Senate Domestic, Foreign Funding Bills Recognize, but Fall Short of Needs for Critical Infectious Disease Responses
Spending bills released by Senate Appropriations Committee Wednesday demonstrate encouraging recognition of some of the most urgent health challenges threatening individual and public health at home and abroad. At the same time, the bills fall short of the comprehensive commitments necessary to fully effective responses.
Funding allocations in the bill submitted by the Senate Labor, Health, Human Services, Education, and Related Agencies reflect awareness that antibiotic resistance is one of the greatest public health threats of our time, and that the imminent collapse of the nation’s antibiotic pipeline only deepens this emergency. The bill’s allotment of $168.5 million for the U.S. Centers for Disease Control and Prevention’s Antibiotic Resistance Initiative represents an increase in funding that will help states and local communities protect public health by tracking disease-resistant pathogens and preventing their spread. Similarly, $600 million allocated for antimicrobial resistance research at the National Institute of Allergies and Infectious Diseases, also an increase from 2019 funding, will support critical work to confront this growing crisis. Importantly too, the $5.937 billion for the National Institute of Allergy and Infectious Diseases, represents an overall increase that includes resources to support the development of the next generation of infectious diseases physician-scientists. The LHHS bill is both responsive and proactive in its recognition of pressing public health threats with $10 million in CDC funding to address infectious diseases related to the opioid epidemic, providing increased resources to address a still growing crisis, and $610 million for CDC’s Immunization Program to combat outbreaks of vaccine-preventable diseases and educate the public about the importance of vaccines.
But when infections resistant to multiple drugs kill an estimated 162,044 people in the U.S. each year, a sustained and multi-faceted approach is necessary to address antimicrobial resistance. The bill’s allocation of $30 million -- level with 2019 funding -- for the Advanced Molecular Detection program, which has improved our ability to more rapidly determine if emerging diseases are resistant to first-line treatments, falls short of what will be needed in the year ahead. Similarly, level funding of $21 million in the bill for the National Healthcare Safety Network, which works to increase the number of healthcare facilities reporting antibiotic use and resistance data will not allow the network to grow at the rate needed. At the same time, the bill also flatlines funding for the Biomedical Advanced Research and Development Authority, which forges crucial initiatives to speed development of urgently needed new antibiotics that can address resistant pathogens. In a year that saw one of the few small antibiotics companies go bankrupt and two others lay off significant numbers of staff, more, not stagnant, investment in antibiotic research and development is essential. Congress must fully fund each these priorities to continue to ensure an extensive, enhanced antibiotic resistance response that will save lives, preserve the gains of modern medicine and help control healthcare spending.
The LHHS bill also recognizes the critical role of continued U.S. leadership against infectious disease outbreaks worldwide with $595 million for the CDC Center for Global Health. This funding includes a $100 million increase for the CDC Global Public Health Protection program – meeting recommendations by the Infectious Diseases Society of America of $208.2 million for the agency’s global health security efforts. Additionally, the bill provides $82.3 million for the National Institutes of Health Fogarty International Center, an increased investment in strengthened international capacities and research The ongoing spread of Ebola in the Democratic Republic of Congo, the now repeated spread of the outbreak into neighboring Uganda, and the continued threat to other bordering nations, however, highlight the importance of increased and sustained commitments to control the current outbreak and build capacities to prevent, detect and respond to infectious diseases of pandemic potential at their source. Disappointingly, Senate and House foreign spending bills flat fund USAID’s global health security efforts. As funds committed five years ago in the Ebola emergency supplemental bill responding to the West Africa crisis expire Sept. 30, additional resources will be essential to sustain efforts to control outbreaks where they originate. Those resources will be critical to proactive global health approaches.
The Senate State and Foreign Operations and Related Programs Appropriations subcommittee shows continued commitment to strong, informed, and sustainable infectious disease responses with $1.56 billion for the Global Fund to Fight AIDS, TB and Malaria, including $210 million in increases over FY 19 funding, $310 million for USAID’s global tuberculosis program, including $8 million in increases that will help supply technical assistance to resource-limited countries as they accelerate their efforts to respond to the world’s biggest infectious disease killer, and $789 million for President’s Malaria Initiative at USAID – an increase of $34 million over 2019 and the current House funding proposal to strengthen vector control, as well as malaria prevention and treatment efforts in countries where the disease is endemic.
But at a time when millions of people living with HIV worldwide still need treatment to save their lives and stop transmission of the virus, and when the path to ending HIV as a global public health threat is clear before us, the bill’s cut of $50 million in funding for the U.S. President’s Emergency Plan for AIDS Relief from last year – when with a $50 million increase the program saw it’s first increase in a decade – represents a discouraging step back. The preservation of the administration’s expanded global gag rule, restricting funding for a broad span of health services essential to controlling HIV, in the SFOPs bill also is counterproductive.
As the federal funding process moves forward, IDSA will continue to urge full funding for CDC, USAID and DoD efforts to control the current Ebola outbreak, to end the threat of HIV at home and abroad, to detect and respond to other infectious disease threats at their source before international spread, and to respond comprehensively to the mounting threat of antimicrobial resistance at home and around the world. We urge the Senate and House to work together to swiftly enact a bipartisan FY2020 bill that provides meaningful funding increases for all of these efforts.