Last year, 15 states declared outbreaks of hepatitis A virus (HAV), which affects the liver and is spread via contaminated food, oral-anal sex, close personal contact with someone with the virus, using contaminated water for intravenous drug use and unsanitary conditions. The virus has largely affected homeless populations across the country, and a recent article in the Huffington Post suggests the crisis reveals much about America’s failing public health system.

Written by West Virginia reporter Lauren Weber, the article points out that cases of hepatitis A more than tripled in the United States in 2018 and that at least 10,582 people have been infected thus far. Some of the most notable outbreaks have occurred in California, Kentucky, Ohio, West Virginia, Colorado, Indiana and Missouri—states where the opioid epidemic continues to take its toll and homelessness is on the rise. 

States, counties and cities have spent millions trying to fight their local outbreaks. But the spending has revealed a dark secret about the nation’s public health system—namely, that it’s collapsing as a result of funding cuts and can’t meet the demands of a growing at-risk and notoriously hard-to-reach population.

For example, officials report that more than 56,000 local health department jobs have been eliminated since 2008. Meanwhile, West Virginia, which has the second worst HAV outbreak in the United States, instituted a 24 percent cut in state aid to public health departments in 2016. Similar cuts are taking place across the country. And until now, few people seem to have noticed.

Meanwhile, the costs of battling hepatitis A have been astronomical for cities caught in the crisis. San Diego estimated it spent $12.5 million to control its outbreak. Kentucky recently allocated $2 million for hepatitis A vaccines alone. And that’s not even counting the underlying hospitalization costs incurred by facilities that often are not reimbursed because many of those with the virus are uninsured.

“Unfortunately, I see this hepatitis A outbreak as a symptom of the fraying social safety net,” said Jeff Duchin, MD, a public health officer for Seattle and King County in Washington who was one of many experts interviewed for the article.

“There is a good reason to suspect that this will further spread to other states,” warned Rahul Gupta, MPH, former head of the West Virginia Department of Health and Human Resources.

“This is a disease of developing countries,” said Jeffrey Howard, the commissioner of Kentucky’s public health department. “One has to ask: Why are we seeing it in the U.S.?”

To learn more about the United States’ ongoing hepatitis A outbreak, click here.