Trump budget cuts threaten re­sponse to Zika and other dis­ease outbreaks

Modern Healthcare - - NEWS - By Steven Ross John­son

As a pres­i­den­tial can­di­date last sum­mer, Don­ald Trump promised to lead an ag­gres­sive fight against the spread of the Zika virus. He urged Congress to fund a pro­posed $1 bil­lion-plus Zika re­sponse plan. But now, the pub­lic health com­mu­nity is ex­press­ing strong con­cerns about Pres­i­dent Trump’s com­mit­ment to main­tain­ing and strength­en­ing the country’s in­fec­tious dis­ease pre­ven­tion in­fra­struc­ture.

Many credit Trump’s draft budget, re­leased last month, for propos­ing the cre­ation of a new federal emer­gency fund de­signed to rapidly re­spond to pub­lic health crises. That’s some­thing pub­lic health lead­ers have ad­vo­cated for years. Cre­at­ing such a fund would end the need to call on Congress to pro­vide crisis fund­ing dur­ing an in­fec­tious dis­ease out­break, as hap­pened with Ebola and then Zika.

“There could be events quite frankly where (hav­ing an es­tab­lished emer­gency fund) could be the dif­fer­ence be­tween a suc­cess­ful re­sponse and a failed re­sponse,” said James Blu­men­stock, chief pro­gram of­fi­cer for health se­cu­rity for the As­so­ci­a­tion of State and Ter­ri­to­rial Health Of­fi­cials.

Yet the Trump budget lacks de­tails on how much money the ad­min­is­tra­tion would ap­pro­pri­ate for the emer­gency fund, or how the pres­i­dent wants to pay for it.

If Trump ded­i­cates new fund­ing, then it has the po­ten­tial to be a pow­er­ful tool to aid pre­ven­tion and re­sponse ef­forts in emer­gen­cies, ex­perts say. But if fund­ing comes from cut­ting other pub­lic health pro­grams, they say its po­ten­tial im­pact would be greatly re­duced. Es­tab­lish­ing an emer­gency fund would not be enough to as­suage larger con­cerns among pub­lic health ex­perts over Trump’s move to re­peal and re­place the Af­ford­able Care Act and im­pose other spend­ing cuts that could un­der­mine pre­ven­tion and re­sponse ef­forts.

In­cluded in the pres­i­dent’s draft budget was a pro­posal to cut the Na­tional In­sti­tutes of Health’s budget by $5.8 bil­lion. The NIH has been the lead­ing fund­ing source for vac­cine re­search and de­vel­op­ment for sev­eral in­fec­tious dis­eases that have had outbreaks in re­cent years, in­clud­ing Ebola and Zika.

“If you de­fund the sci­en­tific in­fra­struc­ture in gen­eral, all as­pects are go­ing to have to suf­fer and that in­cludes pre­pared­ness for new dis­eases as well as re­search and ther­apy for ex­ist­ing dis­eases,” said Dr. David Freed­man, pro­fes­sor of medicine and epi­demi­ol­ogy at the Univer­sity of Alabama at Birm­ing­ham.

Trump’s skep­ti­cism about the hu­man-caused sources of cli­mate change is re­flected in his pro­posed 31% cut to the En­vi­ron­men­tal Pro­tec­tion Agency’s budget, which would force lay­offs of an es­ti­mated one-fifth of the agency’s work­force. Cli­mate change has been linked to an in­creased risk of in­fec­tious dis­eases.

“It’s been one of the warm­est win­ters on record, and that’s good for the Aedes ae­gypti (mosquito) but not good for us,” said Dr. Peter Hotez, dean of Bay­lor Col­lege of Medicine’s Na­tional School of Trop­i­cal Medicine, re­fer­ring to the mosquito that spreads Zika.

Even seem­ingly un­re­lated Trump pol­icy de­ci­sions could have large pub­lic health ram­i­fi­ca­tions. A re­peal of the Af­ford­able Care Act would not only mean a loss of health cov­er­age for mil­lions but also would elim­i­nate the CDC’s Pre­ven­tion and Pub­lic Health Fund. Cre­ated un­der the ACA, the fund pro­vides more than $930 mil­lion for CDC pro­grams, ac­count­ing for 12% of the agency’s to­tal an­nual budget.

A loss of that fund­ing would mean slash­ing $40 mil­lion from the CDC’s Epi­demi­ol­ogy and Lab­o­ra­tory Ca­pac­ity for In­fec­tious Dis­ease Co­op­er­a­tive Agree­ment pro­gram, or ELC, which pro­vides fund­ing to U.S. pub­lic health labs to quickly re­spond to emerg­ing in­fec­tious dis­ease threats. The ELC pro­gram re­ceives around half of its an­nual fund­ing through the ACA’s Pre­ven­tion and Pub­lic Health Fund. Pro­gram funds played a cru­cial role in help­ing state lab­o­ra­to­ries rapidly test sus­pected Zika sam­ples months be­fore Congress ap­proved emer­gency federal fund­ing last year.

Re­peal­ing the ACA and the pre­ven­tion fund would elim­i­nate the ELC’s abil­ity to ad­dress pub­lic health con­cerns such as Zika be­fore law­mak­ers can re­act, said Peter Kyr­i­a­copou­los, se­nior direc­tor of pub­lic pol­icy at the As­so­ci­a­tion of Pub­lic Health Lab­o­ra­to­ries.

Many state and lo­cal pub­lic health de­part­ments have re­ceived at least some of the $1.1 bil­lion in emer­gency Zika fund­ing OK’d by Congress last year. But it’s un­known how the Trump budget cuts would af­fect the na­tion’s re­sponse ef­forts once that money is used up.

Freed­man said a larger con­cern lies in the po­ten­tial im­pact Trump’s budget cuts could have on ef­forts to re­cruit the next gen­er­a­tion of sci­en­tists and re­searchers. “The best and the bright­est aren’t go­ing to pur­sue a ca­reer in sci­ence if there are no op­por­tu­ni­ties for ei­ther jobs or fund­ing,” he said.

Ex­treme weather events cou­pled with milder win­ters as global tem­per­a­tures rise have cre­ated en­vi­ron­ments that are breed­ing ground for dis­eases, in­clud­ing mosquito-borne in­fec­tions.

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