Appropriations Bills Acknowledge Pandemic Challenges, Ongoing Needs, While Failing to Address Critical Impacts
The House Labor, Health and Human Services bill passed by the full Appropriations Committee on July 13, and the State and Foreign Operations Appropriations bills passed by the full committee on July 9, provide critical resources to confront and curtail the COVID-19 pandemic’s impacts at home and abroad. The bills also, however, leave significant gaps in the deeper investments needed to combat antimicrobial resistance, malaria and the next phases of the continuing pandemic. They also lack adequate funding to ensure effective efforts during the coming influenza season and pursue the administration’s initiative to end HIV as an epidemic.
While the Labor, Health and Human Services Appropriations bill does respond to critical ongoing priorities, it also fails to address serious issues that have been highlighted in the midst of this pandemic.
Increased allocations to essential infectious diseases responses for fiscal year 2021 include:
- $175 million for the U.S. Centers for Disease Control and Prevention’s Antibiotic Resistance Solutions Initiative, a $5 million increase over FY2020;
- $4.5 billion in emergency funding for the Biomedical Advanced Research and Development Authority to improve the nation’s preparedness for public health emergencies, including $500 million for BARDA to support innovation in antibacterial research and development;
- A $10 million increase for CDC National Center for Emerging and Zoonotic Infections;
- $9 billion in emergency funding for CDC, including:
- $10 million for Epidemic Intelligence Service Loan Repayment, a $5 million increase over FY2020;
- $400 million for the Infectious Diseases Rapid Response Reserve Fund;
- $4 billion to enhance public health prevention, including an influenza vaccination campaign;
- A $128 million increase for the National Institute of Allergy and Infectious Diseases, and level funding for antimicrobial resistance research at the institute.
- A $5.695 million increase for the Fogarty International Center at the National Institutes of Health;
- $10 million for antimicrobial resistance research at the Agency for Healthcare Research and Quality, and language directing the agency to conduct infectious diseases diagnostic outcomes research;
- And, in a significant acknowledgement of challenges facing the infectious diseases workforce, the bill’s report includes recognition that outpatient evaluation and management reimbursements fall short of the levels needed to recruit, support and sustain necessary specialists in critical areas requiring patient interaction.
At a time when the tragic global and domestic impacts of COVID-19 have underscored urgent needs to detect and respond to emerging pathogens and to protect our health providers, however, the bill falls unacceptably short in allocations for:
- The Advanced Molecular Detection initiative at CDC, with level funding of $30 million when more is needed now to help CDC, state and local health departments rapidly detect emerging pathogens, and integrate next-generation sequencing in the COVID-19 response;
- National Healthcare Safety Network at CDC, with level funding of $21 million.
Finally, while the bill provides a $2 million increase for CDC Center for Global Health, current events tell us that is only one step in the right direction; more will be needed.
Significantly, the House State and Foreign Operations Appropriations bill provides $119 million for the annual U.S. contribution to the World Health Organization, despite the administration’s recent actions to withdraw the U.S. from the multilateral organization. The bill also includes an additional $200 million in voluntary contributions to the WHO, funds typically used for WHO programs on HIV, TB, malaria, polio and other infectious diseases. Continued congressional funding of the WHO is not only a clear indication of policymakers’ disapproval of the administration’s decision to withdraw from the WHO, it is an important step for rejoining the agency in the future.
The State and Foreign Operations bill also provides $10 billion in emergency funding for COVID-19 responses, of which $2.5 billion will go to global health programs, with:
- $150 million for the USAID Emergency Reserve Fund;
- $750 million for Gavi, the Vaccine Alliance;
- $800 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria;
- $142.5 million increase for family planning and reproductive health across all accounts, including USAID family planning and UNFPA, the United Nations Population Fund;
Additionally, the bill repeals the global gag rule, an appropriate, if (in the absence of Senate agreement), likely symbolic, rejection of a policy that bans federal aid to overseas programs providing comprehensive reproductive health services that include pregnancy termination information and services.
While, in the absence of authorizing language for CEPI, the Coalition for Epidemic Preparedness Innovations, the bill does not name that initiative, it allows for funds to be made available to “a multilateral vaccine development partnership to support epidemic preparedness,” an essential investment.
While the bill provides a $25 million increase for USAID global health security activities, acknowledging the pivotal role that strengthening public health capacities worldwide must play in protecting public health at home, that amount remains far short of what is needed.
Unfortunately, as well, the bill leaves unaddressed other global infectious disease challenges that have only been worsened by the ongoing pandemic. These shortfalls include flat-funding for the U.S. President’s Emergency Plan for AIDS Relief, the Global Fund, and USAID’s TB program and a $15 million cut to the President’s Malaria Initiative, even as COVID-19 impacts disrupt efforts to combat these diseases and threaten to reverse hard-won gains.
These are extraordinary times that will continue to require new and greater resources to contain the current crisis and the damage left in its wake. The Infectious Diseases Society of America will continue to urge our House and Senate appropriators to meet the unprecedented challenges before us with appropriate resources.