At a time when threats from pandemic influenza, antibiotic-resistant infections, and HIV/AIDS are growing, the budget proposal President Bush has submitted to Congress undermines the nation's ability to fight infectious diseases, the Infectious Diseases Society of America (IDSA) told Congress today.
In testimony before the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, IDSA President Martin J. Blaser, MD, said that while IDSA supports the president's proposal for $2.3 billion in emergency spending for pandemic influenza preparedness, the IDSA is deeply concerned about longer-term cuts to other parts of the budget.
"Infectious diseases are the third leading cause of death among Americans," Blaser said. "Although the president's budget would help build a roof against pandemic influenza, it would weaken the foundation of our public health system at the same time."
An influenza pandemic is an inevitable fact of nature, whether it come from avian flu or some other strain.Â The Centers for Disease Control and Prevention (CDC) estimates that in even a "mild" pandemic, U.S. casualties would run into the hundreds of thousands. The president's $2.3 billion request would go toward much-needed improvements in disease surveillance, vaccine and antiviral research and development, and buying enough antivirals to treat 25 percent of the population.
But the president proposes adding no additional funds to the National Institutes of Health (NIH) in FY2007, which would result in a net cut when inflation is taken into account. Flu research at NIH's National Institute of Allergy and Infectious Diseases (NIAID) is already under-funded. IDSA urged Congress to make a significant investment to develop new antivirals, vaccines, and diagnostics. Also, the lack of sufficient funds will block an essential plan to expand surveillance sites in Asia to monitor the emergence of new influenza viruses with pandemic potential.
"The president's proposed budget for NIH would cut beyond muscle and into the bone of critically important ID research grant programs," Dr. Blaser said.
In addition to harming flu research, the proposal cuts $15 million from HIV/AIDS research, harming research into vaccines, treatments, and prevention strategies. It also would force NIAID to cancel a planned public-private partnership to develop new drugs against tuberculosis.
The federal government has spent the last several years doubling NIH's budget.Â "Congress ought to be protecting its investment," said Blaser. "After putting so many resources into this national asset, it would be foolish to waste it by letting inflation erode it away." IDSA supports at least a 6 percent increase in NIH's budget.
Furthermore, IDSA says it is very concerned about cuts tucked into the CDC budget. Budgets for several areas contain one-time "emergency" funds. When these are taken out, the result is a 4.5 percent cut to CDC's core programs.
"This is the agency responsible for safeguarding the health of all Americans," Dr. Blaser noted. "CDC's immunization programs, disease prevention programs, and research pay dividends in healthier citizens."
IDSA is interested in several key areas in particular:
Â· Antimicrobial resistance. As rates of resistant infections are rising, increasing the number of deaths, hospital stays, and costs, IDSA supports a doubling of CDC's antimicrobial resistance budget to $50 million.
Â· Immunizations. "Vaccines are one of the greatest public health successes ever achieved," Blaser said, reducing or even eliminating many serious and life-threatening diseases in the United States and worldwide. In addition to a new vaccine for children against rotavirus diarrhea, several new vaccines are on the horizon for adolescents and adults, including vaccines against pertussis and the virus that is the major cause of cervical cancer. IDSA is concerned that adult vaccination rates are much too low, however, and recommends new funding to raise them. "Vaccines can save money in the long run," Blaser said, "but we need to make the investment up front to make them available." IDSA recommends increasing immunization program funding by $321 million to a total of $846 million.
Â· HIV prevention. IDSA says it is pleased to see the president's budget proposal includes a $93 million increase to expand HIV testing. Roughly 25 percent of those infected don't know it. Identifying them earlier means they can get treatment earlier, before the disease progresses, and helps to reduce the risk that they will transmit the virus. However, while IDSA applauded the CDC's HIV testing initiative, there is a major flaw. "Those people who test HIV-positive will need treatment, but under the president's budget proposal they may be out of luck," Blaser said.
The HIV epidemic is hitting the poor and uninsured hardest. The program designed to provide them medical care and services, the Ryan White CARE Act, is straining to keep up with the current patient load. In some states, patients are on waiting lists for medications they need to avoid progressing to full-blown AIDS and death. The president's proposal would add $95 million to the program's $2 billion budget, but that is nowhere near enough.
"This program needs a substantial investment from the federal government to provide access to lifesaving medical treatment to those who can least afford it," Blaser said.
"Today's investment in infectious diseases research, prevention, and treatments will pay significant dividends in the future by dramatically reducing health care costs and improving the quality of life for millions of Americans," Blaser said. "In addition, as the global leader in infectious diseases research and prevention, the United States will see these benefits translate into worldwide health benefits."