The Infectious Diseases Society of America (IDSA) applauds the new Centers for Disease Control and Prevention (CDC) Detect and Protect Against Antibiotic Resistance Initiative, proposed in the President’s Budget Request (PBR) for Fiscal Year (FY) 2015. IDSA has long insisted upon increased federal leadership to address the public health crisis of antibiotic resistance. This new initiative is an important step forward. However, we are disappointed that the PBR maintains sequestration, which continues to inhibit investments in lifesaving biomedical research and public health activities. Of particular concern, the PBR essentially level funds the National Institutes of Health (NIH), which would continue their trend of decreasing purchasing power seen since FY 2004.
The new CDC antibiotic resistance initiative would enhance surveillance, implement interventions to prevent the spread of resistant infections, and promote appropriate antibiotic use—all key components of a national strategy to combat resistance. IDSA shares CDC’s hope that the isolate library the agency intends to develop as part of this initiative will help facilitate the development of desperately needed new antibiotics and diagnostics. In addition, IDSA supports the proposed $14 million increase for the National Healthcare Safety Network (NHSN), which would help increase the number of healthcare facilities reporting the antibiotic use and antibiotic resistance data and develop and evaluate new infection prevention strategies.
In addition to fully funding the antibiotic resistance initiative and the NHSN request, IDSA urges Congress to advance the following administration-proposed investments:
CDC Advanced Molecular Detection (AMD) Initiative ($30 million): Continuation of this initiative would allow CDC to more quickly determine where emerging diseases come from, whether microbes are resistant, and how microbes are moving through a population. AMD would strengthen CDC’s epidemiologic and laboratory expertise to effectively guide public health action.
CDC Global Health Security Initiative ($45 million): This new initiative would strengthen the capacity of nations to prevent, detect and slow the spread of infectious diseases, simultaneously reducing threats to the United States.
CDC Pandemic Influenza ($55 million increase): This funding would support improvements in vaccine production and manufacturing efficiency, ongoing countermeasure stockpiling and storage, antiviral drug advanced development, and improvements in respiratory protection devices. This funding also supports the advanced development of potential candidates for a universal influenza vaccine, which builds upon previous research completed by NIH.
CDC Food Safety ($10 million increase): The proposed enhanced investment in food safety would improve our nation’s ability to detect foodborne disease case clusters, facilitate real-time communication among health departments, quickly identify outbreaks, and better determine areas where implementation of new measures is likely to increase the safety of our food supply.
Medicare Physician Payment: IDSA continues to call for a repeal of the severely flawed Medicare Sustainable Growth Rate (SGR), and we are pleased to see that the administration shares this goal.
IDSA urges Congress to provide a stronger investment than proposed by the administration for these priorities:
National Institutes of Health ($200 million increase): IDSA appreciates the proposed $200 million increase for NIH. However, NIH estimated that the Biomedical Research and Development Price Index for 2015 would be 2.9%. As such, the 0.7% increase provided NIH in the PBR continues the 10-year downward trend in purchasing power at the NIH. The NIH grant success rate for FY 2013 is likely to be reported as falling to 15%, its lowest level in history. IDSA believes that even during a difficult budget environment, strong NIH funding should be a national priority. IDSA supports a budget of $32 billion for NIH in FY 2015.
National Institute of Allergy and Infectious Diseases (NIAID) ($30 million increase): While IDSA is thankful for the proposed $30 million increase for NIAID, we believe a larger increase is necessary to sufficiently address research needs. We propose increased support the for NIAID’s new Clinical Trials Network on Antibacterial Resistance. Additional funding also is needed for research on diagnostics as well as new influenza antivirals to treat resistant strains of the virus.
Biomedical Advanced Research and Development Authority (BARDA) (flat funding): IDSA is disappointed that the budget fails to seek increased funding for BARDA. Additional investment in medical countermeasure development is critical to prepare for both intentional attacks and naturally emerging infections, particularly those resistant to current antimicrobials.
Food and Drug Administration ($25 million increase): IDSA is concerned that the PBR does not provide sufficient funding to meet the FDA’s expanding responsibilities. Increasing antimicrobial resistance continues to place greater demands on FDA, including ensuring the safety of our food supply and swiftly reviewing new antibiotics and diagnostics.
Immunizations ($51.5 million decrease): IDSA continues to oppose the administration’s proposal to decrease funding for CDC immunization programs. Recent changes requiring insurance coverage of immunizations does not lessen the need for these programs. Public health programs are critical to help providers obtain and store vaccines; establish and maintain vaccine registries; educate providers and the public about vaccine recommendations, effectiveness and safety; and promote universal vaccination of health care workers. According to the February 2014 CDC Morbidity and Mortality Weekly Report (MMWR), adult immunization rates remain low for most routinely recommended vaccines and considerably short of Healthy People 2020 targets.