The Maine Center for Disease Control and Prevention is the front line of defense in public health. It organizes immunization clinics and other prevention efforts to keep infectious diseases from getting a foothold. It tracks health data to identify outbreaks before they get out of control. It coordinates the response when an outbreak does occur, so that as few people as possible are affected.

And at a time when the negative impact of outbreaks could not be clearer, the Maine CDC is understaffed, without a compelling reason why.

Public health officials in Maine aren’t sure whether the state is equipped to handle the outbreak of a serious disease, such as H1N1, which killed Maine residents in 2009. igor.stevanovic/Shutterstock.com

Gov. LePage’s two-year budget proposal eliminates 44 public health positions at the CDC, most of which have been kept empty during the last few years as people left the agency, and more than half of which are federally funded and thus have little impact on state spending.

Those and other vacancies have left the CDC shorthanded, and Maine people vulnerable.

The number of public health nurses is down at least 25 percent, at a time when the state’s low vaccination rates leave it susceptible to the resurgence of illnesses such as measles and whooping cough.

In addition, the state epidemiologist and deputy epidemiologist positions remain vacant, as do a number of central infectious disease and regional epidemiologist posts, further hindering the state’s ability to prepare and respond to those kind of outbreaks.

The street-level impact of these kinds of cutbacks was displayed last year when the CDC, working without its top hepatitis coordinator, mishandled the possible exposure to hepatitis A of diners at an unnamed Portland restaurant.

If a more serious, widespread outbreak were to occur – something similar to the H1N1 virus that killed Mainers in 2009, or the SARS virus that was stopped by a strong public health response a decade ago – would Maine be equipped to handle it?

Public health advocates are not so sure. The executive director of the Maine Public Health Association says the cuts represent the “dismantling” of the public health system. The senior vice president of public health at MaineHealth says the state’s response to a public health crisis is now “incredibly fragmented.” An epidemiologist who investigated outbreaks for the federal CDC says the state is “really poorly prepared now.”

The agency has argued that the work is getting done despite the vacancies. The CDC’s new director, Kenneth J. Albert, hinted in a letter to public health workers that the cutbacks are part of “potential opportunities for efficiencies through reorganization and reengineering.”

But from where we sit, the CDC, and its ability to respond to acute health crises, have been weakened.

Maine has in recent years dealt with outbreaks of H1N1 and seasonal flu as well as the threat of measles, whooping cough and even Ebola.

Experience shows that another crisis is always just over the horizon. Unless the CDC is at full strength, the state won’t be ready.

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