Smallpox Planning Detracts From Core Public Health, Washington Officials Say

The Homeland Security push to make local health districts the first defense against bioterrorism, together with shrinking health budgets, have contributed to Seattle's worst tuberculosis outbreak in 30 years, said Dr. Alonzo Plough, public health director for Seattle-King County. "It has forced trade-offs in everything we do," Plough said. The smallpox campaign began last December when President Bush ordered the voluntary vaccination of 450,000 civilian health workers. The bulk of the burden for carrying out the plan fell to state and local health departments.

"All of a sudden, we're doing solely smallpox," said Dr. Kim Thorburn, health officer for the Spokane Regional Health District. "We're spread really, really thin," he said. "We're beginning to slip on things."

"It's the largest logistical activity I've ever seen us do in this department, and it's not covered at all by any funding," Plough said. The costly mandates came just as local health agencies' funding was being cut. In Washington, public health departments lost most of their funding when voters abolished the motor vehicle excise tax.

Over the past six years, per-capita spending on public health shrank 33 percent in King County, 35 percent in Snohomish County and 41 percent in Spokane County. Plough said his budget could be cut in half if the state does not bail out public health districts this year. Public health agencies nationwide face similar money woes as states struggle with budget crises.

Meanwhile, tuberculosis continues to spread in Seattle -- with 158 cases last year. Public Health-Seattle and King County officials are bringing a portable X-ray machine to homeless shelters to screen for the disease, spending hours on the streets trying to find people who may have been exposed, and tracking the outbreak. But they could have been "faster and more focused," Plough said -- if they had more money, or fewer smallpox demands.

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