Our Approach to Financing Epidemic Response is Broken

Earlier this week, the AP reported that the Obama administration has agreed to re-purpose roughly $589 million of the $5.5 billion that was originally appropriated to combat the Ebola virus epidemic for the response to Zika. The administration had proposed a Zika-specific appropriation of $1.9 billion in February, but encountered resistance from Congress, who were of the opinion that “left over” funds from Ebola could be applied to this most recent infectious disease emergency.

The bulk of the reprogrammed funds had been committed to supporting the Global Health Security Agenda (GHSA), whose reason for being is to help support international capacity to detect and respond to new epidemics before they cross borders, and threaten global health. Nearly all nations are obligated via the 2005 International Health Regulations to develop these programs, but by and large don’t have the necessary resources to meet those commitments. GSHA was established, in part, to mobilize support for establishing and maintaining those surveillance and response systems. We hope those programs will receive funding commensurate with their importance, as has been suggested by the White House and members of Congress.   

The referenced $589 million also appears to take funds out of domestic preparedness programs, as the New York Times noted:

In addition to funds moved from the Ebola budget, an additional $79 million would come from several other accounts, including money previously allotted to the national strategic stockpile of vaccines and other emergency supplies for epidemics, said Sylvia Mathews Burwell, the secretary of the Department of Health and Human Services.

So in effect, what we’ve done is take from prevention and preparedness to fund Zika response.

Now, I recognize that resource allocation decisions are inherently political. The two month-long back and forth between Congress and the White House represents a fundamental reordering of perceived threats and priorities, such that the present threat of Zika, particularly to expectant mothers in Puerto Rico and the Gulf Coast, now trumps the threat posed by the Ebola virus (put aside, for a moment, the fact that that disease has flared back up). Make no mistake - Zika represents a clear danger, and HHS and others are poised to respond. But to do the job right, funds over and above their routine operating budgets are needed. 

We have to face up to an uncomfortable reality: the way we finance responses to severe infectious diseases like Ebola and Zika is fundamentally flawed. This problem isn’t unique to the US government either. Governments around the world as well as international organizations have struggled to respond promptly in the face of new infectious disease threats. SARS, H1N1 influenza, MERS, Ebola, and now Zika have all emerged, and all caught us flat footed. In the global health arena, the WHO has recognized the importance of dedicated funding for epidemic response, and has included financing in their post-Ebola reform measures. If enacted, such a contingency fund would enable a more nimble organizational response to outbreaks and disasters.

In the federal budget, such rainy-day funds are a rarity, due in part to the practice of budgetary raiding and a desire on the part of appropriators to maintain control over the purse strings. Rare, but not non-existent. FEMA’s Disaster Relief Fund is one example of “no year” money. In general, this mechanism allows for FEMA to provide funding for emergencies without having to wait for an event-specific appropriation, and is replenished periodically by the Congress. No such mechanism exists for epidemic response. In my view, it may be time to consider establishing such a fund within the HHS budget, so that the business of epidemic response isn’t contingent on the waging and deciding of political battles going forward.