Obama seeks more funds for novel flu fight

Jun 5, 2009 (CIDRAP News) – President Barack Obama this week asked Congress for another $2 billion in supplemental funds to fight the novel H1N1 influenza epidemic, on top of $2 billion requested a month ago, and also proposed to tap federal economic stimulus funds for up to another $3.1 billion for the same purpose.

Meanwhile, public health advocates said even more may be needed if a nationwide H1N1 vaccination campaign is launched in the fall.

House and Senate conferees are working to reconcile supplemental appropriations bills that provide $2.05 billion in the House version and $1.5 billion in the Senate version for the H1N1 flu fight. The administration, in a Jun 2 letter, asked Congress to pass the House version and add another $2 billion to it.

In addition, Obama proposed to use up to 1% of unspent stimulus funds to battle the flu if needed. The Wall Street Journal reported yesterday that that would amount to about $3.1 billion out of the $311 billion in discretionary stimulus funds.

In a letter to House Speaker Nancy Pelosi, Obama said he was asking for the money "out of an abundance of caution" and appealed for "maximum flexibility" in how the funds are used.

Public health advocates welcomed the administration's new request, but Dr. Paul Jarris, executive director of the Association of State and Territorial Health Officials (ASTHO), estimated that a nationwide H1N1 vaccination campaign could cost as much as $15 billion.

In an interview this week, Jarris said that 600 million doses of an H1N1 vaccine—two doses per American—could cost about $6 billion ($10 per dose). Administering the vaccine might cost another $15 per dose, or roughly $9 billion, he said.

"We need to make sure we have the people and resources to give the vaccine to people, which is on the order of $15 per dose," he said.

Meanwhile, the Democratic leader in the House said Obama might not get the extra $2 billion he asked for, and Republicans criticized the proposal to take money from the stimulus fund, according to news reports.

House Majority Leader Steny Hoyer, D-Md., was skeptical that Congress would add any more funds to the amounts approved by the two houses already, according to a Jun 3 Reuters report. He said more funds could be appropriated later if needed.

Republican critics derided the proposal to funnel stimulus money into the flu response as an effort to turn the stimulus package into an all-purpose "slush fund," according to the WSJ report.

Diverting Bioshield funds?
Besides seeking to use some of the stimulus money, the administration is proposing to take money from the Bioshield program and harness it for the H1N1 battle, a plan that drew fire from public health advocates at a press conference yesterday.

The administration proposes to "amend the purpose of Project Bioshield's authority to include pandemic influenza," according to a copy of the proposal, which was provided by the nonprofit group Trust for America's Health (TFAH).

The Bioshield program, enacted in 2004, provides funds to support private-sector-development of medical defenses against biological, chemical, and other unconventional weapons.

At a press briefing yesterday on the H1N1 situation, TFAH Executive Director Jeff Levi, PhD, criticized the proposal to use Bioshield money.

"The administration proposes to use $2.9 billion from the program to support H1N1 vaccine development," he said. "This means programs for things like anthrax and smallpox will need to be put on hold. This would be robbing Peter to pay Paul. If we need this money for an H1N1 vaccine, we should appropriate it."

Levi's criticism was seconded by Thomas V. Inglesby, MD, deputy director of the Center for Biosecurity at the University of Pittsburgh Medical Center, who also spoke at the briefing. "This is an extraordinary event, and the funding provided years ago for the acquisition of contracts and development work for anthrax, for example, should not be diverted for this particular problem," he said.

Groups support House version
Earlier this week, a coalition of groups led by TFAH urged the House and Senate conferees to adopt the House version of the pandemic funding proposal and add more funds to it. (The list of health and medical organizations and biomedical companies that signed the letter included the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News.)

The coalition's letter to Congress said the House's proposed $2.05 billion appropriation for the H1N1 epidemic includes:

  • $350 million for state and local pandemic preparedness efforts
  • At least $1.5 billion in flexible funding to the Department of Health and Human Services' Public Health and Social Services Emergency Fund, for use to continue building domestic vaccine capacity, replenish and build antiviral stockpiles, and expand domestic and international disease surveillance
  • $200 million to support global efforts to track, contain, and slow the spread of a pandemic

The coalition endorsed all of the above items and urged the congressional conferees to consider several other needs it said are not addressed in the current House or Senate bill.

At the top of the list was extra money for vaccinations. The group voiced concern that the $1.5 billion in flexible funds in the House bill would not be nearly enough to buy, distribute, and administer a vaccine and set up electronic systems to track the program and monitors adverse reactions. But the letter did not specify an amount.

The coalition also called for:

  • A contingency fund for the ongoing H1N1 response by state and local governments, to be used in the case of a public health emergency
  • $122 million to complete state antiviral stockpiles and extend the shelf life of antivirals that will soon expire; the group said more than 8 million treatment courses are still needed to meet the original stockpile goal of 75 million courses
  • At least $563 million to help states and localities buy personal protective equipment and antivirals for workers in public health, healthcare, and critical infrastructure operations

In a separate letter this week, ASTHO and the National Association of City and County Health Officials also urged the congressional leaders to adopt the House version of the pandemic funding. The letter said state public health agencies spent more than $80 million on the response to the H1N1 epidemic between Apr 21 and May 15.

The pandemic funding is part of a supplemental appropriations bill mainly dedicated to funding the military campaigns in Iraq and Afghanistan.

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