We complain when there isn't enough swine flu vaccine and we complain when our health departments don't count all the cases. It's probably good so many people are out of work and can't eat in restaurants, because they aren't getting inspected because all available staff are trying to deal with the flu pandemic:

The current swine-flu wave may have peaked, but thousands of public health workers are trying to vaccinate millions of people against the new disease, fearing that another wave could emerge in the new year. Yet recession-driven budget cuts have thinned their ranks so far that they are being forced to cut back on childhood immunization clinics, restaurant inspections and planning anti-obesity programs to get the H1N1 job done.

Swine flu provides the first big test of the U.S. public health system in the economic downturn. Of the roughly 205,000 job positions in the public health sector, more than 12,800 jobs were eliminated from July 2008 to June 2009, according to the Association of State and Territorial Health Officials, a nonprofit organization that advocates for more public health funding.

An additional 12,000 local health department staff had hours cut or were put on furlough in the first half of 2009, according to the National Association of County and City Health Officials. About 55% of local health departments and 74% of state health departments cut programs from July 2008 to June 2009, according to two surveys by these organizations. (Betsy McKay, Wall Street Journal)

When Republican wingnut Grover Norquist said his goal was to cut government to the size where he could drag it into the bathroom and drown it in the bathtub, he didn't say he do it by getting into bed with Jack Abramoff. Instead of screwing each other they proceeded to screw the rest of us, with the help of all the Republicans and too many Democrats. Public health is now in worse shape than at any time in my 40 years in the profession:

Last spring, dozens of Mr. Fulton's staff spent six weeks dealing with a tuberculosis outbreak that involved tracking down 145 exposed people. Were an outbreak like that to happen now, "We would call all our staff out and would be working day and night," he said.

In Maine, which is still experiencing a surge of swine-flu cases, state health officials are reserving home visits by public health nurses only for major threats such as tuberculosis or child-abuse cases, said Dora Anne Mills, director of the Maine Center for Disease Control and Prevention. About three-quarters of the department's staff has been diverted to H1N1. Some chronic-disease programs have "taken a back seat" for the time being, she said.

"We're learning how thinly staffed we really are and have had to choose which types of health threats can hopefully wait six months to be addressed," she said. Among them are home visits by public health nurses that aren't related to a major health threat.

I know some of you don't think this pandemic is so bad. And as pandemics go, it isn't. It could be far, far worse and it might get that way. So far it is following closely the pattern of 1957 which began in the spring, had a second wave that started late summer peaking about now, then subsided, only to come back with a big third wave in January to March. In 1957 we didn't have a vaccine for the new H2N2 that appeared suddenly in the spring. We still don't know if the current vaccination campaign will make this pandemic different from 1957, but no responsible public health official is going to call an all out effort on the chances there won't be a wave 3, which would lead to many thousands of additional deaths, including perhaps hundreds more children. If the people who say the vaccine is completely ineffective are right (and you know we don't think they are) the health departments and hospitals will still be fully occupied with the flu problem in the form of sick people.

If swine flu is a test of public health, we've already flunked. And we have only ourselves -- and the political leaders who have been disinvesting in public health since 1980 -- to blame.

This blog post first appeared at Effect Measure.