In urging Congress to reject public health cuts proposed by the Trump Administration, the Infectious Diseases Society of America (IDSA) said on Wednesday that the fiscal year 2019 budget proposal reflects a “narrow and short-sighted understanding of national safety and well-being.”
President Donald Trump’s budget blueprint calls for cutting funding Department of Health and Human Services (HHS) public health programs that are funded annually by 18 percent, or $15.1 billion. The proposal would also make cuts to State Department programs that advance global health response and security interventions.
IDSA President Paul Auwaerter said the budget proposal speaks of critical health challenges facing the United States and the world, but it does not “reflect those challenges highlighted or ways to address them.”
“The budget should reinforce and strengthen our national health infrastructure, advance urgently needed scientific discovery, address the public health impact of the continuing opioid crisis, ensure access for preventive measures and protect Americans by building capacities to detect, to prevent and to respond to infectious disease outbreaks overseas where they originate,’ Auwaerter said.
The budget proposal calls for cutting the National Institutes of Health budget by $5.8 billion, and for cutting training programs for health professionals like nurses by $400 million. Additionally, it outlines $85 million in cuts for Centers for Disease Control and Prevention (CDC) immunization programs and $111 million in cuts to the National Institutes of Allergy and Infectious Diseases.
“And while we appreciate continued funding for antimicrobial resistance research and development through the Biomedical Advanced Research and Development Authority, the current investment is insufficient, as evidenced by an antibiotic pipeline that falls far short of projected needs, while pharmaceutical company investments in antibiotic research continue to diminish,” Auwaerter said. “Also, the plan would limit CDC efforts to address and prevent growing resistance to existing antimicrobial drugs with a nearly $25 million cut.”
In terms of the opioid epidemic, Auwaerter said the budget proposal overlooks secondary public health impacts of injecting drugs, including outbreaks of endocarditis and HIV, hepatitis, as well as skin, bone and joint infections.
“Following the Scott County Indiana HIV outbreak that was linked directly to opioid use, the CDC identified 220 counties in 26 states across the country that are at risk for similar HIV outbreaks among people who inject drugs,” Auwaerter said. “The CDC has identified significant increases in acute hepatitis C related to increased opioid use — with acute hepatitis C cases increasing by 133 percent from 2004 to 2014 — and hospital admissions due to injection drug use increasing by 93 percent during the same period.”
The proposal does include $40 million to establish an Elimination Initiative for AIDS, viral hepatitis, sexually-transmitted infections and tuberculosis — but Auwaerter notes that the funding is accompanied by $34 million in cuts to CDC domestic AIDS prevention and research efforts.
The proposal also calls for restoring State Department Global Health Security Agenda funding to pre-Ebola levels. It would also cut funding for U.S. Agency for International Develop (USAID) tuberculosis eradication efforts, the Global Fund to Fight AIDS Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief.
“This is short-sighted and reflects a limited understanding of the lessons presented by the 2014 crisis in West Africa,” Auwaerter said. “Further undercutting overseas work that protects Americans, the White House plan proposes significant cuts to USAID global tuberculosis investments, to the U.S. contribution to the Global Fund to Fight AIDS Tuberculosis and Malaria, and to the President’s Emergency Plan for AIDS Relief.”
Auwaerter said IDSA would continue to monitor the budget process and urged Congress to respond with a “bipartisan and comprehensive budget that protects and prioritizes our nation’s health.”