Disaster response is, theoretically, more of a state and federal issue than a local one. A catastrophic event — a tornado, a flood, a pandemic — requires fast cross-agency coordination and access to stockpiled equipment and other resources, which higher levels of government are supposed to have more of. That's who mayors and county executives are requesting help from when they declare an emergency, noted Matt Boyce, a senior public health researcher at Georgetown University. What an emergency declaration indicates, he said, "is 'OK, this is a serious situation, we're going to need external resources.'"
But the coronavirus pandemic has taught cities that bigger bureaucracies are not all that reliable. The federal government, beginning in 1999 and extending through the George W. Bush administration, built a national medical stockpile to prepare for pandemics. But it was depleted and not adequately replaced by later administrations, due partly to congressional partisanship. This has led to the current bidding wars among states for crucial equipment like ventilators.
State governments were also unprepared for COVID-19, and in some cases missed opportunities to ramp up for such a crisis. In California in 2006, for example, then-Gov. Arnold Schwarzenegger spent more than $200 million on large mobile hospitals filled with emergency supplies. But much of that supply was later donated away by Schwarzenegger's successor, Jerry Brown, in a budget-balancing move. New York Gov. Andrew Cuomo did not fund an adequate ventilator supply despite a 2015 report estimating that in an influenza pandemic, the state would need another 16,000 units.
The lesson for local governments is that they need to do at least some basic pandemic prep of their own instead of fully relying on their states or the feds. The problem is that such preparation isn't easy at any level of government.
One reason for the current ventilator shortage, for example, is that the equipment breaks down over time, requiring money for ongoing maintenance. It's hard for local officials to justify this expenditure when their constituents have more immediate concerns like potholes and police. Another problem is that not all emergencies are the same — different kinds of disease outbreaks require different medical equipment.
But at very least, said Boyce, localities can prepare by stockpiling basic equipment for medical workers. Things like masks, gowns, gloves and scrubs are needed in every crisis, and providing it keeps medical staff safer and better able to do their jobs. "It's hard to anticipate what the patients are going to need, because you can't possibly know what infectious disease outbreak is going to happen," said Boyce. "But we do know what the standard equipment is for medical workers. So if you're a city or state, at least having some stockpile of that equipment would be a good idea."
Funding for this is where higher levels of government can step in, to work around the poor incentive structure local politicians face to provide disaster prep. One way would be for the federal government to send block grants to states, or for states to send them to cities, mirroring the decentralized model of other programs. If the grants came without too many strings attached, money could be used for preparation and stockpiling, the details of which would vary by locality. Coastal cities might be inclined to buy equipment that helps with hurricanes or floods, for instance, while cities with older populations might buy what helps with flus or other contagious diseases.
These block grants could drive experimentation in which strategies a locality pursues or who it would contract with. But a baseline provision for every state could be to ensure supplies of protective gear for medical workers, who've been particularly at risk during COVID-19.
The idea of using block grants to deal with disasters isn't new. The Department of Housing and Urban Development, for example, provides grants for areas hit by disasters. But that's after the fact. What I'm proposing is something that, rooted in the same federalism approach, would provide states or local governments with money to prepare for a disaster before one hits, letting them use it with their local circumstances in mind. They would be better prepared for catastrophic events that nobody much thinks about until they actually happen.
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