Strengthen Texas' Public Health Capabilities

Sept. 30, 2020

The Honorable Sarah Davis, Chair

House Committee on Appropriations – Subcommittee on Article II

Submitted via email to

RE: Interim Charge I

Dear Chair Davis and Subcommittee Members:

On behalf of the Texas Medical Association, attached please find comments relating to Interim Charge I:

  • implementation of new funding and full-time equivalent positions for the Department of State Health Services (DSHS) Vital 2 Statistics Unit; and
  • implementation of DSHS Rider 29; evaluate the capacity of immunization programs to prevent, reduce, and eliminate vaccine preventable diseases in adults and children.

Vital Statistics

As with all other components of Texas’ public health infrastructure, the COVID-19 pandemic and the resulting sheer volume of records drastically inundated and strained the state’s vital statistics system. Though implementation of the improved funding to support DSHS’ Vital Statistics Unit had yet to be completed prior to the onset of COVID-19, the pandemic has only reinforced the need for continued investment to better bolster our state’s vital statistics capacity.

TMA continues to strongly support improving the state’s vital statistics system to ensure the quality of our health data and surveillance capacity. This includes prioritizing funding allocations for quality improvements to the state system and meeting the shortfalls identified from the strains of COVID-19 reporting, as well as the hiring and retention of skilled staff. Our state’s vital records provide critical data needed by the state, local jurisdictions, and families, and we depend on public health data to identify where to best prioritize our public health response efforts.

Rider 29

House Rider 29 requires DSHS, out of its current funding, to conduct an economic study on the costs and financial burdens to local and state health institutions in investigating and responding to outbreaks involving vaccine-preventable diseases (see full text of rider below). Due to COVID-19, the agency has understandably not completed the study. One of the takeaways from this pandemic is that the cost of preparedness may be far less than the cost of responding, from both an economic and a health burden perspective. Thus, TMA continues to strongly advocate that the objectives of Rider 29 be fulfilled as soon as DSHS has the capacity to do so.

COVID-19 has certainly provided a real-world example of the severe economic burden an infectious disease outbreak can cause. While the direct medical costs for assessing and treating individuals with COVID-19 are still accumulating, projections from the beginning of the pandemic in April expected U.S. direct medical expenses associated with hospitalizations, ventilators, and other health resources to be anywhere from $164 billion to $658 billion, depending on the proportion of the population that becomes

infected.1 Indirect costs such as business and school closures also have had profound impact. In Texas, the unemployment rate reached a historical high 13.5% in April 2020 and remains almost double from what it was prior to the start of the pandemic.2 While COVID-19 differs from other infectious disease for which we have a vaccine, we should not underestimate the significant impact a measles or flu outbreak can have on our economic health, especially if vaccination levels decline.

This pandemic also has generated a demand for rapidly improving public health surveillance systems, expanding the workforce necessary to stop infectious disease spread, and ensuring supply chains for necessary protective and testing equipment are sustained. While these investments in local and state level epidemiology and disease response hopefully will remain after the threats of the pandemic are mitigated, the existing infrastructure may not be enough to meet future infectious disease threats. The goal of Rider 29 to assess the direct, indirect, and associated financial burdens to the state when investigating and responding to vaccine-preventable disease outbreaks is needed now more ever so that we understand how to prepare for future outbreaks.

Should you have any questions, please email Troy Alexander, director, legislative affairs, or (512) 871-9997 or email Christina Ly, PhD, MPH, director of public health or (214) 649-5867; mailing address: 401 W. 15th St., Austin, TX 78704

Thank you for the opportunity to comment. Sincerely,

Diana L. Fite, MD President
Texas Medical Association 

Rider 29 Text

Cost Analysis of Outbreaks Involving Certain Vaccine Preventable Diseases. Out of the funds allocated above, the Department of State Health Services (DSHS) shall study and assess the costs to the department and local public health organizations incurred in responding to vaccine preventable diseases outbreaks. The study shall include the direct costs associated with prophylaxis and treatment of exposed individuals in management of the outbreak. The study shall also include the indirect costs associated with the response phase of an outbreak such as: (1) staff hours expended by the department and local public health organizations to track and investigate the exposure and risk of each person that has been potentially exposed during the outbreak; (2) the value of hours spent for public outreach/education; (3) the impact on businesses relating to lost hours and absenteeism rates; (4) the impact on schools relating to dismissals or early childhood program closures; and (5) any other potential downstream impacts. Not later than September 1, 2020, department shall: (1) prepare all findings from the study; (2) submit the findings to the relevant House and Senate committees; and (3) submit the findings for consideration by the Public Health Funding and Policy Committee. Nothing in this rider prevents the department from initiating rulemaking on the issues contained in the study under their existing authority.

1 The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States. Sarah M. Bartsch, Marie C. Ferguson, James A. McKinnell, Kelly J. O'Shea, Patrick T. Wedlock, Sheryl S. Siegmund, and Bruce Y. Lee. Health Affairs 2020 39:6, 927-935.

2 U.S. Bureau of Labor Statistics.

86th Texas Legislature Letters and Testimonies

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Last Updated On

October 09, 2020

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