear: Chronic underinvestment in emergency preparedness has undermined the government’s ability to manage the coronavirus pandemic.
Between 2005 and 2017, the federal government spent $81 billion on natural disaster relief programs, which help communities recover from disasters by funding debris removal, rebuilding of critical infrastructure and other important post-disaster activities. By contrast, they spent a measly $31 billion on programs that prepare for and, ideally, mitigate future disasters, despite the fact that every $1 spent on preparedness results in $15 in future savings in terms of the damage it prevents.
Our federal system requires that state governments take the lead during disaster, yet a recent study by the PEW Charitable Trusts reveals considerable variability in state spending on disaster preparedness, ranging from 93% of total disaster spending to zero. In fact, most states do not even track natural disaster spending, which makes it impossible to determine their level of preparedness.
State public health agencies rely on an eclectic mix of federal matching programs to fund preparedness. However, national government support for these programs has been declining for years. Federal funding for the Public Health Emergency Preparedness (PHEP) cooperative, a vital revenue stream for state public health preparedness agencies, fell from more than $849 million in 2004to $729 million in 2008 to $623 million in 2019. Similarly, support for the Hospital Preparedness Program (HPP), which is the only source of federal funding for health care system readiness, dropped from $390 million in 2010 to $228 million in 2014 to just shy of $227 in 2018.
President Trump’s mishandling of the outbreak only magnifies our emergency management system’s deep flaws. He has sabotaged his own administration’s credibility by brazenly spreading misinformation and contradicting public health officials. However, our failure to prepare for the coronavirus pandemic is the byproduct of a lack of political will among politicians on both sides of the aisle. Elected officials have historically been disinterested in investing in pre-disaster activities despite repeated warnings from experts that the U.S. is grossly underprepared for an array of disasters.
Whether the coronavirus pandemic will change policymaker thinking about preparedness remains to be seen. Both the Coronavirus Preparedness and Response Supplemental Appropriation Act of 2020 (P.L. 116-123) as well as Coronavirus Aid, Relief, and Economic Security Act or CARES Act (H.R. 748) make significant investments in public health preparedness. The CARES Act, for example, infuses more than $250 million into the HPP while setting aside another $500 million to bolster disease surveillance and data collection programs.
Still, preparedness cannot be magically activated in the middle of a crisis. It needs to be cultivated across time through sustained investments and constant planning. The sudden infusion of preparedness funding is no doubt a promising sign, but policymakers need to continue to replenish these funds in coming years. As of this writing, most of the money allocated through the Supplemental Appropriations Act and the CARES Act is set to expire by 2024.
We do not need to restructure our existing emergency management institutions or create new government agencies. Instead, we need to demand that elected officials begin to make adequate investments in preparedness. Nor are emerging diseases the only threat we need to be prepared for in the years ahead. The dangers posed by a host of climate-related hazards, like heat waves, flooding, wildfires, and drought, necessitate considerable investments in pre-disaster programs as well.
It is high time the U.S. tips the scales in favor of greater preparedness funding so we are ready when—not if—the next disaster strikes.