Proposed US budget cuts could have ‘disastrous’ effect on global health
President Trump’s proposed 2021 budget would reduce HHS funding by more than 9%, including large cuts to the NIH and CDC budgets. Reductions to some programs could impact the country’s ability to prevent and respond to public health threats and weaken support for global efforts to fight HIV/AIDS, observers warned.
The proposed budget slashes NIH funding by 7% and CDC funding by 9%, said Emily Conron, a U.S. policy and advocacy officer at Global Health Technologies Coalition. The proposed cuts were announced even as the CDC “mounted a rapid response” to the coronavirus outbreak, Conron said.
“If enacted, these reductions would have a disastrous impact on scientific advancements for global health. Cuts could mean fewer breakthrough vaccines, diagnostics and treatments developed and more lives worldwide at risk of deadly diseases and debilitating conditions,” Conron told Healio.
“For the past 3 years, Congress has acted in a bipartisan manner to reject the president’s proposed budget cuts to global and medical research. We urge Congress to do so once again and maintain our nation’s strong legacy of humanitarian and scientific leadership in global health [research and development].”
Cuts to preparedness
Crystal Watson, DrPH, MPH, senior scholar at Johns Hopkins Center for Health Security, reviewed the proposed budget and noted several cuts that she said would limit the country’s preparedness for infectious disease threats, including:
- a $200 million reduction to the BioShield fund, which procures medical countermeasures like drugs and vaccines for the strategic national stockpile;
- a $25 million reduction to CDC’s public health preparedness and response programs, “which are intended to increase preparedness at CDC and for state and local health departments,” Watson said. “The cuts are specifically to CDC’s internal preparedness and response programs, and to CDC-supported Academic Centers for Public Health Preparedness.”
- an $85 million reduction to funding for emerging and zoonotic infectious diseases, including a $33 million cut to the CDC’s antibiotic resistance initiative, and elimination of the agency’s epidemiology and lab capacity program and the health care-associated infections program.
The administration also proposed an $18 million reduction in funding for the Assistant Secretary for Preparedness and Response’s Hospital Preparedness Program (HPP), “which provides grants to hospitals nationwide to support preparedness for emergencies like the coronavirus outbreak,” Watson said.
“This proposed budget overall does not increase support for preparedness and response to emergencies like the [COVID-19] outbreak. In some cases, it will even degrade our ability to respond to infectious disease emergencies,” she said.
The cuts are part of a downward trend in funding for preparedness programs, according to Watson.
“Over time, public health departments have had to reduce staff and cut preparedness programs, and the hospitals funded by HPP often do not receive enough federal support to sustain preparedness efforts,” Watson said.
She noted that the proposed CDC budget includes an additional $50 million for global health security, raising the program’s funding to $175 million. This would mean more money “for work that increases international capacity to prepare for, detect and respond to emerging infectious diseases,” Watson said.
An HHS spokesperson told Healio that the proposed budget includes $135 million in added funding over 2020 levels for CDC activities addressing infectious disease, global health and emergency preparedness activities involving infectious disease response, immunization, and HIV, tuberculosis and sexually transmitted infection prevention. It includes an addition $50 million in funding for pandemic influenza preparedness, bringing total funding to $310 million.
The proposed budget seeks around $12.6 billion in funding for the CDC’s programs budget, a $175 million decrease in what it received last fiscal year.
“Unfortunately, I think the budget ignores a larger number of important issues, particularly antibiotic resistance,” Amanda Jezek, senior vice president of public policy and government relations for the Infectious Diseases Society of America, told Healio. “I think it’s really challenging in the areas that are slated for proposed increases for those increases to really meet their full potential and to achieve their maximum goals. [They go] against a backdrop of a public health system that is chronically underfunded.”
Large cuts to Medicare and Medicaid
The budget also includes proposed cuts of $756 billion in Medicare spending and $920 billion in Medicaid spending over a decade.
The Medicare cuts “would include drawing down payments for uncompensated care, expanding costlier Medicare Advantage Plans at the expense of traditional Medicare, and promoting high deductible health plans for seniors,” the ACP said in a statement. “Medicaid would be cut ... by limiting eligibility, imposing work requirements, and offering states waivers to curtail Medicaid spending. All of these changes would hurt access to coverage for care for Medicaid beneficiaries.”
The HHS spokesperson said “funding for Medicaid continues to grow and funding levels will be no lower each year than they are today.” They said the budget slows the average annual growth of Medicaid from 5.4% to 3.1% “to ensure a more sustainable program for the truly needy and gives states flexibility to reform and innovate.”
Ending the HIV Epidemic
The proposed budget provides $1.2 billion for CDC’s domestic efforts against HIV/AIDS, including $371 million for the second year of HHS’s Ending the HIV Epidemic initiative.
“While we strongly support the goal of ending the HIV epidemic in the United States, as advocates we must decry proposed cuts of nearly $60 million from CDC’s global AIDS program, nearly $1.2 billion to the President’s Emergency Plan for AIDS Relief, and $900 million from the U.S. contribution to the Global Fund,” Conron said. “Global health progress means progress everywhere, and we must remain committed to making progress against HIV/AIDS globally to ensure the strides we have made are sustained and accelerated.”
The spokesperson said the HHS has expanded its HIV prevention services to all community health centers within the “targeted initiative areas” through the Health Resources and Services Administration and has requested $27 million for Indian Health Services to “enhance HIV testing and linkages to care for American Indians and Alaska Natives.”
These investments will advance HHS’s efforts to reduce new HIV diagnoses by 75% in 5 years and by 90% by 2030, the spokesperson said.
“We appreciate the increased funding to end the HIV epidemic domestically, but on the flip side of that, the budget proposes reducing funding of more than a billion dollars for global HIV programs, which is truly stunning when you consider that infectious diseases don’t respect national borders and combating them here, means combating them everywhere,” Jezek said. – by Ken Downey Jr.