President's FY2013 Budget is a Mixed Bag for Infectious Diseases

The Infectious Diseases Society of America (IDSA) says it is deeply concerned about cuts proposed in President Obamas Fiscal Year (FY) 2013 proposed budget for the nations immunization programs, state and local public health preparedness, and the Prevention and Public Health Fund, as well as budget policies that discourage research. 

While the budget proposal includes additional investments for some key IDSA priorities, IDSA calls for sustained investments across-the-board for infectious diseases (ID) research and public health programs to protect Americans from a growing number of ID threats.

The IDA's statement is as follows: 

IDSA opposes the proposed budget cuts that will weaken the nations research and public health enterprises:

Flat-lined National Institutes of Health (NIH) Funding/Salary Cap:  While IDSA is relieved that the Administration did not propose cutting funding for the NIH and, specifically, the National Institute for Allergy and Infectious Disease (NIAID), we firmly believe that greater, not flat-lined, investment in biomedical research is critically important for our nations health.  Also, we remain concerned with the budgets proposed policy, also adopted for FY12, to limit the salary of NIH extramural researchers to Executive Level II ($179,700 a reduction of $20,000 from the Executive Level I cap used the past 10 years).  Reducing the salary cap will disproportionately affect physician investigators and serve as a deterrent to their recruitment into research careers at a time when our country is already struggling to remain globally competitive in research and technology. 
 
Immunizations:  IDSA is disappointed in the proposed $58 million reduction to the Centers for Disease Control and Prevention (CDC) Section 317 immunization program. The Administrations rationale that recent changes requiring insurance coverage of immunizations lessens the need for the 317 program is faulty.  Insurance coverage alone will not ensure access and utilization.  Section 317 funds 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.  Of tremendous concern, vaccination rates for adults range from 26% to 65%, depending on the type of vaccine and population.

State and Local Preparedness:  While IDSA supports the modest increase proposed to strengthen CDCs preparedness and response capacities, we are disappointed by the correspondingly larger proposed cut in funding to state and local preparedness and response.  Multiple reports have demonstrated that our state and local public health systems are woefully under-prepared to respond to a public health emergency, such as a bioterror attack or mass infectious disease outbreak.  We need to strengthen state and local capacities, not further erode them.

Prevention and Public Health Fund (PPHF):  IDSA is worried about the Administrations proposal to decrease the PPHF by $4.5 billion over several years.  As CDCs budget authority has seriously eroded in recent years and faces yet another proposed cut in FY13, the PPHF has been repeatedly raided to fill funding gaps in core public health activities that should instead be prioritized and sustained as part of CDCs base appropriation.  The PPHFs true purposeproviding unique investment in new and innovative public health effort is being undermined.  The PPHFs integrity must be restored so that it is available to  provide crucial support for immunization efforts, epidemiology and laboratory capacity, and the Emerging Infections Programa network of 10 state health departments that conduct surveillance, prevention, and control of emerging infectious diseases.

While we oppose the cuts noted above, IDSA must applaud the Administration for heeding our recommendations and proposing new investments to strengthen our nations surveillance of and response to infectious diseases:

Biomedical Advanced Research and Development Authority (BARDA):  IDSA supports the Administrations proposed $547 million for BARDA in FY13, a significant increase over the $415 million it has received for the last two years. BARDA facilitates advanced research and development (R&D) of medical countermeasures (MCMs), including therapeutics, diagnostics, vaccines, and other technologies, including new antibiotics for both intentional attacks and naturally emerging infections.  This funding is particularly needed for antibiotic R&D, given the plummeting private investment in this area.

Strategic Investor:  IDSA supports the Administrations proposal to establish an MCM Strategic Investor with an initial funding level of $50 million.  This new entity will fill a significant void by partnering with small innovator companies and private investors to address urgent needs, first focusing on: (1) novel antimicrobials for multidrug-resistant organisms, (2) novel mechanisms for disrupting pathogenesis through host pathway targeting, and (3) multiuse platform technologies for diagnostics, vaccines/prophylaxis, and therapeutics. 

CDC Infectious Diseases Funding:  IDSA supports the proposed increases for the National Center for Emerging and Zoonotic Infectious Diseases ($27 million increase) and the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections and Tuberculosis Prevention ($35 million increase).  NCEZID houses CDCs antimicrobial resistance activities, including surveillance, data collection and stewardship.  These programs are critical if our nation is to stem the tide of dangerous pathogens increasingly resistant to antibiotics.

CDC National Healthcare Safety Network and EpiCenters:  IDSA supports the Administrations proposal to almost double funding for the National Healthcare Safety Network from $14,840 in FY12 to $27,468 in FY13.  The new funding will allow CDC to further invest in the EpiCentersfive academic centers which conduct infection control and prevention research including projects on health care-associated infections and antibiotic-resistant infections.  The EpiCenters have survived on a $2 million budget over the past 15 years with no increase. 

Maintaining a strong biomedical research enterprise and public health infrastructure in the U.S. are crucial to promoting the health of our citizens and preserving the ability to prevent and respond to health emergencies, both natural and manmade.  While IDSA strongly supports the new ID-related investments proposed by the President, we are mindful that their impact will be lessened by the simultaneous cuts also proposed.  Filling existing gaps by creating new ones is not a sustainable path forward.  We appreciate the need to reduce our nations deficit, but recognize that over the past few years, health programs have already borne more than their share of  belt-tightening measures.  Expenditures in public health, research, and health care can yield tremendous rewards for our nations economy and the well-being of our population by creating jobs, reducing unnecessary health care costs, and saving lives.