Lab Matters Winter 2020 - Page 12

FEATURE The Virginia facility—which has provided surge capacity testing for the National Capital Area—once routinely tested a portion of all non-influenza respiratory outbreak specimens for a slate of other respiratory viruses, “so we could at least identify a causative agent for an outbreak.” But with less federal funding that is no longer feasible. For public health laboratories struggling to, as Toney puts it, “provide the support we know we can provide,” the fiscal year 2020 (FY2020) budget enacted this past December will be neither a disaster nor a game changer. According to data published by TFAH, there is a $4.5 billion gap between current funding levels and what is needed to achieve “an adequate level of public health protection” nationwide. Said APHL Policy Director Peter Kyriacopoulos, the budget “does not represent the kind of increases we would get excited about. It also does not represent the kind of decreases that had been proposed. Congress, again, kept us going at a modest level.” CDC got a $637 million boost over the agency’s FY2019 budget, almost a 9% increase, discounting inflation. Just over a third of this will go to building projects on the CDC campus. Among the good news items for public health are funds for an urgently needed data initiative (see sidebar), $140 million for a new Ending HIV/AIDS Initiative, an additional $75 million for the Global Health Security Agenda (totaling $183 million for GHSA) and an extra $35 million for the Infectious Disease Rapid Response Reserve Fund, which was established in FY2019 with an initial $50 million in funding. There were no new funds for influenza planning and response, vector-borne diseases, CDC’s Advanced Molecular Detection program, opioid overdose surveillance, laboratory training, laboratory safety and quality, public health workforce development or the Public Health Emergency Preparedness (PHEP) Cooperative Agreement, the main source of federal support for state and local public health emergency preparedness and response. (Kyriacopoulos guesstimates that about 10% of overall PHEP funding goes to public health laboratories.) 10 LAB MATTERS Winter 2020 Other CDC programs, such as emerging infectious diseases, food safety and the Antibiotic Resistance Initiative, got a two or three million dollar bump each—a negligible gain after factoring in inflation. At the same time, the FY2020 CDC budget includes no supplemental funding for Ebola, which had provided around $120 million/year on average for GHSA activities from FY2015 through FY2019. Although the budget news could have been worse, it continues a worrying, long- term trend of public health underfunding. According to data published by the advocacy group Trust for America’s Health (TFAH), there is a $4.5 billion gap between current funding levels and what is needed to achieve “an adequate level of public health protection” nationwide. TFAH reports that between FY2010 and FY2019, CDC’s budget actually fell by 10%, after adjusting for inflation. One measure of the funding shortfall for public health laboratories is the CDC Epidemiology and Laboratory Capacity (ELC) cooperative agreement, which builds capacity for emerging infectious disease control in the 50 states, District of Columbia, eight US territories and six US cities. In 2019, CDC received over $400 million in qualified ELC funding requests, but had only $231 million to award. Team Lead Dr. Bethany Bolling sets up a PCR plate to test mosquitoes for vector borne diseases. Photo: TX DSHS Arbovirus Lab PublicHealthLabs @APHL