For Ebola, don’t forget lessons from the AIDS epidemic

A disease caused by a poorly understood virus began making headlines. For the victims, death was cruel and almost always certain. The initial devastation was largely confined to a community at the margins of mainstream American society – and many of our elected officials saw no reason to commit the research funding necessary to understand the disease. 

In the mid-1980s, when I established the first HIV/AIDS clinic at the Minneapolis Veterans Affairs Hospital to care for people with that mysterious new virus, there was little that we could do other than diagnose the condition and provide supportive care. We held our patients’ hands and later went to their funerals.  We partnered with patients and joined growing voices in the gay community to demand public investment in medical research to find the answers that were so desperately needed. But research cannot be flipped on like a light switch, the response was reactive and the wait for answers seemed interminable: the antiviral drugs that would transform treatment and patients’ lives were still years away. Thousands of people died. 

{mosads}But political activism changed the course of AIDS, prompting a national conversation about medical research. Soon the nation’s commitment to research transcended the AIDS epidemic. In 1999, Congress enacted bipartisan legislation that would double federal investment in research by 2003. 

During that time, research funding provided support for many exciting projects, including one that produced a vaccine for another mysterious virus – Ebola – that proved to be 100 percent effective in monkeys.   However, that vaccine was never tested in humans.  Government funding that was so robust in 2003 has languished in the intervening years.  Federally funded research, adjusted for inflation, has experienced a 20 percent decline in purchasing power over the past decade.  The Ebola vaccine, which potentially could have been ready for licensing by 2011, instead sat on the shelf.  Faced with diminishing resources and the competition of many deserving projects, deciding to not greenlight further tests for a vaccine against an obscure virus mostly afflicting the poor and powerless might be seen as a logical choice. 

The impact of the Ebola outbreak remains to be seen.  Predictions run from tens of thousands of cases by the end of January 2015 under most favorable circumstances to more than a million cases under worst circumstances.  The World Bank estimates that the global economy could lose more than $30 billion by the end of next year due to Ebola.  Even a fraction of this amount could dramatically change the course of the Ebola epidemic through the development of improved diagnostics, drugs, and vaccines. 

Whether or not the more favorable predictions are realized partly depends upon the response of public health workers and caregivers, and partly upon how quickly and effectively research can be deployed. 

For those of us who witnessed the beginning of the AIDS epidemic, this all too familiar scenario is particularly sobering.   Medical research is not a fly-by-night enterprise.  It requires the engagement of highly-trained scientists who are given the encouragement and resources to investigate complex questions.   Unfortunately, in the United States for the past decade, many laboratories have had to scale down due to funding cuts, promising research proposals go unfunded, and young scientists are discouraged from pursuing research careers. 

Had the Ebola vaccine that was developed a decade ago been allowed to go forward with testing in humans, the disease might not be in the headlines today.  We will never know. 

All of these hard lessons should be kept in mind today and tomorrow as Senate appropriators and members of the House Foreign Relations Committee gather to consider our nation’s response to the Ebola crisis, including a $6 billion increase in crucial medical research funding. Meanwhile, Sens. Orrin Hatch  (R-Utah) and Elizabeth Warren (D-Mass.) are proposing an increase of the budget of the National Institutes of Health of $1 billion per year for each of the next 10 years.  While admirable and forward-thinking, even if such legislation were enacted, it would not restore NIH’s purchasing power to 2003 levels. 

When you have your health, you have everything, the saying goes. The same is true for America. Without a commitment by Congress to fund basic medical research, the lives of millions are put at risk, along with the nation’s economic and national security. Outbreaks of deadly viruses – including AIDS or Ebola – have shown us the costs of not remaining vigilant. 

So how much funding is enough?   It’s time for us to have that national conversation once again.  We do not know what the superbugs of tomorrow will look like.   But we do know that novel pathogens will emerge or existing ones will mutate, and that as global travel and migration inexorably increase, disease knows no border.   It is time for us to stop chasing at AIDS and Ebola from behind, and take stock of our capacity to commit. 

Such conversations are never easy, particularly in a political environment in which cutting taxes and slashing the budget seem to be the only items up for discussion.   But consider:  Front-line doctors and nurses can now do little more than provide palliative care for patients with a distressingly fatal disease.   People live in fear of contagion from their neighbor, and patients are stigmatized the moment they fall ill.   We have been through this before.   As we cope with the current crisis, let’s make sure that it does not happen again.  

Pomeroy is president of the Albert and Mary Lasker Foundation.