The Maine Center for Disease Control and Prevention has eliminated more than 40 public health positions, which has weakened the state’s ability to respond to infectious disease outbreaks and could result in the loss of millions of dollars in federal funding, public health experts say.

The cuts, most of which are open positions left vacant over the past four years, are part of Gov. Paul LePage’s two-year, $6.5 billion budget proposal. The eliminated positions and other cuts total about $10 million in CDC budget savings, according to public health advocacy groups. The Maine CDC has a $120 million annual budget and about 385 employees.

But critics say more than half the positions were federally funded, and cutting these won’t save the state a cent. But by leaving the positions vacant, the state could lose – and may have already lost – millions in federal money, they say. Some of these positions were critical to the state’s ability to respond to disease outbreaks, health experts said last week.

“It’s a dismantling of our public health system,” said Tina Pettingill, executive director of the Maine Public Health Association, a nonprofit advocacy group.

Pettingill and other public health experts say that at least 24 of the 44 positions eliminated in LePage’s 2016-17 budget were federally funded. Among them were positions for an epidemiologist, administrators, researchers and public health educators. Almost all of the federally funded positions became vacant after LePage took office in 2011.

But a Maine CDC spokesman said the federal money that funded the eliminated positions has not been lost, but can be “re-purposed” to cover other health-related expenses.

“It is common practice for the funding to be re-purposed in a way that supports the grant requirements,” said John Martins in an email response to questions on the cuts. “Requests to do so are routinely approved by the federal government.”

Other health officials dispute this. Dr. Dora Anne Mills, former Maine CDC director, said it’s “unlikely” that federal funding earmarked for a specific job in the state agency – such as an infectious disease researcher – could be left vacant for years without losing the federal money that goes with it.

Mills, who left the CDC in 2011 when LePage took office, was the agency’s director from 1996-2011, and oversaw the agency’s federal grant requests. Most of the grants are targeted to specific needs, she said. The federal government frowns on using federal money to alleviate state cutbacks.

“They want the federal money to be used to increase capacity and increase resources. They don’t want (the state CDC) to use the money on what the state was already funding,” Mills said.

Kenneth J. Albert, the new CDC director who replaced Dr. Sheila Pinette this year, is declining all media interviews at this time, Martins said.

‘INCREDIBLY FRAGMENTED’ RESPONSE

Other health officials in Maine say that some of the cut positions, both federal- and state-funded, are directly tied to the state’s ability to prevent or respond to public health crises.

“I believe our response to a public health crisis would be incredibly fragmented, and potentially dangerous to the public’s health” (if the positions aren’t filled), said Deborah Deatrick, senior vice president of community health at MaineHealth, the parent company of Maine Medical Center in Portland. Without effective state coordination, she said, an outbreak could get out of hand. Maine has one of the lowest vaccination rates in the country for kindergartners entering school, according to the federal Centers for Disease Control and Prevention, which leaves the state more vulnerable to infectious disease outbreaks such as those in California or Oregon, which experienced recent measles outbreaks, and also have relatively high rates of schoolchildren who have not been vaccinated.

Also cut from the CDC’s budget were nine public health nurses, the frontline employees who organize immunization clinics, work with schools on prevention efforts and respond to infectious disease outbreaks throughout Maine. The public health nurses were mostly funded with state dollars.

Roughly estimated, the 24 federally funded jobs represent $1 million to $2 million annually, according to state documents, based on the salaries the state employees are paid, plus benefits.

Mills said much of the federal funding received by the CDC is “use it or lose it,” money earmarked to pay for specific positions. If those positions have been left vacant, the money has almost certainly been lost, she said.

“If we don’t use the funds, they will simply be re-directed to another state,” Mills said.

Pettingill agreed, and she said the federal government is not flexible in how grant money is spent.

“Most of the federal money is very specific,” Pettingill said. “You either use it or you send it back. If you don’t use the money set aside for a TB (tuberculosis) coordinator, for example, you couldn’t use it for something else.”

PUBLIC HEALTH RANKING COULD BE HURT

Mills said she’s perplexed by the state’s decision to cut the employees at a time when the federal government is flush with grant money for preventive health.

The federal Affordable Care Act, approved in 2010, devotes $1 billion per year for various public health efforts, according to the U.S. Department of Health and Human Services, and much of that money is directed to state health programs.

Where that leaves the Maine CDC remains to be seen. According to The Trust for America’s Health website, which evaluates public health data by state, Maine’s public health spending is mixed, compared to other states. While Maine ranks 30th in state dollars spent on public health, a health policy website ranks the state in the top 10 in federal spending per capita.

The rankings are based on 2013 data, and reflect the fact that Maine has historically been successful in attracting federal money to operate the state health agency.

By giving up the federal funds, the state’s ranking will likely plummet, experts said.

In an open letter to public health providers last week, Albert wrote that he will work to improve and bring efficiencies to the Maine CDC.

“I can assure you that any reorganization of the Maine CDC will be achieved with thoughtful analysis and consideration of what is best for public health in our state,” Albert wrote.