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IDSA Statement on the President’s Fiscal Year 2019 Budget Proposal

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Statement from IDSA President Paul Auwaerter


The Infectious Diseases Society of America urges Congress to reject the cuts proposed in the White House Budget Plan for Fiscal Year 2019 released Monday. More details on the priorities and impacts it promises are clearly needed.

While the plan released by the White House speaks of the most critical health challenges facing our nation and our increasingly interconnected world, the proposals do not reflect those challenges highlighted or ways to address them. The budget should reinforce and strengthen our national health infrastructure, advance urgently needed scientific discovery, address the public health impact of the continuing opioid crisis, ensure access for preventive measures, and protect Americans by building capacities to detect, to prevent and to respond to infectious disease outbreaks overseas where they originate.

While emphasizing themes of infrastructure strengthening and national security, the White House proposes to cut the current budgets of the Department of Health and Human Services and the State Department, including the global health response and security interventions it leads. These proposed budget cuts reflect a narrow and short-sighted understanding of national safety and well-being. Concrete examples of the challenges facing our nation’s health are not hard to find. We are amidst of our most deadly and far-reaching influenza season in many years. Outbreaks of endocarditis, hepatitis C and HIV fueled by the opioid epidemic continue to flare in many communities. A growing crisis of antimicrobial resistance has the potential to wipe out many of the gains of modern medicine, threatening both individual health and national security. Epidemics of emerging and resurging infections threaten health, stability, and development around the world. Cuts to vital agencies and programs at CDC and NIH that support ID research, prevention, and public health proposed in the White House plan are anything but “efficient, effective and accountable.”

We welcome the additional funding for pandemic influenza response under the Assistant Secretary for Preparedness and Response. At the same time, however, the White House plan proposes cutting more than $85 million from the CDC’s immunization programs, critical to protecting Americans from influenza as well as other illnesses, including measles and pneumonia -- all with serious public health impacts. And while we appreciate continued funding for antimicrobial resistance research and development through the Biomedical Advanced Research and Development Authority, the current investment is insufficient, as evidenced by an antibiotic pipeline that falls far short of projected needs, while pharmaceutical company investments in antibiotic research continue to diminish. Also, the plan would limit CDC efforts to address and prevent growing resistance to existing antimicrobial drugs with a nearly $25 million cut.

Further endangering advances against public health challenges, the President’s budget proposal appears to include a $111 million cut in funding for the National Institutes of Allergy and Infectious Diseases. If actualized, this would weaken efforts to advance the development of vaccines to protect against Ebola, Zika, and the next pathogen with pandemic potential.

The White House attention to the opioid crisis is similarly limited and critically lacking. The plan speaks to a still growing epidemic of addiction but not to expectations that significant outbreaks of endocarditis, HIV, hepatitis, and skin, bone and joint infections will continue to follow its path without focused and evidence-based public health resources. Following the Scott County Indiana HIV outbreak that was linked directly to opioid use, the CDC identified 220 counties in 26 states across the country that are at risk for similar HIV outbreaks among people who inject drugs. The CDC has identified significant increases in acute hepatitis C related to increased opioid use -- with acute hepatitis C cases increasing by 133 percent from 2004 to 2014 -- and hospital admissions due to injection drug use increasing by 93 percent during the same period.

The plan includes $40 million to support a new Elimination Initiative to jointly address diseases that include HIV, viral hepatitis, sexually-transmitted infections, and tuberculosis, areas where we agree that increased investments are needed. But while we look forward to working with the CDC on innovative approaches, we emphasize that proven approaches must not be imperiled or neglected. Continued robust support for public health as well as for pandemic preparedness, at home and abroad must continue, reflecting these as foundational efforts that cannot be disrupted. As the Elimination Initiative funding is accompanied by a more than $34 million cut to CDC domestic HIV/AIDS Prevention and Research, it appears to come at the expense of current, critically important efforts.

The plan proposes to continue funding for the Global Health Security Agenda, but at levels before additional funding provided by the Ebola emergency response allocation provided by Congress. This is short-sighted and reflects a limited understanding of the lessons presented by the 2014 crisis in West Africa. Further undercutting overseas work that protects Americans, the White House plan proposes significant cuts to USAID global tuberculosis investments, to the U.S. contribution to the Global Fund to Fight AIDS Tuberculosis and Malaria, and to the President’s Emergency Plan for AIDS Relief.

As the opioid crisis, severe influenza season, and other threats demonstrate, the need for a robust public health workforce continues to grow. We await further details on the Public Health Service Corps proposals but emphasize the importance of the public health workforce, not only to respond to public health emergencies but to carry out regular ongoing infectious diseases surveillance, prevention, and detection efforts to keep us safe from threats that include foodborne illness and vaccine-preventable diseases.

While we continue to watch for and respond to details and impacts of the President’s budget proposal, the Infectious Diseases Society of America urges Congress to once again respond to the President’s plan with a bipartisan and comprehensive budget that protects and prioritizes our nation’s health.

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