During a recent visit to Liberia, Health and Human Services Secretary Tom Price was correct when he reaffirmed the federal government's longstanding commitment to global health security.
"We know that by ensuring that all countries around the world are better prepared to prevent, detect, respond to and control disease outbreaks at the local level," he said, "we can reduce the threat of international health emergencies."
Cuts to global health security programs in the president's proposed budget, however, are a drastic move in the wrong direction.
The vast majority of epidemics and pandemics that could pose a threat to the U.S. begin abroad, merely a flight away. And because there is no effective way to fully insulate our country from epidemics, our best defense is to respond quickly when outbreaks emerge overseas and contain them at their source before they have the chance to spread.
Federal programs that do just that would face major cuts if the president's budget is approved. The proposed budget would cut $76 million from CDC's Global Health programs, including cuts to Global Disease Detection and other programs that train and prepare countries to diagnose and respond to emerging diseases, and to the Global Immunization Program. It would reduce by $65 million CDC's Emerging and Zoonotic Infectious Diseases programs, which aim to prevent and control outbreaks of diseases such as Zika. It cuts by $136 million the CDC Preparedness and Response Capability budget, which includes the funding for CDC's Emergency Operations Center and the deployment of its people abroad to emergencies such as the Ebola epidemic in West Africa.
The hundreds of scientists from CDC and their colleagues from USAID, DOD and other government agencies and NGOs who responded to the Ebola outbreak did incredible work to help contain the disease after it wasn't recognized locally for months and spread from one sick child in Guinea to other villages, then into Sierra Leone and Liberia. It accelerated in hospitals, killing doctors and nurses, and spread in cities, killing entire families, neighbors and friends. Before it was over, more than 11,000 lives were lost. We are fortunate Ebola never took root in the U.S., though we did not escape unscathed. The epidemic in West Africa undermined decades of U.S. investments to bring stability to a war-torn region and mitigate the risk of terrorist groups gaining control.
Ebola is only one recent health security crisis that has threatened U.S. interests. For nearly two decades, a series of infectious disease emergencies — the anthrax attacks in 2001, the rapid global spread of SARS in 2003, the 2009 H1N1 pandemic, the emergence and international spread of MERS coronavirus, persistent dangers around H5N1 bird flu, and the emergence of a new strain of Zika virus — have presented new threats to human health and economies.
Critically important U.S. global health security initiatives are now threatened as well. Global health funding at USAID and the State Department would be cut by more than $2 billion — or approximately 24 percent — largely in the form of reductions to programs responding to leading global health killers: HIV, TB and Malaria, among other serious diseases. The world-renowned PEPFAR program that has prevented more than 7 million deaths from HIV would shrink by $600 million. It is important to know that capacities built to combat HIV/AIDS under PEPFAR are credited with helping Nigeria quickly respond to stop the spread of Ebola there. The budget also eliminates the NIH Fogarty International Center, which has for decades been an international leader in critical global health research.
Disappointingly, the president's budget does not include a line item commitment for future CDC work on the Global Health Security Agenda (GHSA). The GHSA is an initiative by the U.S. and more than 50 other countries to prevent an Ebola-like event — and far more severe epidemics — from occurring. Over the past three years, GHSA leaders have worked to strengthen global health security capabilities in vulnerable countries that most need help. Their efforts protect the U.S. by preventing the emergence of deadly outbreaks that could spread here.
Taken together, all of these programs have saved millions of lives and are building the capabilities that are needed for early warning of and rapid response to major new epidemics. Congress should recognize the extraordinary benefits these programs bring to security, health and U.S. diplomacy and should provide steady funding for them, at minimum consistent with FY17 level of support. It's an essential investment for this country, and for the world.
Dr. Tom Inglesby (email@example.com), Anita Cicero (firstname.lastname@example.org) and Jennifer Nuzzo (email@example.com) are faculty at the Johns Hopkins Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. The Center has been the recipient of grants and contracts from some of the federal agencies mentioned in this piece.