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Dear Majority Leader McConnell, Speaker Pelosi, and Minority Leaders Schumer and McCarthy:

As Congress undertakes the next iteration of legislation to speed the response to the COVID-19 pandemic, the undersigned organizations urge you to include a significant, long-term investment in public health infrastructure. This investment is critical to support the public health system as it rebuilds from the COVID-19 response, but also to strengthen it before the next pandemic hits and avoid the loss of life and social and economic disruption we are facing today. The importance of strong, predictable federal investment in this system is even more vital now as the economic impacts of the pandemic are felt nationwide. State and local governmental budgets, and therefore public health budgets, are likely to be devastated. This will leave our nation even more vulnerable to emerging health risks. By building the core public health infrastructure of states, localities, tribal governments and territories, as well as the Centers for Disease Control and Prevention (CDC), the nation will be better prepared for the next threat.

Our groups recommend $4.5 billion in additional annual funding for CDC, state, local, tribal and territorial core public health infrastructure to pay for such essential activities as disease surveillance, epidemiology, laboratory capacity, all-hazards preparedness and response; policy development and support; communications; community partnership development; and organizational competencies.

For too long, the nation has neglected basic public health capacity. More than 56,000 local public health jobs were eliminated between 2008 and 2017—nearly one quarter of the workforce.1 Health departments are still dependent on archaic methods of tracking diseases, including phone,fax and paper.2 CDC’s funding remains just above level with FY2008, when adjusting for inflation,3 and funding specific to state and local public health preparedness has been cut from $939 million in FY2003 to $675 million in FY2020. That means there has been little room to modernize, retain skilled workforce, and address emerging threats. In fact, only 51 percent of the U.S. population is served by a comprehensive public health system, and the estimated gap in funding foundational public health capabilities is about $13 per person per year, yielding the requested $4.5 billion.

The COVID-19 pandemic is illustrating in the direst terms the consequences of underfunding public health. The delays in diagnostic testing are hampering communities’ ability to suppress the virus. Public health departments are attempting to conduct statewide situational awareness and management of medical supply shortages. The response is personnel-heavy – investigating cases, managing supplies and volunteers, conducting risk communications, coordinating with governmental and healthcare partners, and planning for the next phase of response.

The U.S. has followed a pattern of underfunding of vital public health services, followed by a crisis, a quick infusion of cash, and then dwindling investments over time.5 This pattern is placing American lives at risk. We must think not just of the short-term needs of this pandemic, but the long-term readiness of our nation. We applaud Congress for taking quick action to provide $8.3 billion for the initial response, which included $950 million for the state and local public health response. However, short-term, supplemental funding does not allow public health to recruit and retain the expert workforce needed for protecting the nation against emerging threats. We urge you to do act now to prevent and prepare for the next pandemic.


1,000 Days

317 Coalition

Advocates for Better Children’s Diets

Advocates for Youth

African American Health Alliance

AIDS Alliance for Women, Infants, Children, Youth & Families

The AIDS Institute

AIDS United 
Alliance for Aging Research

Alzheimer's Association and Alzheimer's Impact Movement

Alzheimer's Los Angeles

Alzheimer's San Diego

American Academy of Pediatrics

American Association for Clinical Chemistry

American Association for the Study of Liver Diseases

American Association of Colleges of Pharmacy

American Association of Colleges of Osteopathic Medicine

American Association on Health and Disability

American Clinical Laboratory Association

American College of Clinical Pharmacy

American College of Nurse-Midwives

American College of Preventive Medicine

American Dental Education Association

American Dental Hygienists' Association 

American Diabetes Association 

American Foundation for Suicide Prevention

American Geophysical Union

American Geriatrics Society

American Heart Association

American Immunization Registry Association

American Institute for Medical and Biological Engineering

American Lung Association

American Mosquito Control Association

American Physical Therapy Association

American Podiatric Medical Association

American Public Health Association

American School Health Association

American Sexual Health Association

American Society for Microbiology

American Society for Reproductive Medicine

American Society of Transplantation

American Society of Tropical Medicine & Hygiene

American Therapeutic Recreation Association

American Thoracic Society

America's Blood Centers

Americas TB Coalition

The Arc of the United States

Asian & Pacific Islander American Health Forum

Association for Prevention Teaching and Research

Association for Professionals in Infection Control and Epidemiology

Association for Women's Health, Obstetric and Neonatal Nurses

Association of American Cancer Institutes

Association of American Medical Colleges

Association of Immunization Managers  

Association of Maternal & Child Health Programs

Association of Nurses in AIDS Care

Association of Public Health Laboratories

Association of Schools Advancing Health Professions

Association of Schools and Programs of Public Health

Association of State and Territorial Health Officials

Association of University Centers on Disabilities

Autistic Women & Nonbinary Network

Biophysical Society

Bipartisan Policy Center Action

CAEAR Coalition

Campaign for Tobacco-Free Kids

CDC Southeastern Center of Excellence in Vector Borne Diseases

Center for Science in the Public Interest

CenterLink: The Community of LGBT Centers

ChangeLab Solutions

Children's Environmental Health Network

Commissioned Officers Association of the USPHS


Council of State and Territorial Epidemiologists

Delta Vector Control District


Emergency Nurses Association

End AIDS Now

Endocrine Society

Entomological Society of America 

Epilepsy Foundation

Florida Institute for Health Innovation

Foundation for Healthy Generations

The Gerontological Society of America

GLMA: Health Professionals Advancing LGBTQ Equality

Global Health Security Roundtable

Green & Healthy Homes Initiative

Hawaii Health & Harm Reduction Center

Health Resources in Action

Healthy Schools Campaign

Healthy Teen Network

Hepatitis Education Project

Hep Free Hawaii

HIV Medicine Association

Human Rights Campaign

Immunize Nevada

Infectious Diseases Society of America

International Certification & Reciprocity Consortium

Lakeshore Foundation

Let’s Kick AIDS Survivor Syndrome New York   

Los Angeles LGBT Center

March of Dimes


National Alliance of State and Territorial of AIDS Directors (NASTAD)

National Association for Biomedical Research

National Association of Chronic Disease Directors

National Association of County and City Health Officials

National Association of Nurse Practitioners in Women's Health

National Association of Pediatric Nurse Practitioners

National Association of School Nurses

National Athletic Trainers' Association

National Black Nurses Association

National Center for Healthy Housing

National Coalition of STD Directors

National Environmental Health Association (NEHA)

National Family Planning & Reproductive Health Association

National Forum for Heart Disease & Stroke Prevention

National Foundation for Infectious Diseases 

National Health Care for the Homeless Council

National League of Cities

National Network of Public Health Institutes

National Nurse-Led Care Consortium

National Tuberculosis Controllers Association

National Viral Hepatitis Roundtable

National WIC Association

National Women's Health Network

New Jersey Health Care Quality Institute 



OSA, The Optical Society

Partners for Our Children

Peggy Lillis Foundation


National Prevent Blindness

Prevention Institute

Project HOPE

Public Health Accreditation Board

Public Health Institute

Public Health Management Corporation

Redstone Global Center for Prevention and Wellness GWU


Ryan White Medical Providers Coalition

Safe States Alliance


SIECUS: Sex Ed for Social Change 

Society of General Internal Medicine 
The Society for Healthcare Epidemiology of America

Society for Public Health Education

Society for Vector Ecology

Spina Bifida Association


Treatment Action Group

Trust for America's Health

USA Patient Network

Vaccinate Your Family

Washington State Association of Local Public Health Officials

Washington State Public Health Association

Welcome Back Initiative

YMCA of the USA