The nation's preparedness effort to fight outbreaks of Ebola and other infectious diseases has been under-funded and lacking in political will and commitment.
"We don't really have a pharmaceutical response for Ebola," said retired Air Force Col. Randall Larsen, the former executive director of the Congressional Commission on the Prevention of Weapons of Mass Destruction. "But could you imagine if there were 20,000 sick people in 10 cities and we did not have a pharmaceutical response? We would be completely overwhelmed."
Emergency preparedness programs ramped up significantly in the U.S. after the Sept. 11 attacks and the 2001 anthrax scare, said Dr. Gerald Parker, a former principal deputy assistant secretary in the U.S. Health and Human Services preparedness office. Those efforts included research and development of vaccines and anti-viral drugs.
"It was recognized that there would be a dual benefit from research on vaccines, therapeutics and diagnostics to counter bioterror threats and emerging infectious diseases," said Parker, now a vice president at Texas A&M Health Science Center.
But a combination of budgetary constraints and politics has delayed many of those plans.
Larsen said the setbacks are partly the result of an inefficient, fragmented federal system, which leaves no single agency in charge.
Both the Clinton and George W. Bush administrations had a senior position in the White House to lead response efforts to biological attacks and natural pandemics. The Obama administration eliminated the position.
President Barack Obama appointed Democratic operative Ron Klain as Ebola response coordinator on Oct. 17. But there are currently about two dozen presidentially appointed officials who have some emergency response responsibility for infectious disease outbreaks, Larsen said.
Budget cuts also have slowed progress at the local level.
Since 2002, the U.S. Centers for Disease Control and Prevention has given states and territories more than $10 billion to help public health care systems ramp up when faced with a major disease outbreak. The CDC program has been cut more than 30 percent since reaching $897 million in fiscal year 2007, which led to thousands of layoffs by state and local health departments, according to the National Association of County and City Health Officials.
All 50 states and several major cities receive additional annual money through HHS's Hospital Preparedness Program, which helps private hospitals develop plans to better handle surging emergency room volume. The program has handed out a total of $5 billion since 2002, but annual funding has fallen by about 50 percent since it peaked in 2003 at $515 million as Congress lost enthusiasm for funding biodefense.
Over that same period, state-level budget cuts and the congressional sequester have forced many states to eliminate emergency preparedness positions.
"I do believe we are lot more prepared than we were a decade ago, but we still have work to do," Parker said.
In an interview Wednesday with the Associated Press, Dr. Nicole Lurie, the HHS assistant secretary for preparedness and response, acknowledged that funding limitations had contributed to some of the delay in vaccine development.
In the meantime, a flurry of Ebola-related work is further straining resources, even when such efforts turn out to be false alarms — or worse, based on rumor.
Members of West Virginia's Kanawha-Charleston Health Department were recently called to Yeager Airport to investigate four passengers on a plane from Atlanta — three who started their journey in Dallas, one who started out in Houston. "Someone on the plane overheard a conversation that a passenger or passengers were coming from a Dallas hospital. No one in the meeting had any idea if these people were ill," according to a summary report.
The four passengers were isolated, interviewed and subjected to a complete screening evaluation by staff equipped with gloves, respirator and protective gowns. Other staffers collected contact information from all other passengers.
It was determined that none of the four from Texas met any CDC Ebola travel criteria, and were not symptomatic. All passengers and crew were cleared to depart the airport.
The incident cost taxpayers more than $2,350 in staff time — 60 man-hours, according to records.
"That's a real drain on the system every time these things happen," said Dr. Rahul Gupta, the health department's executive director. "If you have to spend that kind of money three or four times a week, it builds up."
AP national investigative reporters Garance Burke, Jeff Donn and David B. Caruso also contributed to this story.
The AP National Investigative Team can be reached at firstname.lastname@example.org