Proposed budget cuts state biodefense funds, boosts drug stockpile

Robert Roos

Feb 11, 2005 (CIDRAP News) – The Bush administration has proposed cutting funds that support state and local preparedness for bioterrorism and other health emergencies in fiscal year 2006, drawing protests from public health advocacy groups.

However, the proposal for the fiscal year that begins next October would increase funding for the nation's emergency stockpile of drugs and medical supplies by more than 50%. The budget was released Feb 7.

The budget would reduce overall state and local bioterrorism preparedness funds by 12.6%, according to public health groups. The money includes grants from the Centers for Disease Control and Prevention (CDC) for state and local health agencies and funds from the Hospital Resources and Services Administration (HRSA) for hospital preparedness.

CDC funding for state and local bioterrorism preparedness would drop from $927 million this year to $797 million in 2006, a 14% decrease, according to a Department of Health and Human Services (HHS) budget report.

Proposed HRSA funding for hospital preparedness would be $483 million, a drop of about 3% from this year's spending level of $498 million, according to HHS figures.

But the proposal would increase funds for the Strategic National Stockpile (SNS) of drugs and medical supplies from $397 million this year to $600 million in 2006, a 51% increase. "We're requesting $600 million to buy additional medicines, replace old ones, provide specialized storage, and get any needed medicine and supplies to any location in the United States within 12 hours," HHS Secretary Mike Leavitt said in a Feb 7 briefing.

The SNS increase includes $50 million for portable hospital units that could be used to treat victims of a bioterrorist attack, according to HHS.

Commenting on the administration's efforts to hold down domestic spending, Leavitt said, "No question, we have made some tough choices. If we had an unlimited budget, we would spend more on many programs; since we don't, we have focused money on the most urgent priorities that will make the biggest difference in the health and well-being of all Americans."

Since the terrorist attacks of 2001, the administration has spent or requested nearly $19.2 billion for bioterrorism preparedness, including the 2006 request, Leavitt said.

Public health groups criticize cuts
But the Association of State and Territorial Health Officials (ASTHO) said the proposed cuts "would weaken the ability of state and local public health agencies to respond to bioterrorism, emerging infectious diseases, or other public health threats and emergencies."

The American Public Health Association (APHA) echoed that view. APHA Executive Director Georges C. Benjamin, MD, said the increased funding of the past few years has strengthened the nation's preparedness and the public health system. "But after suffering decades of neglect, cuts will jeopardize the initial progress we made," he added.

The Trust for America's Health (TFAH), a nonpartisan advocacy group, also expressed disappointment with the proposed cuts, as did the Infectious Diseases Society of America.

In discussing the CDC's state bioterrorism preparedness grants, HHS' budget report says, "The FY 2006 budget retargets some preparedness resources, making modest reductions in awards to states, and concentrating efforts in directed investments that will benefit the nation as a whole."

One program marked to get some of the retargeted money, according to the HHS report, is the Cities Readiness Initiative, an effort to equip major cities to quickly distribute drugs and medical supplies in the event of a bioterrorist attack. HHS officials first revealed plans to divert some money from state bioterrorism grants to that program in May 2004.

Another proposed change is the elimination of the CDC's Preventive Health and Health Services Block Grant program, which is providing $131 million to states this year. The funds can be used to deal with unexpected health emergencies such as Escherichia coli outbreaks or to help prevent injuries and chronic diseases, according to ASTHO.

But the HHS report says grants from that program often duplicate other CDC programs, so it is being eliminated in the name of efficiency.

CDC to take 6% reduction
The overall CDC budget would be reduced $491 million, to $7.5 billion, according to the HHS report. That amounts to about a 6.1% cut. But an analysis by the TFAH puts the reduction at $531 million, or 6.6%.

A $240 million reduction in spending for buildings and facilities makes up much of the decrease. HHS officials said that reduction results from the completion of major building projects, according to a Feb 8 report by GovExec.com.

Thanks mainly to the 51% increase for the national stockpile, total CDC funds for bioterrorism would be $1.616 billion, an increase of $56 million over 2005 spending, according to HHS.

That total includes the $600 million for the SNS, $797 million for state and local preparedness, $140 million for upgrading CDC capacity and anthrax research, and $79 million for "biosurveillance." The latter consists mainly of BioSense, a program to automatically sift electronic health data in search of potential public health problems.

HHS is proposing to spend a total of $439 million on influenza, including $120 million for pandemic influenza preparedness, a subject much on the minds of public health experts because of avian influenza in Asia. The latter amount, a $21 million increase, was applauded by the APHA and TFAH. The money is intended "to develop the year-round domestic surge vaccine production capacity that will be needed in a pandemic, including new cell culture vaccine manufacturing processes," the department's report says.

The proposed budget includes $34 million for the CDC's global disease surveillance efforts, an increase of $12 million, according to HHS.