Just before the end of its September session, Congress finally did what public health officials had been begging it to do for more than seven months and approved substantial funding for Zika response efforts. The $1.1 billion package fell short of the $1.9 billion President Obama requested back in February – and, according the tally from POLITICO’s Dan Diamond, it came 233 days after Obama’s request and after 23,135 cases of Zika virus were identified in US states and territories.
Unlike an earlier House bill, this funding measure doesn’t prohibit funding from going to Planned Parenthood – which would have been an unconscionable move given that one of the surest ways to reduce the number of Zika-affected babies is to prevent unintended pregnancies. Here’s how the money is allocated:
- $394 million to CDC “to support vector control, technical assistance for states, and international response activities,” including $44 million to reimburse states for Public Health Emergency Preparedness money they transferred to Zika response.
- $397 million to NIH and the Biomedical Advanced Research and Development Authority (part of HHS) for vaccine and diagnostic development.
- $75 million to reimburse healthcare provided to those without private insurance in US states and territories with active Zika transmission.
- $66 million for community health centers, National Health Service Corps, and Maternal and Child Health special projects of regional and national significance in Puerto Rico and other US territories.
- $175 million for foreign operations, the majority of which ($146 million) is “to support the ability of affected countries to implement vector management and control programs to reduce transmission of the Zika virus,” including through contributions to the World Health Organization and other UN agencies.
CDC will likely pass on much of its money to localities facing the greatest Zika threats, as well as using it for CDC emergency teams to assist individual states where local transmission has been discovered. “The agency also plans to invest in new technologies to better detect Zika and set up regional centers to track the growing problem of diseases spread by insects,” the Washington Post’s Lena H. Sun and Brady Dennis report.
Costs of the delay
Congress’s delay of nearly eight months has taken a toll on the US response to Zika and on other public health priorities. A not-insignificant amount of time that federal officials could have spent figuring out how best to fight Zika instead went to figuring out how they could shuffle around funds to allow critical Zika activities to occur. And that shuffling means short-changing other important health priorities, as CDC director Tom Frieden and National Institute of Allergy and Infectious Diseases director Anthony S. Fauci warned in a Washington Post op-ed. Passage of this Zika funding measure doesn’t mean all that re-allocated money will be reimbursed, NBC’s Maggie Fox reported just after Congress approved the Zika funding:
The National Institutes of Health and the Centers for Disease Control and Prevention said they had run out of fresh money to fight Zika. The administration had already pulled $589 million from other programs, including $500 million meant to help prevent another Ebola outbreak. The CDC and NIH had robbed emergency preparedness, cancer, vaccine and HIV programs for more cash.
This bill does not give back any of the borrowed money, said National Institute of Allergy and Infectious Diseases director Dr. Tony Fauci.
That includes $11 million from tuberculosis, malaria, flu; $47 million from reprogrammed Ebola funds and $34 million from the National Cancer Institute and other NIH institutes. "We may never get to officially pay that back," Fauci told NBC News.
Delayed Congressional funding has taken a toll on multiple response activities. Bill Bekrot reports for Reuters:
"Because we've had to wait these seven months, we haven't been able to get a running start on some of the critically important studies to understand more fully the impacts of Zika, to establish better diagnostic tests, to improve our way of controlling mosquitoes," said Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, adding that vaccine development efforts were also delayed.
… Health and Human Services Secretary Sylvia Burwell promised that the new funds would be allocated quickly. But she said critical time and energy were spent on working to get the funding instead of working to use it.
"That money would be out the door if we had received it at the time we asked for it," Burwell said.
Asked for examples of what would not be funded or would be underfunded because Congress approved $800 million less than what was requested, Burwell pointed to hard-hit Puerto Rico. She said $141 million would be earmarked for Puerto Rico and other U.S. territories out of $271 million that had been requested.
Delays also have implications for vaccine development, Melissa Healy writes in the Los Angeles Times:
Had funding materialized earlier, scientists said they would be closer to producing a vaccine to protect women of child-bearing age and the men they have sex with. Given Congress’ delay, some vaccine manufacturers saw fit to “walk away from negotiations with us because they weren't sure if the money was going to be there,” said Nicole Lurie, assistant HHS secretary for preparedness and response.
"We are behind where we should be on vaccine development and diagnostic test development," Lurie added.
It’s also less helpful to get this funding in the fall than it would have been before the 2016 mosquito season started. Shefali Luthra of Kaiser Health News has more on the problems with inadequate surveillance during mosquito season:
Mosquito season generally peaks in the summer, though it’s certainly longer in states like Florida and Texas. So for many at-risk states, it’s too late to do any real prevention work — at least this time around.
For instance, it’s possible that Zika is being actively spread in states other than Florida, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. No one would know, he said, because there has not been enough money to support thorough surveillance.
Philanthropic efforts worked to fill the gap in Puerto Rico, with the CDC Foundation using money from Pfizer and the Bill & Melinda Gates Foundation to launch the Zika Contraceptive Action Network, Aleszu Bajak reports for Undark.
Zika virus isn’t going away, so it’s good to know researchers and public health officials will be able to ramp up their work between now and the next mosquito season.
Lab capacity lagging
Although some of the reshuffled federal money has gone to increasing capacity for labs to diagnose Zika infections, public health laboratories have already suffered under years of cutbacks to public health funding, and have found it challenging to respond to a virus that requires special testing. Kim Krisberg emphasizes this problem in her post for the Association of Public Health Laboratories (APHL) Lab Blog:
[M]any public health labs have either cut back or stopped ELISA testing altogether because of previous funding cuts, said Chris Mangal, director of public health preparedness and response at APHL. Those funding cuts meant many labs have had to spend valuable time and resources bringing their serological capacity back to the frontline. As of late summer, 43 public health labs could test for Zika using the MAC-ELISA.
“When Congress opts to not provide resources for these emerging threats, it has a big effect,” Mangal said. “Yes, they’re prepared by virtue of their membership in the [CDC Laboratory Response Network (LRN)], but you still have to keep replacing the gas in the gas tank, if you will. That one tank of gas won’t get you across the country.”
In another piece for Kaiser Health News, Shefali Luthra considers the implications of laboratory backlogs and the newly authorized funding:
Houston-based Legacy Community Health Services, a federally qualified health center, is trying hard to fight the Zika virus. It’s screening pregnant women and following federal guidelines to test people at risk.
But despite best efforts, there’s a problem, says Legacy’s chief medical officer, Dr. Ann Barnes. Women who could be infected usually have to wait as long as a month to know if their pregnancy is at risk. That’s the turnaround time from the state public health lab, where blood samples are sent for testing.
… While the congressional funding is a promising start, more investment is necessary, added Chris Gould, senior director for federal government relations at the Association of State and Territorial Health Officials. Local health departments have been shrinking over the past six years. Many don’t have the staffs large enough to operate labs at the level needed, given the volume of samples coming in. They need to expand manpower, especially since testing for Zika isn’t their only responsibility, he said.
[APHL’s Peter] Kyriacopoulos estimates that labs would need about $39 million to adequately meet these challenges. And public health experts expect the virus to return next summer, he said, which could create a need for further funding down the line.
As of September 29, 22 infants born in the US states and DC had birth defects linked to Zika, as did one baby born in a US territory. Also as of September 29, 1,638 pregnant women in US territories had laboratory evidence of possible Zika infection, as did 837 pregnant women in the US states and DC. The October 5 US Zika case count includes 3,818 in the US states (105 of them locally acquired) and 24,201 in US territories (24,118 locally acquired). It will be months, even years, before we can tally the virus’s full impact. I wonder how many members of Congress will regret playing politics with public health as the full toll of Zika becomes apparent.
Some of our past posts on Zika
Will Congress (belatedly) do the right thing on Zika? (September 7, 2016)
Zika research: Microcephaly, stem cells, and, Guillain-Barré (March 7, 2016)
The spread and toll of Zika (January 5, 2016)
"Better late than never" is not any way to run any public health program. Thanks a lot, stupid Representatives.