For two years, we have been following the Zika virus outbreak and the failure of the US government to protect its own citizens, let alone demonstrate world leadership. In total, by the time Congress managed to pass a stopgap spending bill for the fight against Zika in September 2016, more than 23,000 individuals in the US and its territories had been infected with the virus. That stopgap funding ends on June 30.
In the 50 states and DC, from January 2016 through June 13, 2017, we have had 80 infants with birth defects born to Zika-infected mothers (cdc.gov/zika/reporting/pregnancy-outcomes.html). In roughly the same time frame, Puerto Rico and other US territories have seen thousands of new Zika infections and 122 infants born with birth defects.
Remember that a lifetime cost of care for each victim of Zika-caused birth defects is estimated to be about $10 million. The total lifetime cost of Zika to Americans is now estimated to be in the billions and growing.
Remember, too, that Zika is nearly always transmitted by mosquitoes (though it can also be sexually transmitted) and is mostly preventable. Mosquito control and health education and prevention are partially funded by states and local governments but mostly by the federal government.
We have watched both political parties derail Zika funding by tying it to other issues, holding up funding for the fight against the virus for some eight months while health agencies shuffled funds to do what they could until there were no more dollars to be found. No clean Zika prevention bill has been permitted to get to a floor vote. Instead, Zika funding has always been tied to other agendas and other money.
Guilty are Trump and Republicans, who now can alter their previously scandalous behavior and pass a clean bill. Guilty were Obama and Democratic legislators who can now alter their previous behavior and join a bipartisan bill that Trump will likely sign if presented with it. The stopgap Zika funding bill signed into law in September of 2016 is now history; another funding battle must now be fought in the halls of Congress in order for the war against Zika to be waged effectively on the ground.
The Trump administration’s own proposed budget calls for a new federal emergency fund that can be deployed to address infectious disease threats. (No dollar amount has been attached to that proposed line item.) That’s smart policy and a step the public health community has long advocated; however, other, less-wise legislation can easily sabotage the effort. For example, if the ACA were to be repealed, funding for the Epidemiology and Laboratory Capacity (ELC) program will be halved unless that funding is replaced in new healthcare legislation. The ELC program provides flexible funding for equipment and training for staff at the public health laboratories that conduct critical surveillance services nationwide. Effective Zika surveillance to date could not have been accomplished without those dollars. After all, we have to know where the enemy is before we can engage it, even if the enemy is so tiny that it travels on mosquitoes’ wings (theatlantic.com/science/archive/2017/03/the-quiet-cut-that-will-harm-americas-ability-to-deal-with-the-next-zika/519978/).
Public health experts worry about the impact drastic cuts will have on the nation’s healthcare infrastructure as a whole and by extension on our ability to fight Zika and other emerging infectious diseases. If Congress ultimately cuts funding to the National Institutes of Health by $5.8 billion, as proposed in Trump’s budget, what will have they done to undermine vaccine research and development funded by the NIH? The NIH is, after all, the chief funding source for Zika and Ebola vaccine research. Dr. David Freedman, professor of medicine and epidemiology at the University of Alabama at Birmingham, points out, “If you defund the scientific infrastructure in general, all aspects are going to have to suffer, and that includes preparedness for new diseases as well as research and therapy for existing diseases” (modernhealthcare.com/article/20170413/NEWS/170419937).
With Zika’s highest-risk season at hand, we are served today by a CDC short nearly 700 employees as a result of the Trump administration’s hiring freeze (washingtonpost.com/news/to-your-health/wp/2017/05/19/nearly-700-vacancies-at-cdc-because-of-trump-administration-hiring-freeze/). Further, the CDC faces possible budget cuts of 17%, as outlined in the Trump administration’s proposed budget (businessinsider.com/trumps-2018-budget-health-2017-5). Former CDC Director Tom Frieden recently catalogued the far-reaching and varied impacts that the proposed $1.2 billion in budget cuts would have on public health, foreseeing that the cuts “would increase illness, death, risks to Americans, and health care costs” (businessinsider.com/trumps-2018-budget-health-2017-5). A slashed CDC budget further impairs the CDC’s ability to protect Americans against Zika.
And now the Senate’s controversial health bill proposes to cut the critically important Prevention and Public Health Fund entirely, effective 2019. According to the CDC, “Losing this funding would cripple CDC’s ability to detect, prevent, and respond to vaccine-preventable respiratory and related infectious disease threats.” That fund accounts for 12% of the CDC’s budget (about $9 billion), and includes its vaccine program (latimes.com/business/hiltzik/la-fi-hiltzik-gop-healthcare-20170314-story.html).
Will political leaders connect all these dots between policies and consequences and make wise decisions that protect lives and control costs, including costs incurred through lost productivity? Or will they just sling mud at each other or pass legislation without fully considering its impacts while Zika spreads during the summer mosquito season? Will the CDC get the funding it needs, and will the Zika-prone Southern United States and Puerto Rico get federally coordinated help?
Or will our politics again fail us as they did when the threat of Zika first emerged? The US government’s stumbling response to Zika to date is a well-defined litmus test of how poorly our government serves us. I write here about Zika, but Zika is hardly our only infectious disease concern. In an era when infectious diseases spread at the speed of air travel, our failure to maintain a resilient and responsive public health and to equip ourselves to respond effectively to Zika or Ebola or the next flu pandemic comes down not to the limitations of science, but to government. As journalist Ezra Klein observes, “Diseases move much faster than governments” (vox.com/2015/5/27/8660249/gates-flu-pandemic). We can do better than this.