Zika’s coming and we aren’t ready.

If you’re worried about Zika’s arrival in the United States—and you should be—Laurie Garrett has a must-read article at Foreign Policy on the fecklessness of national political leaders and the appalling lack of preparation in the cities that will be hardest hit.

[W]hat Congress fails to recognize is that most aspects of public health, especially insect control, have long been the responsibilities of states, which, in turn, typically throw the onus down the line to the county or municipal levels. In the absence of federal support, localities are typically hard-pressed to maintain serious mosquito-control programs and year-to-year budgets, allowing loss of civil service expertise over time. At local levels, mosquito control tends to lose financial support and personnel when no crisis is perceived, and city or county governments then respond in haste with poorly trained personnel or outsourced contractors when infestation becomes politically significant. In the absence of federal backing and ongoing funded strategic approaches, local insect abatement is typically reactive and may be executed by workers pulled from entirely different departments in city or county governments.

It’s an age-old problem: our federal system diffuses power to manage disease outbreaks to state and local officials who aren’t up to the task. For one example among many, Michael Willrich’s masterful book Pox documents how poorly equipped localities were to deal with smallpox flare-ups in the late 19th and early 20th centuries—and how the untimely but inevitable federal response led to the first major expansion of federal power over public health.

The Zika story is depressing because it’s so familiar. It’s as if some infectious disease had wiped our historical memory, leaving us to repeat, time and again, the errors of the past.


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