Public health efforts face a very difficult problem: they’re like car insurance. You hate paying it…until you get into an accident, then you’re really glad you have it. With that for prelude, we bring you this story about mosquito control–a critical component in stopping the spread of mosquito-borne diseases, including Zika virus and dengue fever (boldface mine):

In the United States, mosquito control — the tracking, spraying and surveillance that, in the absence of a vaccine, provides the best defense — is conducted by a crazy quilt of local districts that are dependent on cities and counties for funding and personnel. Some belong to local health departments, and others to departments of agriculture, transportation, or parks and recreation; almost none of them answer to the Centers for Disease Control and Prevention, the federal agency that directs US response to new disease threats.

When Zika arrives, that unorganized patchwork could leave the United States vulnerable to a rapidly expanding epidemic. The time that it would take to reorganize mosquito control into a coordinated system may already be running out.

“There are more than 700 mosquito-abatement districts in the United States, and it can be very difficult to figure out where they fit into public health,” says Joseph Conlon, a former US Navy entomologist who serves as a spokesman for the American Mosquito Control Association. “Chesapeake, Va. has its own taxing district, nothing to do with the health department. Massachusetts has seven mosquito-control districts, run by the state; so does Delaware. Florida has a government body that establishes policy, but mosquito control is done at the county level; I think they’ve got 66 local abatement districts.”

Some of those bodies, he cautioned, are as well-funded as if they were private industry: “Lee County, Fla., where Fort Myers is, has a budget of $24 million. They have 27 aircraft, more mosquito-control capability than anywhere else in the world. But other places don’t have the budget to do aerial spraying, or the capacity to do mosquito surveillance to drive their control programs. There’s not enough lab capacity, no funding for communication, which is critical.”

Here are some depressing numbers when funding for mosquito-control related efforts was compared from 2012 to 2014:

•Overall federal funding down 60 percent, from $24 million to $10 million.
•Number of staff working at least half-time on West Nile surveillance: down 41 percent.
•Proportion of states conducting mosquito surveillance: down from 96 percent to 80 percent.
•States that had reduced mosquito trapping: 58 percent; states that had reduced mosquito testing: 68 percent.
•States that had reduced testing of human patients suspected of having West Nile: 46 percent.

The article quotes one infectious disease expert as saying, “We won’t know that Zika’s here until babies start showing up in delivery suites with microcephaly.”

What I would like to see in a debate, one that would focus on science and health policy, would be to let the candidates know ahead of time what areas will be covered, and then grill them on things like public health. Yes, your usual talking head/new anchor type wouldn’t have close to the technical knowledge to handle this, but, rather than trying to play ‘gotcha’, I would like to hear what candidates would do about this and other public health issues.

Like, let’s say, antibiotic resistance. Or hospital infection control.

Well, a boy can dream, can’t he?