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Congress struggles to reach agreement on Zika funding bill
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President Barack Obama is calling upon the Senate and House of Representatives to settle on a bill that provides emergency funding for Zika response efforts. While the Senate voted 68-29 to advance $1.1 billion in funding, the House of Representatives only approved $622.1 million in a 241-184 vote. Lawmakers in both chambers have been unable to come to an agreement over reconciling the two bills.
Between both funding options, Obama, at best, would receive a bill that provides about half of his $1.9 billion request. If sent to his desk, Obama has stated he will veto the House bill for falling well short of the amount of funding the White House has said is necessary to effectively combat the Zika virus.
“We didn’t just choose the $1.9 billion from the top of our heads,” Obama said during a briefing. “This was based on public health assessments of all the work that needs to be done. [The] bottom line is Congress needs to get me a bill that has sufficient funds to do the job. This has to get done over the course of the next several weeks in order for us to be able to provide confidence to the American people that we’re handling this piece of business.”
House members, who criticized the Obama administration for failing to provide them with justification for its funding request, defended their decision to approve nearly half of the Senate’s proposal, stating that $622.1 million in Ebola funding has already been reallocated to the Zika epidemic. Altogether, they said $1.2 billion in federal funding would be used to fight Zika.
“We have made our own funding determinations, using what information is available and through discussions with federal agencies, to craft a proposal to fight the spread of this damaging disease,” House Appropriations Committee Chairman Hal Rogers, R-Ky., said in a press release. “This legislation will make dollars available to fight the disease now, prioritizing critical activities that must begin immediately, such as vaccine development and mosquito control. The legislation funds these efforts in a responsible way, using existing resources — including excess funding left over from the Ebola outbreak — to pay for it.”
White House Press Secretary Josh Earnest, however, previously said during a briefing that Ebola funds are still being used by the CDC in Guinea and Liberia to investigate nearly 1,000 Ebola contacts who are at risk for potentially spreading the disease.
“The lesson we should have learned from 2014 is that the United States and the American people benefit from enhanced capacity of public health officials in other countries, that stopping the spread of a dangerous virus in another country makes the American people safer,” he said.
CDC borrows funds to combat Zika
Stephen C. Redd, MD, director of the CDC’s Office of Public Health Preparedness and Response, recently said in a press release that the funds available through the CDC for dissemination are insufficient and causing delays in U.S. states and territories’ response to Zika. According to the release, more than $85 million in redirected funds identified by HHS is available to support efforts against Zika in the U.S.
“These funds will allow states and territories to continue implementation of their Zika preparedness plans, but are not enough to support a comprehensive Zika response and can only temporarily address what is needed,” Redd said in the release. “Without the full amount of the requested emergency supplemental funding, many activities that need to start are now being delayed or may have to be stopped within months.”
While addressing the National Press Club in Washington, D.C., CDC Director Thomas R. Frieden, MD, MPH, said the CDC has had to reallocate funds from other projects to respond to the epidemic.
“One of the things that we had to do, because it would be at least 3 months for a supplemental (funding measure), was to borrow money from other parts of CDC,” Frieden said. “That includes emergency preparedness dollars that go out to all the states to deal with things like leading the response, doing lab testing, tracking for outbreaks, responding to the health effects of natural disasters and dispensing counter measures. We had to take nearly $50 million of that money and put it toward Zika. The states weren’t happy about that, but we had no choice.”
Medical organizations urge Congress to pass adequate funds
Several medical organizations have voiced their concerns regarding the funding issue. A statement released by the Infectious Diseases Society of America (IDSA) urged Congress to pass an adequate amount of funds that can be used to develop vaccines, rapid diagnostic tests and therapeutic agents for Zika virus without using other health funding.
“We are disappointed that the U.S. House of Representatives intends to advance a package that would provide roughly half of the funding in the bipartisan Senate bill, and we are alarmed at the lack of foresight that would divert funding from other important public health and biomedical research priorities,” the statement said. “As infectious diseases physicians, IDSA members are on the front lines preparing for and responding to all outbreaks, and have seen firsthand the necessity of a strong public health infrastructure, biomedical research enterprise, and infectious diseases workforce to address all current and future threats.”
In addition, the American College of Physicians (ACP), the American Academy of Family Physicians, the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists released a joint statement announcing they had sent a letter to Congress urging lawmakers to “provide the highest possible funding level for research, prevention, control and treatment” of Zika.
“It is imperative that the House and Senate reach an agreement without further delay; every day that goes by without an agreement is a day where more patients will be at risk of being exposed to the virus,” the organizations wrote.
Researchers determine cost-effective interventions
Although there is a debate over which funding proposal is most cost-effective, a recent study published in PLoS Neglected Tropical Diseases justifies several aspects of Obama’s proposal of $1.9 billion, including $335 million and $41 million to combat Zika in Latin America and the Caribbean, as well as $250 million for prevention efforts in Puerto Rico.
Jorge A. Alfaro-Murillo, PhD, of the Center for Infectious Disease Modeling and Analysis at Yale School of Public Health, and colleagues examined data from Brazil and Colombia to assess the financial burden of Zika. Based on data from northeastern Brazil, they estimated that the probability of microcephaly in fetuses exposed to Zika infection during pregnancy ranged from 0.49% to 2.1%, and the probability of Guillain-Barré syndrome (GBS) in patients infected with Zika virus ranged from 0.02% to 0.06%.
Using a web-based, cost-effectiveness tool, the researchers determined that each case of microcephaly represents a loss of 29.95 disability-adjusted life-years (DALYs) at a direct cost of $91,102 per lifetime, and each case of GBS represents a loss of 1.25 DALYs at a cost of $28,818 per lifetime. In a base case analysis, assuming interventions against Zika virus prevented infections in just 1.6% of the population across Latin American and the Caribbean, the researchers found that interventions costing less than $409 million would be “very cost-effective.”
“Thus, the $376 million for foreign aid in Latin America and the Caribbean proposed by the U.S. President to combat Zika would likely be a very cost-effective investment,” they wrote.
Alfaro-Murillo and colleagues also demonstrated that if 90% of infections among the 13,490 pregnant women at risk for Zika virus infection in Puerto Rico were averted, a cost-effective prevention intervention would total $195.4 million. Therefore, Obama’s $250 million proposed for Puerto Rico is “justified” since these funds would also be used for medical costs associated with Zika virus infection, the researchers wrote.
“Difficult decisions related to next steps confront community members and leaders of areas that are currently facing, or will soon be facing, an epidemic of Zika,” they concluded. “Given the potentially high health burden of Zika, the cost of inaction — or even insufficient action — may warrant significant expenditure.” – by Stephanie Viguers
- Reference:
- Alfaro-Murillo JA, et al. PLoS Negl Trop Dis. 2016;doi:10.1371/journal.pntd.0004743.
Disclosure: The researchers report no relevant financial disclosures.