Fighting pandemics abroad is in our own best interest

The U.S. was known during the Second World War as the “Arsenal of Democracy,” building enough tanks, planes and ships, not only for our armed forces, but also for Canada, Great Britain, China, the USSR, France and other nations. This was good for our allies — but even better for us because we could fight the war, mostly far from U.S. shores.

For several decades, the U.S. continued its leadership in protecting people at home against diseases. The U.S. Centers of Disease Control and Prevention (CDC) historically had the greatest capacity to intervene globally in epidemics.

{mosads}We have been at the forefront of fighting diseases, which often start in Asian or African countries needing rapid assistance to curtail their spread, keep down death tolls, and prevent those diseases from gaining a foothold here.

Now, American leadership is faltering. Recently, the House appropriations bill for Health and Human Services slashed 2018’s $1.26 billion Public Health Preparedness and Response budget by one-third, down to $860M for 2019.

The House also proposed cuts to the CDC’s emerging infectious diseases budget; $583.68 million, down from 2018’s $614.5 million. These plans dismantle the front line of defense against emerging outbreaks that can become epidemics, not to mention the support we provide to our partners in building capacity to identify, diagnose and effectively fight diseases on their ground. A case of being penny-wise and pound-foolish, the results could be catastrophic.

The timing of proposed cutbacks couldn’t be worse, as epidemics take a massive toll worldwide. Over the last decade, there have been millions of cases of cholera and 1,430,000 deaths; 28,833 cases of Ebola and 11,437 deaths; 35.6 million cases of influenza and 56,000 deaths; and 53,436 cases of meningococcal meningitis and 3,948 deaths.

Of emerging diseases, there have been 10,215 Monkeypox cases and 16 deaths; 224 Nipah virus infection cases and 173 deaths; 2,530 Lassa Fever cases and 200 deaths; and 3 million Chikungunya cases; none of these diseases have a cure or vaccine to stop its spread.

While most of these haven’t yet affected the U.S., Zika has hit Puerto Rico, and the threat to the U.S. from climate change is ominous (e.g. Aedes mosquitoes can transmit yellow fever, dengue fever and Zika; Anopheles mosquitoes transmit malaria).

Sadly, these proposed cuts seem part of a trend. In 2016, I chaired a panel of public health, emergency response and communications experts that issued a report requested by the HHS Secretary on lessons learned from the 2014 Ebola epidemic. We outlined sobering challenges.

From response and coordination to public communication, we found that our country was unprepared to face pandemics (epidemics that affect large parts of the globe). We reported the hard fact that there was not enough money for HHS to fight the Ebola outbreak; it took thirteen months for emergency congressional appropriations to pass, long after the immediate threat had passed.

We outlined how the CDC scrounged private funding as a stopgap to mount the necessary initial response, without which we could have faced a disastrous pandemic.

We recommended that HHS strengthen public health infrastructure and medical response capabilities of other countries. Ww should coordinate with the National Security Council and federal partners to develop a U.S. government framework for multi-agency response to international incidents, and improve internal coordination for preparedness and response.

But beyond accelerating development of the still experimental Ebola vaccine and aiding in prevention and early intervention, the U.S. has fallen short on instituting recommendations. We urged establishment of an HHS emergency fund for fighting epidemics here and abroad, eliminating prolonged waits for Congressional emergency appropriations.

While this has not been acted upon, it is essential to ensure that U.S. response is timely and of sufficient magnitude. This is the kind of health security that may be erroneously assumed by a concerned public to be in place.

The current Ebola outbreak in the Congo shows that, even before the cuts come, America is already withdrawing from global health efforts. The response has been handled without our leadership. The effort has received no special funding from the administration. Washington’s influence is waning and those who take the reins in fighting global pandemics will not prioritize U.S. needs.

Influence aside, preparedness is critical. April marked 100 years since the Spanish Influenza killed 675,000 Americans. Bill Gates warned that if it hit today, there would likely be 30 million deaths in the U.S. within six months. He announced that The Gates Foundation and Larry Page launched a fund for developing a universal flu vaccine. Other private sector players are stepping up to close what they know will be a widening gap.

A failure to renew funding for worldwide epidemic prevention should not be seen as a budgeting victory. Leadership is crucial because many low-income countries, as starkly illustrated by the delayed response to the Ebola epidemic, do not have the infrastructure to quickly identify and track epidemics or provide needed medical care.

The possible pandemics we face are based on diseases that could emerge at any time; slashing budgets self-destructively courts disaster by eliminating one of our most effective national security programs.

We need to be prepared — not only against pandemics, but epidemics that threaten to become pandemics and to anticipate potential unknowns. Investment in global public health is, in the end — less costly, more effective and safer for everyone.

Jonathan Fielding, M.D., is a professor of public health and pediatrics at University of California, Los Angeles.