The outbreak in West Africa represents the largest Ebola Virus Disease (EVD) outbreak in history. While there have only been a few cases in the United States, and the risk of an outbreak in the United States is low, the public health and healthcare communities have, and continue to, implement steps to prevent, prepare for, and respond to the threat of Ebola domestically. For example, local health departments across the country are monitoring returning travelers and healthcare workers from the infected countries, educating the public and community partners, planning and exercising with healthcare, emergency management, and municipal partners, and collaborating with state officials to implement Centers for Disease Control and Prevention’s (CDC) guidance for a tiered hospital readiness strategy.
While these actions are necessary to help protect the public, they do not come without substantial cost and resource implications for local health departments and their partners. Recognizing that Ebola is a top national public health priority, policymakers and the federal government have recently taken steps to provide additional funding to support and accelerate state and local public health preparedness and readiness for Ebola.
The Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP) and CDC’s Public Health and Emergency Preparedness (PHEP) program are the two primary federal sources of preparedness funding for local health departments.
Assistant Secretary for Preparedness and Response Ebola Funding
|Funding Source||Funding Amount||Funding Distribution||Eligible Awardees||Funding Purpose|
|ASPR FY 2014 Appropriations – Hospital Preparedness Program Supplemental||$1 million||$50,000 – $1,000,000 per eligible applicant based on need, subject to availability||State and local public health departments serving five enhanced screening airports||Personal protective equipment procurement and training, implementation of laboratory testing for Ebola, minor retrofitting of healthcare facilities, planning with waste management|
|ASPR FY 2015 Ebola Funding Appropriations||$576 million (appropriated amount)||To Be Determined||To Be Determined||To Be Determined|
Table 1: ASPR Ebola Funding to state and local health departments
ASPR is providing $1 million in supplemental HPP grants to select state and local health departments serving the five enhanced screening airports (i.e., Chicago, Georgia, Maryland, New Jersey, New York, New York City, Virginia, and Washington, D.C.). This funding will support the following Ebola activities: procurement of and training on personal protective equipment; purchases of equipment and supplies for laboratory testing; minor retrofitting of healthcare facilities to promote good infection control; and coordination with healthcare facilities and other partners to ensure proper waste management, disposal, and environmental clean-up.
The FY2015 spending bill (H.R. 83) also appropriated additional Ebola funding in the amount of $733 million to the Public Health and Social Services Emergency Fund for ASPR and the Biomedical Advanced Research and Development Authority (BARDA). ASPR is currently working with partner organizations to define funding opportunities that would support healthcare preparedness and response activities for Ebola and other infectious diseases at the state and local level. NACCHO expects that a portion of the funding will be allocated to support healthcare Ebola preparedness activities through the HPP grant. NACCHO will post an update to the Preparedness Brief blog when new information about potential funding opportunities from ASPR becomes available.
Centers for Disease Control and Prevention Ebola Funding
|Funding Source||Funding Amount||Funding
|Eligible Awardees||Funding Purpose|
|CDC FY 2014 Appropriations – PHEP Supplemental||Approximately $4.7 million||Base + Allocation percentage based on volume of travelers from Ebola-infected countries||PHEP Awardees||Support state and local health departments with active monitoring and direct active monitoring (AM/DAM)|
|CDC FY 2015 Ebola Funding
Appropriation – PHEP Supplemental
|Approximately $145 million||Base + allocation percentage based on volume of travelers from Ebola-infected countries||PHEP Awardees||Public health preparedness planning, coordination with healthcare for implementation of tiered strategy, contact investigation, AM/DAM|
|CDC National Center for Emerging and Zoonotic Infectious Diseases FY 2015 Ebola Funding – Epidemiology and Laboratory Capacity (ELC) Supplemental||Approximately $106 million||Competitive||Current ELC grantees||Healthcare infection control assessment and response; enhanced laboratory biosafety and biosecurity capacity; global migration, border interventions, and migrant health|
Table 2: CDC Ebola funding to state and local health departments
At the end of December, CDC made available approximately $4.7 million in supplemental PHEP funding to support state and local health departments conducting active monitoring and direct active monitoring of travelers returning from the infected West African countries (i.e., Guinea, Sierra Leone, Liberia, and Mali). Under this grant, the existing 62 PHEP awardees are all eligible for a fixed base funding amount and a percent of additional funding based on the average volume of travelers from the affected West African countries in their jurisdictions. The accompanying guidance from CDC strongly encouraged states to distribute a “significant portion” of the Ebola supplemental funds to the local level.
A second CDC funding stream includes approximately $145 million dollars to further support state and local health departments Ebola preparedness and response activities including public health preparedness planning, active and direct active monitoring of travelers, contract tracing, and coordination with healthcare systems to implement a tiered approach to Ebola patient care. PHEP awardees will receive a base funding allocation to accelerate public health preparedness planning for Ebola and other infectious diseases and additional funding for response-related activities based on each jurisdiction’s volume of travelers from the affected West African countries. This funding is part of the Ebola funding appropriated to CDC under Title VI of the FY2015 Consolidated and Further Continuing Appropriations Act (H.R. 83), passed by Congress on December 13, 2014.
On January 20, 2015 CDC, National Center for Emerging and Zoonotic Infectious Diseases released a new funding opportunity within their existing epidemiology and laboratory capacity (ELC) program. The supplemental funding totals $106 million and is split into three projects: (A) $80 million for healthcare infection control assessment and response, (B) $21 million for enhanced laboratory biosafety and biosecurity capacity, and (C) $5 million for global migration, border interventions, and migrant health.
Background on Ebola Funding under H.R. 83
On December 13, 2014, Congress passed the “Consolidated and Further Continuing Appropriations Act, 2015” (H.R. 83), which provided $5.4 billion dollars in additional funding to support Ebola preparedness and response. The $5.4 billion is for both domestic and international Ebola response efforts and is spread across various agencies including the Department of Health and Human Services, the Department of Defense, the Department of State and the U.S. Agency for International Development.
Appropriated Amount (in millions)
|Department of Defense Total||
|Procurement, Defense-wide||$ 17.0|
|Research, Development, Test and Evaluation, Defense-wide||$ 95.0|
|Food and Drug Administration Total||
|Department of Health and Human Services Total||
|Centers for Disease Control and Prevention (domestic and international)||$ 1771.0|
|National Institutes of Allergy and Infectious Diseases||$ 238.0|
|Office of the Secretary, Public Health and Social Services Emergency Fund (includes BARDA and ASPR)||$ 733.0|
|Department of State Total||
|Diplomatic and Consular Programs||$ 36.4|
|International Security Assistance||$ 5.3|
|United States Agency for International Development||
|TOTAL Ebola Funding||
Table 3: FY 2015 Omnibus Ebola Preparedness and Response Funding (International and Domestic)
More information about the full spending bill can be found here.
- In October, the CDC and DHS announced additional screening measures at airports that receive a large volume of travelers from West Africa. The five enhanced screening airports are New York’s JFK International Airport, Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta International. http://www.cdc.gov/media/releases/2014/p1008-ebola-screening.html
- Existing PHEP awardees include the contiguous 50 states, separately Chicago, Los Angeles, New York City, and Washington D.C., and the U.S. territories of American Samoa, Guam, Marshall Islands, Micronesia, Northern Marianas Islands, Palau, Puerto Rico, and the US Virgin Islands. http://www.cdc.gov/phpr/coopagreement.htm
- This article was updated on January 22, 2015 to reflect this new funding opportunity from CDC that was released in grants.gov on January 20, 2015.
- Although FDA is an operational division of the Department of Health and Human Services, it is funded through a separate appropriations act and therefore is separated for consistency.