FY 2020 Spending Bill Funds Critical Initiatives While Neglecting Urgent Priorities

The federal spending bill passed by Congress today is a welcome step forward. Allocations in the bill will strengthen public health and research efforts during the year ahead and will provide critical support for important goals. At the same time, the legislation in its final form also brings inadequate responses to current and urgent challenges with the potential for long-term and costly consequences.

The bill includes a $50 million increase for antimicrobial resistance research at the National Institute for Allergy and Infectious Diseases that will be essential to strengthening approaches to combating the continuing spread of infections that do not respond to current treatments. A $2 million increase for the CDC Antibiotic Resistance Solutions Initiative also is important, but a greater investment is needed to support CDC efforts to promote antibiotic stewardship, track resistant pathogens and prevent their spread.

In addition, the bill’s flat funding for the Advanced Molecular Detection program is a matter for concern, as this program speeds our ability to identify resistance and emerging threats and understand how they move through communities. In turn, flat-funding the National Healthcare Safety Network limits CDC capacities to collect data on healthcare-associated infections, antibiotic use, and resistance – data that is fundamental to our ability monitor progress, evaluate the impact of interventions, and learn best practices to protect patient and public health.

With drug-resistant infections causing an estimated 2.8 million illnesses and as many as 35,000 deaths in this country each year, building our capacities to protect the infection-fighting medicines we have, and to ensure the development of urgently needed new medicines must be a significant priority. But while our nation’s antibiotic pipeline faces the prospect of further diminishment in a year that saw the bankruptcy of one of the remaining small companies developing new infection-fighting drugs, and mass layoffs at two more, flat funding for the Biomedical Advanced Research and Development Authority falls far short of urgent need.

Similarly, the bill both recognizes the critical role that a strengthened global health infrastructure must play in our own public health and security, but neglects vital initiatives.

The $1.56 billion for the Global Fund to Fight AIDS, TB and Malaria, including a $210 million increase over the previous year’s funding will be critical to efforts aiming to achieve epidemic control of the three biggest infectious disease killers globally. In addition, the $310 million for USAID’s global tuberculosis program, brings an increase of $8 million and $770 million for President’s Malaria Initiative at USAID brings an increase of $15 million. Also important to sustainable global health advances is the bill’s $80.760 million for the Fogarty International Center -- $2.65 million increase for important investments toward new infectious disease and HIV diagnostics, treatments, and cures, and strengthened global capacities to respond to infectious diseases.

But while the bill’s $570.8 million for the CDC Center for Global Health includes a needed $75 million increase for the CDC Global Public Health Protection program, it falls short of the $100 million needed to sustain CDC’s role in implementing the Global Health Security Agenda.

And, at a time when efforts to control HIV require accelerated efforts, the bill flat-funds the President’s Emergency Plan for AIDS Relief.

Domestic public health priorities also receive mixed acknowledgment in the bill. The $5 million increase in CDC funding to address infectious diseases related to the opioid epidemic and $12 million in new funding to provide loan repayment to health care professionals who care for individuals with substance use disorders recognize the urgency of responding to growing public health crisis. At the same time, however, in the wake of measles outbreaks across America that brought domestic incidence of the disease to a two-decade high, the bill flat funds CDC’s Immunization Program to combat outbreaks of vaccine-preventable diseases and educate the public about the importance of vaccines.

It is important to note that the bill invests in the future, with a $362 million funding increase for the National Institute of Allergy and Infectious Diseases, including resources to support the next generation of ID physician-scientists.

Confronting public health challenges at home and abroad through dedicated programs and research and building strong health capacities to meet future challenges remain pivotal to our country’s strength and growth. IDSA will continue to urge Congress to provide meaningful and sustained funding for infectious disease and HIV priorities.