In February, the Obama administration requested from Congress $1.9 billion in supplemental, emergency funding to combat the Zika virus through a comprehensive approach: prevention and mosquito control; development of and access to therapeutics; further study into the biological implications of Zika and its transmission; and funding to the states so that they can attack the threat. It also includes additional funding to Medicaid in Puerto Rico and other U.S. territories to support pregnant women at-risk or who have contracted Zika, children with microcephaly, and to cover other healthcare costs.
After more than 40 congressional hearings this year, the good news is that lawmakers from both sides of the aisle agree that the Zika threat justifies new funding. The bad news is, three months after the White House's initial request, there remains little agreement about how much funding to provide, for what, when to provide it, and through what mechanism. And while Congress debates the details, public health agencies can't afford to wait. The administration has been forced to redirect nearly $600 million previously allocated to fight the ongoing Ebola threat toward the Zika efforts--under the assumption this funding will eventually be made whole by Congress in the Zika package--as well as $44 million from emergency preparedness grants intended for use by the states. As the Washington Post recently reported, the reallocation of these Public Health and Emergency Preparedness (PHEP) funds is particularly concerning because that money is critical for states to address ongoing and emerging public health crises such as outbreaks and natural disasters in real time. As Cynthia Harding, interim director of the Los Angeles Department of Public Health told the Post, "this is stealing from Peter to pay Paul."
So where are we now?
On May 18, the House of Representatives passed a $622 million Zika supplemental bill, which was completely offset using “unobligated” Ebola funds and unused administrative funds at the Department of Health and Human Services. As expected, the vote was almost entirely partisan, highlighting the fundamental differences in strategies between parties on almost every piece of the supplemental funding process. The House bill provides funding only for FY2016, as lawmakers plan to use the normal appropriations process to provide additional funds for 2017. This would inevitably lead to cuts to other programs. On May 19, the Senate passed the Blunt-Murray amendment to a transportation appropriations package which would provide $1.1 billion for the public health response, and the funding by the Senate is not offset and would be available for FY2016 and FY2017. The White House will likely support the Senate compromise, but there have already been veto threats from the administration for the House bill. In short: as usual, we are functioning in dysfunction here in Washington.
Zika is pressing. In doing the necessary and immediate work of responding to Zika, however, lawmakers should not ignore the underlying public health infrastructure that has been neglected and is in dire need of repair. We need to keep training our public health workforce, reinvesting in early warning systems, and continuing our upkeep of preventive and responsive public health services on a state and local level. We need Congress to support supplemental funding for Zika now, and to continue to support the public health system that protects us against the next Zika that has yet to emerge.
CSTE has been closely involved with advocacy efforts to support robust a supplemental funding stream for Zika prevention, research, and therapeutics development which does not steal from our already eroding public health infrastructure. CSTE representatives have joined meetings on the Hill to discuss the needs of the states, and have vocally opposed any funding which pulls from PHEP, the Public Health Prevention Fund, or other public health funding streams.
Emily Holubowich, MPH and Zara Day, JD, MPH are CSTE’s Washington representatives in the nation’s capital at Cavarocchi Ruscio Dennis Associates, LLC. Find out more about CSTE’s advocacy activities on the CSTE Advocacy page. You can also read Executive Director Jeff Engel’s article in the new edition of journal JPHMP. Log in as a CSTE member through this link to access it for free or visit the journal’s public webpage.