Last year’s Hepatitis A outbreak in San Diego was the worst in the nation since the vaccine was released in the 1990s, killing 20 people and sickening nearly 600. While this was a widespread disaster, the homeless population was hit the hardest. Such an unprecedented epidemic would naturally lead to an analysis of what went wrong and how to prevent it from happening again. Yet in a move that has become all too expected, San Diego County, this time via Supervisor Dianne Jacob, distanced itself from any culpability by laying the blame for the outbreak  at the feet of former city leaders.
It’s ironic that Jacob is assigning the county’s constitutional responsibility on matters of public health to the cities. Apparently after more than 20 years of status quo from Jacob and her colleagues on the board, they need to be directed to their own county website, which states they are “responsible for planning and managing the delivery of a variety of government-delivered health and social services.” That includes alcohol and drug services, and children, adult and older adult mental health services — all areas that if not addressed correctly can contribute to people ending up on the streets.
Given the finger-pointing and lack of culpability being displayed, we strongly support California Assemblyman Todd Gloria’s public request for a statewide audit to examine  the local response to the horrific Hepatitis A crisis that ravaged San Diego in 2017. In fact, we believe that the audit should be expanded. San Diegans should know exactly who knew what, and when they knew it. The audit should include all of the funding streams that San Diego County has at its disposal to address homelessness, and recommend actions Sacramento can take to step in where the county refuses to take action.
Ensuring the same mistakes aren’t made twice from an independent audit is not just appropriate. It is desperately needed.
In the meantime, we encourage Jacob and county officials to examine their overall approach to treating individuals, so they don’t end up homeless in the first place. Prevention is the most inexpensive way to solve homelessness. A plan to get people off the street quickly with housing and other services is also in order. The Hepatitis A outbreak can be linked to the larger homeless issue in the county; if the problem was less severe, perhaps the outbreak would have never started.
Jacob and the other supervisors need to accept that the county is at the epicenter of every health crisis — that’s one of the main reasons their job exists. The Hepatitis A crisis was no different. But it’s not surprising to see Jacob is sensitive to the issue, given the well-documented interactions between the city and county uncovered by the media, which show dysfunction and inaction  by both agencies. Hundreds of exchanges between city and county officials, revealed through public records requests, show the problem grew from lack of action for months — despite the increase in cases and deaths.
A disturbing timeline  shows the county first told health and public safety officials about the outbreak in March, but the city and county did not meet to discuss it until May 4, despite three deaths and 80 documented cases. The effort to tackle the crisis needed early leadership, so the county should have taken action while the city fumbled around trying to figure out how to permit hand-washing stations.
Sadly, we are not shocked by the county’s inept approach to health crises. Its past performance on addressing substance use disorder issues and the mental health of our vulnerable citizens speaks volumes about the job it’s been doing. Programs meant to address causes and symptoms of homelessness — including Drug Medi-Cal, Project One for All, housing and shelter projects, basic food assistance and other safety net programs — are rolled out and promoted in press conferences again and again, while thousands of people remain on the streets suffering from lack of services. The efforts lack sufficient transparency and accountability, despite receiving hundreds of millions in funding.
The county cannot continue its long history of inaction and this cannot continue to be normal. We’re not alone in our assessment. We’ve heard from providers, public agencies, elected officials and many others, who say the county lacks any urgency to dig into the issue and work together to tackle it. Instead, it prefers paying lip service to collaboration, while continuing to work in silos.
Politics aside, our county deserves leadership vested in its citizens’ health and safety — officials who will take responsibility for the roles they were elected to serve, rather than looking for scapegoats to take the blame. We strongly support a state audit to ensure officials are held accountable, and a preventable tragedy like this never happens again.
David Alvarez is a San Diego city councilman representing District 8, and plans to run for county supervisor in 2020. Michael McConnell is a homeless advocate, small business owner, and former vice chair of the Regional Task Force on the Homeless. See anything in there we should fact check? Tell us what to check out here .