Public health prevention and emergency preparedness funding in the United States: Are we ready for the next pandemic?

Highlights • The CDC's cumulative funding for Public Health, Prevention, and Emergency Preparedness decreased over the course of 2011–2020, however, NIH funding dedicated to Prevention displayed an overall increase from 2008 to 2019.• The Hospital Preparedness Program (HPP) is the only source of federal funding for healthcare system readiness, yet their budget exhibited consistent reductions from 2003 to 2018.• Public health emergencies like the COVID-19 pandemic have demonstrated more significant consequences than other diseases that receive greater funding.• Allocating additional funding towards CDC health prevention in addition to expanding the Public Health Preparedness Response Fund (PHPR) and Prevention and Public Health Fund (PPHF) may improve future prevention and preparedness measures.

The CDC's Public Health Emergency Preparedness (PHEP) Cooperative funding, a subcategory of the PHPR, was reduced 30% over 18 years [1,2]. PHEP is the primary source of federal funding for state public health and emergency response.
The impact of public health emergencies cannot be overlooked. As of September 10, 2020, there were 191,766 deaths due to COVID-19 in the US, over 12 times the amount of annual deaths due to HIV/AIDS in twothirds of the time [4]. Yet, the funding for HIV/AIDS continues to increase, while funding for the CDC's public health prevention continues to decrease (Fig. 3).
There have been many public health emergencies in the past to support an increase in public health funding. The high fatality burden COVID-19 places on the US should be recognized, and the funding matched to the damage inflicted on the population and healthcare system. Ebola infected over 27,000 people worldwide, leading to 11,000 worldwide deaths, prompting the implementation of a $1.76 billion funding budget dedicated to Ebola Response and Preparedness [1]. Moreover, other public health emergencies stress the importance of public health prevention and emergency preparedness such as the Zika outbreak. From 2015-present, Zika virus has infected 43,194 people in the US and is transmitted by mosquitos [1].
A couple recommendations can be made. Improve emergency preparedness by increasing the CDC's funding for emergency preparedness programs. Increasing the PHEP funding will give core resources to local and state entities. Next, increase HPP funding. Since 2003, HPP funding has been reduced by more than 50% (Fig. 2), creating significant obstacles in their ability to support the healthcare system during periods of emergency. Finally, the PPHF funding can be expanded so that the vaccine infrastructure and surveillance capacity are adequately supported. In the case of the PPHF, prevention should not be sacrificed for treatment funding. One feasible strategy to limit a public health crisis is to prevent and inhibit the course of the crisis from the beginning, rather than merely reacting to the burden placed on the nation. If funding to the agencies that foster prevention and preparedness measures can be increased, we may have an opportunity to prevent the next public health emergency.
Public health emergencies place a significant burden on the nation and yet, the CDC Public Health and HPP funding continues to decrease. Increasing the HPP, CDC Public Health funding, and other public health bills provides an avenue to pursue in order to lessen the burden public health emergencies such as the COVID-19 pandemic place on the nation.

Ethical approval
Not applicable.

Sources of funding
None.

Author contribution
Study design and conception: Adel Elkbuli. All authors read and approved the final manuscript.

Research registration Unique Identifying number (UIN)
Name of the registry: Unique Identifying number or registration ID: Hyperlink to the registration (must be publicly accessible): Not applicable-no human subjects or research participants' data were utilized or collected.

Provenance and peer review
Not commissioned, editor reviewed.

Declaration of competing interest
Authors declare no competing interests.