Current and past leaders of the Infectious Diseases Society of America (IDSA) are taking aim at proposed budget cuts they say could cripple efforts to combat antimicrobial resistance (AMR).
In a letter published yesterday in Annals of Internal Medicine, IDSA treasurer Helen Boucher, MD, past president Barbara Murray, MD, and current president William Powderly, MD, argue that the budget cuts for public health and research proposed by the Trump administration will not only diminish the nation's surveillance capacity and its efforts to reduce infections and promote appropriate antibiotic use, but also undercut US leadership in global efforts to tackle the AMR threat, which is responsible for more than 700,000 deaths each year globally.
"Although the United States has to date been a leader in combating AMR, our international status on this issue as well as the safety of patients here and elsewhere will be seriously threatened if funding is reduced," the trio writes.
The president's FY18 budget, released in May, proposed a $22.7 million (14%) cut to the Centers for Disease Control and Prevention's (CDC's) Antibiotic Resistance Solutions Initiative (ARSI), which funds statewide efforts to detect and track resistance threats. It also seeks to move ARSI's funding source to the Prevention and Public Health Fund, which itself has been threatened by Congressional bills aimed at repealing the Affordable Care Act.
The budget would also cut $1.1 billion (23%) from the National Institute of Allergy and Infectious Diseases (NIAID), which funds research into badly needed new antimicrobials, and $1.6 billion (51%) from the global health programs of the US Agency for International Development (USAID), including a $62.6 million (26%) cut to USAID's global tuberculosis program. The authors write that the USAID cuts, combined with proposed cuts to the CDC's global health security efforts, "would substantially reduce U.S. support for global surveillance, laboratory capacity, and coordination, thus increasing the risk for deadly multidrug-resistant pathogens spreading across borders undetected."
Cuts could derail AMR efforts
As the letter explains, the cuts would be a significant drop from the increased financial support for AMR efforts in recent years. The $379 million provided by Congress in 2016 for AMR activities at several federal agencies nearly doubled what the government had been investing in the fight against drug-resistant bacteria.
That funding has enabled the CDC to boost surveillance and detection capacity at state and local health departments, helped US hospitals enhance infection prevention networks and antibiotic stewardship programs, supported NIAID's efforts to better understand how resistance develops and spreads, and boosted programs for developing new antibiotics and rapid diagnostics at the Biomedical Advanced Research and Development Authority (BARDA).
These efforts, the authors write, would be "at grave risk" if the proposed budget cuts are passed, placing hospital patients in danger and threatening the US role as a leader in international efforts to respond to AMR.
"Given the severity of the threat posed by AMR, and the United States' position as a world leader traditionally at the forefront of global progress, we believe that we must reaffirm our investment in research and public health efforts to combat this threat," they write.
The Trump administration's proposed cuts to public health programs and biomedical research have been widely criticized by health advocacy and public health professional groups since they were released in May. Lawmakers from both parties have indicated that many of the proposed cuts are unlikely to be part of the final version of the budget.
Sep 5 Ann Intern Med letter