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Funding for medical research and public health must reflect reality
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The last few years have seen a growing force of infectious disease challenges that together pose an unprecedented range of threats to health here in the United States and in countries around the world where Americans travel and conduct business. While outbreaks of Ebola, Zika, SARS and MERS have spread from their places of origin with devastating impacts, rising rates of resistance to antimicrobial drugs threaten the gains of modern medicine at home and globally. New and re-emerging diseases with pandemic potential continue to surface, and diseases that include tuberculosis, once considered all but conquered, have evolved faster than the medicines to control them, to pose new dangers.
The Infectious Diseases Society of America, the oldest and largest association of physicians, scientists and other health care professionals specializing in preventing and treating transmissible illnesses, has recognized these threats. We have worked for more than a decade to raise awareness that antibiotic development is falling far short of need, and urged accelerated and immediate action in research, education, training, evidence-based practice and informed medical stewardship to improve our capacities to detect, prevent and respond to infectious diseases at home and abroad. We recognize that when medical research lags, pathogens gain ground, and that in an increasingly connected world, we cannot afford the costs that infections that are not countered by effective interventions inflict on families and communities, on individual and public health. And we are concerned because the budget proposal released by the Trump administration for the coming fiscal year does not reflect recognition of any of these realities.
With massive proposed cuts to medical research and public health programs, the plan would stall the work necessary to get ahead of infectious outbreaks and antimicrobial resistance, undermine ongoing efforts to meet those challenges, and do nothing to fill existing gaps. Standing still is not an option in infectious disease responses, and so we would fall behind.
This is true in a literal sense. With a proposal to slash the NIH budget by $7.2 billion, the White House plan would revert funding for the world’s premier medical research institution to its 2002 level. Current realities, which in just the last few months have included a domestic outbreak of treatment-resistant fungal infections, ongoing discoveries of the impacts of Zika virus, and a new outbreak of Ebola, highlight the recklessness of that. A cut of that magnitude also would have a ripple effect well into the future, reversing efforts to attract and retain young physician-scientists, withdrawing support and incentives to develop urgently needed new antibiotics and hobbling or halting investigations leading to develop vaccines that historically can take decades.
Included in that cut would be a drop of $544 million in funding for the NIH Office of AIDS Research — a little more than 18% of the prior year’s funding to the NIH office that has led ground-breaking medical advances that have not only prevented illness, deaths and transmission of HIV, but propelled progress in other fields. The White House plan also proposes the elimination of the NIH’s Fogarty International Center, a training ground for American and international physician-scientists that coordinates 500 research collaborations and partnerships involving more than 100 universities, and provides support for scientific inquiry at academic institutions across the U.S. with more than 80% of its grants.
In addition, the White House budget plan would deal cuts to the CDC amounting to $1.2 billion overall and would include cuts to the agency’s funding to counter antimicrobial resistance. That funding, in turn, would be shifted to the Prevention and Public Health Fund, which the administration and Congress are seeking to repeal. And it would include cuts to CDC’s Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at a time when outbreaks of hepatitis C and HIV, fueled by the opioid epidemic, as well as rising rates of syphilis and treatment-resistant gonorrhea, threaten public health.
While greatly compromising efforts to promote and protect health at home, the budget also would leave Americans vulnerable by abandoning long-standing and successful commitments to global infectious disease responses and health security. With a proposed $470 million cut to the President’s Emergency Plan for AIDS Relief, the plan would jeopardize efforts to end HIV as a worldwide public health threat, and fuel the spread of opportunistic infections that have accompanied the HIV pandemic. With proposed cuts to the Global Fund to Fight AIDS, Tuberculosis and Malaria and to CDC’s global health programs, the budget would also strip away support toward making U.S. global health investments sustainable for the long term. A nearly 51% cut to USAID’s global health allocation would have further sweeping effects on international efforts to improve capacities to detect, prevent and respond to infectious disease threats where they originate, and endanger domestic health security.
The White House budget proposal also is greatly at odds with global efforts to strengthen responses to infectious disease outbreaks and antimicrobial resistance. Last year, the U.N. held its first high-level meeting on the global threat of antimicrobial resistance, one of only four General Assembly events recognizing a shared public health threat, and this year WHO released a list establishing priorities for research and development of antimicrobial medicines to fight infections for which other treatment options are diminishing quickly — both efforts to which IDSA has given support and guidance.
Finally, the proposed cuts to domestic and global public health and research efforts the White House is asking for will gravely limit the effectiveness of positive points in the plan: a new federal fund for outbreak responses, the maintenance of support for the Biomedical Advanced Research and Development Authority, and additional funding for Zika and other vector-borne disease preparedness — all of which IDSA supports. Those measures indicate recognition that investments in research and public health preparedness are critical to our country’s safety and security, but they will not stand alone.
We hope now that Congress, which has long shown bipartisan support for infectious disease responses, will recognize the realities we face now and provide the resources needed to ensure that the world is better prepared to face the challenges ahead. Legislators on both sides indicated that they will reject the cuts proposed in the president’s budget, but on its own, that is a low bar in the face of these public health challenges. If legislators are realistic, they should assess the needs we confront outside of the White House request altogether. In reality, they will be hard pressed to find the money to protect the programs they have recognized as valuable unless they raise the budget caps imposed by sequestration.
IDSA is advocating for increased funding for critical medical research and public health programs because we recognize the increasing and complex nature of the challenges to adequately respond to infectious disease threats. Congress needs to hear from you, too, as they weigh spending priorities for the year to come. For information on opportunities to engage in advocacy, visit http://newsmanager.commpartners.com/idsa/issues/2017-05-31/7.html.
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- William G. Powderly, MD, is president of the Infectious Diseases Society of America. He is also the Dr. J. William Campbell Professor of Medicine and the Larry J. Shapiro Director of the Institute for Public Health at Washington University in St. Louis, and co-director of the division of infectious diseases at the Washington University School of Medicine.
Disclosure: Powderly reports no relevant financial disclosures.