Federal Health Security Funding: Doing More with (Much) Less

My colleagues and I have recently published our annual article that describes federal health security programs and their associated funding levels in the President’s annual budget request. The programs we include fall into several broad categories, including civilian biodefense; chemical, radiological/nuclear, and pandemic and emerging infectious disease preparedness and response; and multiple-hazard or general preparedness and response. This work is an expansion of an earlier series of articles that examined federal funding for biodefense programs alone. We’ve also published one article on funding and programs dedicated to nuclear consequence management.

Briefly, the President’s FY2016 budget proposed approximately $13.7 billion for health security programs across the US government, an increase of $1.2 billion from the FY2015 estimated total for health security programs. Much of this increase ($750 million) comes from the Multi-Hazard and Preparedness programs, including proposed additional investments at the Department of Health and Human Services (HHS) in the BioShield fund, the Biomedical Advanced Research and Development Authority (BARDA), and a new Public Health Emergency Response fund within the Public Health and Social Services Emergency Fund. Funding for health security is split in the following way:

  • Multiple Hazard and Preparedness Programs: $8.09 billion (59%)
  • Civilian Radiological/Nuclear Programs: $2.60 billion (19%)
  • Civilian Biodefense Programs: $1.38 billion (10%)
  • Civilian Pandemic/Emerging Infectious Disease Programs: $1.20 billion (9%)
  • Civilian Chemical Defense Programs: $423 million (3%)

In this year’s analysis, while proposed funding is set to increase for health security writ large, my coauthors and I were once again struck by how depleted the funding streams for state and local public health and healthcare preparedness have become. This declining support is particularly exemplified by the CDC’s State and Local Preparedness and Response program and the National Hospital Preparedness Program (HPP) in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at HHS. Not only has funding for these programs not kept up with inflation, funding has been cut dramatically since they were established or expanded in the aftermath of September 11th, 2001.

Since that time, funding for State and Local Public Health Emergency Preparedness at CDC (which is comprised almost entirely of the Public Health Emergency Preparedness Cooperative Agreements (PHEP) that fund preparedness efforts at state and local health departments), has decreased from $940 million per year in FY2002 to a low of $619 million in FY2013, with a proposed budget of $643.6 in FY2016. For the coming year, this would mean that state and local public health departments would receive $300 million (32%) less than the funding level originally designed for this program.

The HPP program, which was funded fully in 2003 at $515 million per year has dropped to a low of $255 million proposed for FY2016. This means an overall reduction of $260 million (51%) per year to a program that is intended to support preparedness and response capabilities at the country’s more than 5,600 hospitals. These funds have been instrumental in the formation and operation of healthcare coalitions for emergency preparedness and response.

When adjusted for inflation by using 2002 dollars, the funding decline for these two programs is even more pronounced. Today’s funding simply has less buying power for health departments and hospitals and supports fewer people dedicated to preparedness than it did 15 years ago. The consequences of declining preparedness funding has been further described in the Trust for America’s Health’s annual “Ready or Not?” and “Outbreaks” reports.

Given recent global experiences with Ebola and MERS, which highlighted our reliance on prepared, resilient healthcare systems and illustrated the role that state and local health departments play during crisis response, it seems only prudent to devote adequate resources to public health and healthcare system readiness at all levels of government. Given recent challenges, we’re hopeful that Congress will see the wisdom in making long term investments to our nation’s health security going forward.