Local public health officials were excited when the Baker administration recently announced a modest grant program to help beleaguered towns and cities be better prepared for the next pandemic. For the first time in decades, they said, the state was investing new money on the front lines of disease prevention.
But then came Governor Charlie Baker’s announcement on Thursday that not a single dollar out of $2.8 billion in federal pandemic relief funding he plans to allocate would go toward public health programs. Instead, he said, the money would be used to ease the state’s housing crunch and other priorities.
Now, some of the same leaders who were praising the administration days ago are lamenting what they say is Baker’s shortsightedness. They believe the governor is missing a historic opportunity to make a dramatic new investment in the state’s tattered public health system.
“It’s a public health crisis that caused all of this federal funding to happen. And then he wants to turn his back on this?” said Mike Hugo, government affairs liaison at the Massachusetts Association of Health Boards. Just two days earlier, Hugo had praised Baker for the state grants, saying, “This is the beginning of something extremely exciting.”
The sharp turn against the governor underscores the urgency local public health officials feel about improving their system after a pandemic that has killed more than 17,000 people in Massachusetts. The state’s threadbare network of local health departments was simply overmatched by COVID-19 and the directors say a massive infusion of money is needed to not only be ready for the next pandemic, but to provide basic disease prevention services more equally across the state.
A coalition of public health groups earlier this month called on the Baker administration and state lawmakers to allocate $250.9 million from the federal pandemic relief fund, known as the American Rescue Plan Act, over the next five years to upgrade training and build statewide health data tracking systems.
Many local health departments operate without a single nurse, infectious disease expert, or health agent trained in detecting toxic lead in households. Computer software systems are so archaic that Massachusetts lacks the ability to track whether proper food inspections are happening across the state, how housing complaints vary across regions, and whether those issues are uniformly addressed, health leaders say.
“This is not a theoretical problem anymore. Lives have been lost,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association. “We have experienced the consequences of our disinvestment in our local public health system. And it’s part of what contributes to the inequities in COVID outcomes.”
Baker, in announcing his spending priorities for the $2.8 billion in federal pandemic relief, praised local health officials and did not rule out more state spending to rebuild public health systems. However, he suggested the money for local health programming could come from another $2.5 billion in federal funds that the Legislature will manage.
Local public health officials ”have been great partners on our [COVID] testing initiatives, our contact tracing initiatives, our vaccine initiatives,” Baker said Thursday. “And I think that’s a great example of an item that we would love to work with them and with the Legislature on, to come up with an appropriate investment there going forward.”
Spending on local public health across the country has been stretched thin for over a decade and many states were overwhelmed by COVID-19. But Massachusetts, the birthplace of the public health movement in America, was caught particularly flat-footed in the pandemic’s early days, suffering the third-highest per capita COVID-19 death toll in the nation.
Unlike other states, which provide public health programs through county or regional health departments, Massachusetts relies on a fractured system of hundreds of local departments that are largely supported through local property taxes. And many local health departments lacked the staffing, technology, and training to track and contact trace the daily flood of new COVID infections, prompting the Baker administration to tap Partners in Health, a Boston-based nonprofit, to lead the initiative for a price tag of more than $130 million.
Now, as the number of infections wanes and vaccinations grow, the Baker administration is making some investments in public health, which local officials were quick to praise. The state is currently awarding roughly $30 million in grants of federal and state money that will allow some local health departments to hire experts in disease tracking and bolster other long-neglected services.
Public health advocates say the money, while not nearly enough, is a welcome down payment.
“I have been in public health since 1989 and have never seen this level of support from the state to public health,” said Peabody health director Sharon Cameron, who served on a special state commission that warned two years ago that local public health departments were ill prepared to handle many basic services, let alone a large public health crisis.
The pandemic laid bare glaring inequities, with communities of color and lower-income neighborhoods suffering a heavier burden of disease and death, and having fewer resources among their local health departments to handle the toll. The Baker administration identified 20 such cities and towns, including Boston, Chelsea, Fall River, and Springfield, and targeted extra resources to improve access to COVID vaccines and affordable housing.
The first batch of 29 state grants, each worth up to $300,000 annually for at least three years, are being distributed to local health departments that agreed to join with at least three other communities for hiring and sharing staff and services. Known as the Public Health Excellence Shared Services Grants, the money, roughly $10 million, was championed by several state lawmakers and included in the state’s current budget, which was finalized in December.
State documents indicate the awards may be renewed every three years, until June 2033, for a total of up to $150 million, assuming the state has sufficient funds.
Baker’s spending priorities are not necessarily the last word for the $2.8 billion in federal spending — the Democrat-controlled Legislature has made it clear it wants a say in spending decisions. The Legislature earlier this month sent Baker a bill that would divert the whole $5.3 billion into an account state lawmakers control, where they could spread the money over several years.
Baker on Thursday rejected that and instead said he would ask lawmakers to amend it, by carving off $2.5 billion for them to divvy up, leaving the rest for him to put to work in housing, job training, and other initiatives.
If Baker prevails in the spending dispute, there will still be new spending for public health, but the dollar amounts are likely to be modest. About a week ago, state health officials announced they would award $19.8 million over two years from another pot of federal money to help local health departments assume all COVID infection tracking and related duties by Oct. 1. That’s when Partners in Health, which handled tracking and tracing for more than 64 percent of the state’s reported COVID cases, bows out.
Exactly how long health departments in Massachusetts and across the country will need to closely track and trace COVID cases is an open question. But with growing concern about more contagious strains of the virus, and uncertainty about how well current vaccines may hold up against future strains, many health leaders say close monitoring will likely be needed well into 2022.
“We may need to monitor for outbreaks, always,” said Emily Gurley, an infectious disease epidemiologist at Johns Hopkins Bloomberg School of Public Health. “It’s not going away in the foreseeable future.”
Geoff Beckwith, executive director of the Massachusetts Municipal Association, said it’s well past time for the state to take bold action.
“We have seen now the urgent need to invest in public health and to invest in communities with a lack of resources,” he said. “We have seen essentially the worst case scenario play out and the massive disruptions.”
Matt Stout of the Globe staff contributed to this report.