The Infectious Diseases Society of America (IDSA) is deeply concerned about cuts proposed in President Obama’s Fiscal Year (FY) 2013 proposed budget for our nation’s immunization programs, state and local public health preparedness, and the Prevention and Public Health Fund, as well as budget policies that discourage research. And, while the budget proposal includes additional investments for some key IDSA priorities, IDSA calls for sustained investments across-the-board for infectious diseases (ID) research and public health programs to protect Americans from a growing number of ID threats.
IDSA opposes the proposed budget cuts that will weaken our nation’s research and public health enterprises:
Flat-lined National Institutes of Health (NIH) Funding/Salary Cap: While IDSA is relieved that the Administration did not propose cutting funding for the NIH and, specifically, the National Institute for Allergy and Infectious Disease (NIAID), we firmly believe that greater, not flat-lined, investment in biomedical research is critically important for our nation’s health. Also, we remain concerned with the budget’s proposed policy, also adopted for FY12, to limit the salary of NIH extramural researchers to Executive Level II ($179,700 — a reduction of $20,000 from the Executive Level I cap used the past 10 years). Reducing the salary cap will disproportionately affect physician investigators and serve as a deterrent to their recruitment into research careers at a time when our country is already struggling to remain globally competitive in research and technology.
Immunizations: IDSA is disappointed in the proposed $58 million reduction to the Centers for Disease Control and Prevention (CDC)Section 317 immunization program. The Administration’s rationale that recent changes requiring insurance coverage of immunizations lessens the need for the 317 program is faulty. Insurance coverage alone will not ensure access and utilization. Section 317 funds are critical to help providers obtain and store vaccines; establish and maintain vaccine registries; educate providers and the public about vaccine recommendations, effectiveness and safety; and promote universal vaccination of health care workers. Of tremendous concern, vaccination rates for adults range from 26% to 65%, depending on the type of vaccine and population.
State and Local Preparedness: While IDSA supports the modest increase proposed to strengthen CDC’s preparedness and response capacities, we are disappointed by the correspondingly larger proposed cut in funding to state and local preparedness and response. Multiple reports have demonstrated that our state and local public health systems are woefully under-prepared to respond to a public health emergency, such as a bioterror attack or mass infectious disease outbreak. We need to strengthen state and local capacities, not further erode them.
Prevention and Public Health Fund (PPHF): IDSA is worried about the Administration’s proposal to decrease the PPHF by $4.5 billion over several years. As CDC’s budget authority has seriously eroded in recent years and faces yet another proposed cut in FY13, the PPHF has been repeatedly raided to fill funding gaps in core public health activities that should instead be prioritized and sustained as part of CDC’s base appropriation. The PPHF’s true purpose—providing unique investment in new and innovative public health effort— is being undermined. The PPHF’s integrity must be restored so that it is available to provide crucial support for immunization efforts, epidemiology and laboratory capacity, and the Emerging Infections Program—a network of 10 state health departments that conduct surveillance, prevention, and control of emerging infectious diseases.
While we oppose the cuts noted above, IDSA must applaud the Administration for heeding our recommendations and proposing new investments to strengthen our nation’s surveillance of and response to infectious diseases:
Biomedical Advanced Research and Development Authority (BARDA): IDSA supports the Administration’s proposed $547 million for BARDA in FY13, a significant increase over the $415 million it has received for the last two years. BARDA facilitates advanced research and development (R&D) of medical countermeasures (MCMs), including therapeutics, diagnostics, vaccines, and other technologies, including new antibiotics for both intentional attacks and naturally emerging infections. This funding is particularly needed for antibiotic R&D, given the plummeting private investment in this area.
Strategic Investor: IDSA supports the Administration’s proposal to establish an MCM Strategic Investor with an initial funding level of $50 million. This new entity will fill a significant void by partnering with small “innovator” companies and private investors to address urgent needs, first focusing on: (1) novel antimicrobials for multidrug-resistant organisms, (2) novel mechanisms for disrupting pathogenesis through host pathway targeting, and (3) multiuse platform technologies for diagnostics, vaccines/prophylaxis, and therapeutics.
CDC Infectious Diseases Funding: IDSA supports the proposed increases for the National Center for Emerging and Zoonotic Infectious Diseases ($27 million increase) and the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections and Tuberculosis Prevention ($35 million increase). NCEZID houses CDC’s antimicrobial resistance activities, including surveillance, data collection and stewardship. These programs are critical if our nation is to stem the tide of dangerous pathogens increasingly resistant to antibiotics.
CDC National Healthcare Safety Network and EpiCenters: IDSA supports the Administration’s proposal to almost double funding for the National Healthcare Safety Network from $14.8 million in FY12 to $27.5 million in FY13. The new funding will allow CDC to further invest in the EpiCenters—five academic centers which conduct infection control and prevention research including projects on health care-associated infections and antibiotic-resistant infections. The EpiCenters have survived on a $2 million budget over the past 15 years with no increase.
Maintaining a strong biomedical research enterprise and public health infrastructure in the U.S. are crucial to promoting the health of our citizens and preserving the ability to prevent and respond to health emergencies, both natural and manmade. While IDSA strongly supports the new ID-related investments proposed by the President, we are mindful that their impact will be lessened by the simultaneous cuts also proposed. Filling existing gaps by creating new ones is not a sustainable path forward. We appreciate the need to reduce our nation’s deficit, but recognize that over the past few years, health programs have already borne more than their share of belt-tightening measures. Expenditures in public health, research, and health care can yield tremendous rewards for our nation’s economy and the well-being of our population by creating jobs, reducing unnecessary health care costs, and saving lives.
For a statement on proposed domestic and global HIV/AIDS spending, please see the HIV Medicine Association’s website (http://www.hivma.org/Presidents_Budget_2012/).
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