0:00

Welcome to Public Health

0:02

on Call, a podcast from

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the Johns Hopkins Bloomberg School

0:06

of Public Health, where

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we bring evidence, experience,

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and perspective to make sense

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of today's leading health challenges.

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If you have questions or

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ideas for us, please send

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an email to Public Health

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Question at JHU.EDU. That's Public

0:25

Health Question at JHU. EDU.

0:27

for future podcast episodes. It's

0:30

Lindsay Smith-Rogers. Today, the

0:32

impact of surprise federal budget

0:34

cuts on a state health

0:36

department. Dr. Manisha Jutani is

0:39

the health commissioner of Connecticut.

0:41

She speaks to Dr. Josh Sharfstein

0:43

about the recent decision by

0:45

the US Department of Health

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and Human Services to abruptly

0:49

stop $11 billion in state

0:52

grants that were provided as

0:54

part of the COVID response.

0:56

Just to note that this

0:58

episode was recorded prior to

1:00

a federal judge's issuing of

1:02

a temporary restraining order

1:05

on the cuts. Let's listen.

1:07

Dr. Manisha Jutani, thank you

1:09

so much for joining me

1:11

today on Public Health on

1:13

Call. How are you doing today?

1:16

It's been a rough few days

1:18

in public health. What is top

1:20

of mind for you today? Well,

1:22

we had almost $150 million

1:24

dollars. caught last week in

1:27

critical funding that was helping

1:29

to support public health

1:31

initiatives for the people

1:34

of Connecticut. Tell me more

1:36

about that. What kind of initiatives?

1:38

So we had funding

1:40

in six different grants,

1:42

all of which were

1:44

canceled effective immediately. And

1:46

the types of programs

1:48

that were funded involved

1:51

setting up laboratory systems

1:53

that help show people

1:55

cases of flu and

1:58

RSV and COVID. and

2:01

the like and all of those

2:03

updates have had to come to

2:06

a halt. So I want to

2:08

take a step back to understand

2:10

what Connecticut was working on with

2:12

these federal funds and what you're

2:15

losing as those funds may go

2:17

away or have gone away. Take

2:19

me back to the pandemic. You

2:21

became health commissioner in the middle

2:24

of the pandemic. What were the

2:26

systems that were straining or failing

2:28

within public health that you became

2:30

aware of? Everybody knows and remembers

2:33

back to the early days of

2:35

the pandemic that people wanted to

2:37

know how many people had COVID,

2:39

how many people had been tested

2:42

for COVID, where were more cases

2:44

coming up? At the beginning of

2:46

the pandemic, everything was really facts-based

2:48

in the state of Connecticut. And

2:51

just to be clear, when you

2:53

say facts-based, do you mean... F-A-X,

2:55

like a fax. As in a

2:57

fax machine. Okay. Meaning lab results

3:00

were sent to the department by

3:02

those F-A-X fax machines and paper

3:04

had to be collated data put

3:06

into systems to be able to

3:09

try to answer those questions that

3:11

actually were guiding public health decision-making

3:13

at the time. So people were

3:15

pulling the faxes off the machine

3:18

and typing in the data into

3:20

some database somewhere. And if we

3:22

were really stated the art, it

3:24

might be an e-fax, where it

3:27

wasn't actually a piece of paper.

3:29

So it varied, but yes. And

3:31

what were the consequences of those

3:33

challenges? So we all are used

3:36

to a technological world where those

3:38

types of delays are beyond what

3:40

people really expect in the United

3:42

States of America at this point

3:45

in time. And this funding really

3:47

helped us get our systems... solely

3:49

getting up to speed. We had

3:51

to focus on that initial COVID

3:54

data initially. But what the pandemic

3:56

highlighted for us is all the

3:58

gaps that we had. our systems

4:00

throughout public health and that's what

4:03

we'd really been working on over

4:05

these last couple of years. Let

4:07

me ask you this question. People

4:10

are going to hear about fax

4:12

machines, the people who remember fax

4:14

machines that go, come on, why

4:16

didn't you solve this before? Why

4:19

couldn't Connecticut have solved this before?

4:21

So we did solve it in

4:23

certain areas, but what is very

4:25

complex for people to see is

4:28

that some of our data is...

4:30

long genetic codes, you need systems

4:32

that can manage that kind of

4:34

data. We have personal private information

4:37

and data security issues that need

4:39

to be dealt with. We need

4:41

the infrastructure, actual cables that can

4:43

actually manage the level of data

4:46

that we're looking at to be

4:48

able to send. So we've most

4:50

certainly made advances, but we hadn't

4:52

quite gotten over the finish line.

4:55

And that is what we were

4:57

finishing up. So for many years,

4:59

would you say there was an

5:01

adequate funding to modernize the system?

5:04

And then you got to the

5:06

pandemic and funding became more available

5:08

and you could accelerate this work?

5:10

Absolutely. That is part of what

5:13

happened in the pandemic, which is

5:15

to say that some of these

5:17

systems were extremely delayed, had not

5:19

been updated for decades, and those

5:22

types of investments were lagging. But

5:24

our government did realize that And

5:26

that's why funding was put towards

5:28

it. And to be clear, millions

5:31

and millions of dollars have already

5:33

been spent of taxpayer federal dollars

5:35

to get us to the point

5:37

where we are now, only for

5:40

it to be paused right now.

5:42

That sounds especially frustrating. You know,

5:44

I think it is frustrating because

5:46

we know that we can do

5:49

better and we know that we

5:51

were almost there. We know that

5:53

we had done the hard work.

5:55

to make sure that the systems

5:58

that for example would allow a

6:00

new... who's born in the state

6:02

of Connecticut and has over 60

6:04

genetic tests done to get reported

6:07

back to their provider quickly,

6:09

efficiently, to try to

6:11

catch genetic tests that need to

6:13

be diagnosed early. And we're still

6:15

working on faxes with some of

6:17

those. That's the kind of upgrade

6:20

that we were really hoping to

6:22

be able to roll out across

6:24

our agency, not just in one

6:26

specific area. This would have made

6:28

test reports much more accessible, and

6:30

so you can give a quicker

6:32

update on the status of an

6:34

infectious disease, but also newborn screening

6:36

and other kinds of data, so

6:38

that it's more easily accessible, but

6:41

also you can do better quality

6:43

control and make sure that the

6:45

patients who need to be found

6:47

can be found. Absolutely, and that's

6:49

just one part, you know,

6:51

the... disease surveillance, actually having

6:54

epidemiologists who can identify where

6:56

infectious disease outbreaks are going

6:59

on, is another part of

7:01

it. And then the third

7:04

part is actually tracking immunization

7:06

rates, identifying pockets in our

7:09

state where immunization rates may

7:11

not be as high, with over $6

7:13

million that were with our local

7:15

health departments who could try

7:17

to... fend off any outbreaks that

7:19

might happen or could happen. And

7:21

that was terminated at a moment's

7:24

notice to all those health

7:26

departments as well. Does that

7:28

make Connecticut, say, more

7:30

vulnerable to measles outbreak, do

7:32

you think? That is exactly what

7:34

we've been worried about. We know,

7:36

for example, in Connecticut, that we

7:39

have a 97.7% measles bumps and

7:41

rubella vaccination rate for

7:43

kindergartners. However... We also know

7:45

that we have schools where that rate

7:48

is lower. We have a public-facing

7:50

dashboard, in part supported by

7:52

funds through these types of

7:54

grants, that allow us to

7:56

show the public where rates

7:58

might be low. where we

8:00

want to focus those immunization

8:02

efforts to make sure that

8:04

we don't have a measles

8:06

outbreak in Connecticut. We don't

8:08

have a case yet and

8:10

we're trying to keep it

8:12

that way. So you're in

8:14

the process of making all

8:16

of these upgrades and delivering

8:18

these services, the funding gets

8:20

cut. Before you tell me

8:22

how that happened, I want

8:24

to just go back. Tell

8:26

me about the source of

8:28

funding. So the source of

8:30

funding is from the Centers

8:32

for Disease Control and four

8:34

of them were... grants related

8:37

to enhancing our laboratory systems.

8:39

One was an immunizations grant

8:41

and one was specifically on

8:43

health disparities. And all six

8:45

of those were terminated. And

8:47

was the funding made available

8:49

through the pandemic funding? So

8:51

they were originally allocated as

8:53

pandemic COVID-related funds, but different

8:55

than what is being purported

8:57

in the media, these were

8:59

not COVID funds anymore. We

9:01

had been authorized by the

9:03

CDC to redirect funds to

9:05

be able to fill holes

9:07

that were clearly identified in

9:09

the pandemic that made our

9:11

response very challenging the first

9:13

time around. And now we

9:15

were making our systems better

9:17

to be able to serve

9:19

the people of Connecticut better.

9:21

And how do you find

9:23

out the funds were getting

9:25

cut? We had notices issued.

9:27

Close of Venice on March

9:29

24th and on March 25th

9:31

we were notified as leadership

9:33

that these notices were coming

9:35

in. So they had already

9:37

been terminated by the time

9:39

we had been notified. And

9:41

that meant no more money

9:43

could go out the door?

9:45

So it is our impression

9:47

that expenses we have before

9:49

March 24th, we can still

9:51

draw down. And it does

9:53

appear that those funds are

9:55

still available to us at

9:57

this moment in time. However,

9:59

expenses beyond March 25th would

10:01

not be able to be

10:03

drawn down. It's kind of hard

10:05

just to shut off programs. It's

10:07

extremely hard to shut off

10:10

programs. You know, our health disparities

10:12

grant, one of the programs that

10:14

it was funding in Connecticut is

10:16

one called Family Bridge, where

10:18

we have a universal nurse home

10:21

visiting program for new families, new

10:23

mothers who just gave birth to

10:25

a baby, where they could be

10:27

visited by a nurse. and or a

10:29

community health worker. And we were

10:31

one of three funding sources.

10:33

I had to let two of my

10:36

sister agencies who were doing this

10:38

work know that they could not

10:40

use this source of funding any

10:42

longer going forward. So these programs

10:45

that were really built to

10:47

make significant impacts in

10:49

the lives of new families. right

10:51

in our community had to get

10:53

stop work orders like we had

10:55

to do with over 69 contracts

10:58

over 50 contractors and we are

11:00

doing the hard work now of

11:02

trying to identify what we can

11:04

save within our department. Is it

11:06

possible that there were people who

11:08

are expecting a home visitor to come

11:10

the next day who might not have

11:12

been able to come? It's very possible,

11:14

you know, we're not running that

11:17

program, we were funding the program.

11:19

But I also know that was work

11:21

looking at how this program was going

11:23

to be sustainable. That was work looking

11:25

at what is the impact this program has

11:27

had so far in Connecticut. And all of

11:30

those contractors had to get stop work orders.

11:32

So there may be work still going on,

11:34

but there are definitely people who may have

11:36

had to be told that they could not

11:39

do that work anymore. Now, I

11:41

understand that a number of state

11:43

attorneys general, including the one in

11:45

Connecticut, are filing a lawsuit about

11:47

the loss of this. funding so

11:49

abruptly. Can you tell me anything

11:51

about that? That's correct. The lawsuit

11:53

was filed today and we look

11:56

forward to hearing the outcome of

11:58

that. The basis for the lawsuit

12:00

was that there was not

12:03

good cause for these terminations

12:05

and we await to see

12:07

what the judge says. Dr.

12:09

Jutani, thank you so much

12:11

for joining me to tell

12:14

me about this development and

12:16

please keep me posted. Thanks

12:18

so much for having me.

12:20

Public Health on Call is

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Hopkins Bloomberg School of Public

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Health, produced by Joshua Sharfstein,

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Lindsay Smith Rogers, Stephanie Desmond.

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