In the fight against emerging infectious diseases, the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) program plays a pivotal role. This federal funding mechanism from the Centers of Disease Control and Prevention (CDC) is designed to bolster infectious disease programs across the U.S. Yet, the distribution of these funds from state to local health departments (LHDs) remains a complex and unclear process.
A study conducted by NACCHO in 2024 sought to get a glimpse into if and how LHDs access these funds. The study involved a focus group with representatives from five states and one-on-one interviews with representatives from four LHDs and two State Associations of County and City Health Officials (SACCHOs). Two of the themes that emerged from the study focused on how ELC funding has been or can be used to support local jurisdictions:
1. Workforce Capacity and Development: LHDs expanded their workforce capacity during the COVID-19 outbreak by hiring essential personnel, including epidemiologists, biostatisticians, nurses, and administrative staff. Although the supplemental COVID-19 ELC funds enabled LHDs to strengthen their workforce capacity, the new positions were not sustainable with ELC funding and had to be transferred to other funding sources, if available. In addition to increased staffing, ELC funding also supported training and technical assistance for new hires.
“I have some new epis on staff that are new to the field. They host an ESC conference every year and I send my staff there as often as I can. The funding was available for the state to reimburse or to sponsor that trip, and so that was fantastic as a local health department because we did not have that funding in the budget. But that conference is so useful and very, very valuable to new epis.”
– Local Health Department
2. Data Infrastructure and Modernization: One suggested priority for use of ELC funding, beyond the COVID-19 specific funding, is updating public health surveillance and data systems. SACCHOs and LHDs underscored the challenges with their outdated data infrastructure. In particular, LHDs reported that they spend significant staff time on manual data entry due to the lack of interoperable systems. This inefficiency hampers timely and accurate disease surveillance and response efforts. To enhance seamless information sharing, LHDs noted the importance of direct funding to modernize their own data infrastructure, as well as statewide data modernization initiatives focused on breaking down these siloed data systems.
“Our state health department desperately needs to modernize how we collect our communicable disease information, how they display data on a regular basis... [The state] provides lots of analysis, but it’s three years old… That’s a huge struggle for us [in] trying to make decisions on a local level.”
– Local Health Department
ELC funding is a critical resource for combating infectious diseases, but its impact is hindered by communication gaps. Many LHDs were unaware of the availability of or had never received core ELC funds until the supplemental COVID-19 grants were distributed. Some states acknowledged this lack of proactive communication, explaining that core ELC funds often barely covered state infrastructure, leaving little for LHDs. As a result, states prioritize funding for initiatives shared by multiple jurisdictions, like a state or regional public health laboratory. Even when funds have been distributed to LHDs, study participants reported there were limited avenues to share their local needs and provide input regarding how the ELC funding would be used. Furthermore, the process of receiving the ELC funds is often slow and extended at times up to six months, forcing LHDs to rely on reimbursement models despite already limited funds. LHDs often highlighted that active and consistent bi-directional communication between the state and LHDs about the ELC mechanism is critical. One practical example of this was shared, with the state engaging the SACCHO as a bridge to LHDs.
LHDs also faced challenges with grant restrictions. For example, the allowable activities through ELC—particularly the supplemental COVID-19 mechanism—often overlapped with those of other funding sources. In addition, local needs can change rapidly. Although overlapping grants can help LHDs braid funding, study participants noted that these factors limited their ability to use supplemental funds in alignment with local priorities. In addition to flexible funding from Congress that allows LHDs to meet their communities’ specific needs, proactive communication from the state and federal government about grant restrictions and opportunities for streamlining funding sources would be beneficial.
“I’m afraid that the state health department gets the money with federal expectations, and then they just decide if they want to add more expectations or restrictions before they pass the money down to the locals.”
– Local Health Department
By fostering transparent bi-directional communication, ensuring timely distribution, and modernizing data infrastructure, state and local health departments can work more effectively together. In addition, LHDs suggested that receiving direct funds from their state would be more useful to their infectious disease and surveillance work. These improvements will ensure that ELC funding is utilized to its fullest potential, ultimately strengthening the public health infrastructure across the U.S.
