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Funding by Crisis: Understanding the Zika Virus Funding Debate

In February 2016, President Obama petitioned Congress for the $1.9 billion dollars the Centers for Disease Control and Prevention (CDC) says are required to combat Zika virus. Amid warnings that the virus has reached the United States, Congress has at last made some progress in responding to the President’s appeal. On May 17, the Senate voted to advance $1.1 billion in emergency funding for the cause. While far below what the CDC requested, this amount is a promising start given the roadblocks this conversation has faced over the past three months. Two days later, the House approved a mere $622 million to the cause— a sum the White House deemed “woefully inadequate.”

Rather than allocate new funds to the Zika response, the bill passed by the House offsets that $622 million by diverting funds reserved for other causes, notably the Ebola response to Zika research and prevention, saying that there is still “plenty of money” available in those coffers. Public health experts and representatives from the White House and at-risk states are alarmed and “outraged” by this proposal, and are urging Congress to appropriate separate federal funding for Zika control efforts in order to avoid lapses in ongoing Ebola surveillance and research.

The Zika virus vector, Aedes aegypti. Image courtesy of James Gathany via Public Health Image Library
The Zika virus vector, Aedes aegypti. Image courtesy of James Gathany via Public Health Image Library

Factions pressing the Obama administration to divert money from the Ebola response and efforts to rebuild West African health systems are technically correct that a large portion of Ebola funds remain untouched. About $2.7 billion remains of the original $5.4 billion allocated to curbing the 2014 Ebola outbreak, which has claimed more than 11,300 lives to-date. Though Ebola transmission in West Africa has not entirely abated, the World Health Organization (WHO) has declared that it no longer constitutes a Public Health Emergency of International Concern (PHEIC). So why are public health officials up in arms about the proposed reallocation of funds from Ebola, which no longer constitutes a PHEIC?

The Band-Aid Approach

It all comes down to a decades-old debate over “funding by crisis.” The concern rests primarily on the patchwork nature of funding for public health emergencies, both on a national and global level. The problem is not that research and prevention efforts are being funded for emerging diseases like Zika virus; the existence of such funding is critical for the appropriate management of these alarming outbreaks of new or resurgent diseases. The problem is that currently, there is not a sound financial infrastructure for detecting and managing global health crises. Each time a new public health emergency arises, response efforts are cobbled together using emergency funding — the financial equivalent of a Band-Aid.

According to global health experts, this emergency management strategy is myopic at best. American Society of Tropical Medicine and Hygiene (ASTMH) president Dr. Stephen Higgs and director of the Global Health Technologies Coalition, Erin Will Morton, critique the current “funding by crisis” model as inhibiting a coordinated response to global health threats. Higgs and Morton compare global health emergencies to house fires: a city doesn’t hire firefighters and buy hoses every time a house fire is reported; a fully outfitted fire station waits in readiness for the next, inevitable emergency.

A Sustainable Solution

zikaMapGif_1200
Source: PLOS Currents Outbreaks, 2016

Public health experts agree it is critical that a strong global health infrastructure be established to extinguish the next disease outbreak before it flares into a regional or global epidemic. A recent paper published in PLOS Medicine by researchers at the CDC Center for Global Health says that health systems can be strengthened by increasing the number of medical Centers of Excellence, including high-quality medical schools and hospitals, and improving sanitation in developing nations. By strengthening public health institutions internationally, scientists and public health professionals will be available to identify and respond to global health threats before they spread internationally or become epidemics. By this model, low-and-middle income countries will be equipped with the health systems capacity and human resources that are required to control emerging epidemics like Zika and Ebola, minimizing the need for outside aid or foreign intervention.

Indeed, the remaining Ebola funds are intended to do just that, protecting against future outbreaks by strengthening medical infrastructure in West Africa and supporting comprehensive surveillance programs. When Ebola swept across three post-conflict nations, Guinea, Liberia and Sierra Leone, it took with it many of West Africa’s doctors and nurses, decimating health systems already ill-equipped to respond to the first wave of the outbreak. Efforts to rebuild health systems in West Africa have been promising, but Higgs and Morton warn that diverting funds in order to fund mosquito control and Zika virus research is “short-sighted” and “dangerous,” and may inhibit recent progress. Efforts to strengthen Ebola-affected countries and prevent future outbreaks requires funding. Two articles published in PLOS Medicine in 2015 share lessons learned during the Ebola outbreak; calling for a sustainable, far-sighted financial support program for global health R&D in order for such efforts to be successful.

Conflict on Capitol Hill

While both houses of Congress have made approved plans to fund the Zika response, a final compromise has still not been reached. In the meantime, Zika is not waiting for politicians to make up their minds. How to pay for Zika virus countermeasures has essentially become a partisan issue, with the majority of Senate Democrats arguing in favor of allocating separate financial support for Zika virus and Republicans arguing against it. Concerns are rising about the potential for Zika transmission within the U.S. and an ensuing wave of microcephalic babies in the U.S. With mosquito season looming and Congress so far unable to come to an agreement on the issue, the White House has now ceded to pressure to divert Ebola funds to Zika research and mosquito control. The Obama Administration emphasizes that these measures are temporary and that Congress still needs to provide additional financial support if Zika control efforts, including mosquito control and vaccine research, are to be successful.

The Zika crisis has clearly highlighted flaws in the system that must be addressed. While it is human nature to react most strongly to the problems directly in front of us, hopefully policymakers will see the short-sighted nature of funding by crisis and realize that sustainable, long-term global health policies are the only way to put the healthcare community in a position to effectively fight emerging diseases. With any luck, this realization will come before they are forced into it by the next devastating outbreak.

Featured image: President Barack Obama convenes a meeting on the Zika virus in the Situation Room of the White House, Jan. 26, 2016. Image: Official White House photo by Pete Souza on Flickr (https://www.flickr.com/photos/whitehouse/24554249431/)

Post updated on May 24, 2016

References: 

  1. ASTMH – Funding by crisis is no cure for global health threats [Internet]. [cited 13 May 2016]. Available: https://www.astmh.org/blog/april-2016-(1)/funding-by-crisis-is-no-cure-for-global-health-thr
  2. Balasegaram M, Bréchot C, Farrar J, Heymann D, Ganguly N, Khor M, et al. A global biomedical R&D fund and mechanism for innovations of public health importance. PLoS Med. Public Library of Science; 2015;12: e1001831. doi:10.1371/journal.pmed.1001831
  3. Bloland P, Simone P, Burkholder B, Slutsker L, De Cock KM. The role of public health institutions in global health system strengthening efforts: the US CDC’s perspective. PLoS Med. Public Library of Science; 2012;9: e1001199. doi:10.1371/journal.pmed.1001199
  4. Centers for Disease Control and Prevention. CDC Global Health Strategy 2012-2015 [Internet]. [cited 13 May 2016]. Available: http://www.cdc.gov/globalhealth/strategy/pdf/CDC-GlobalHealthStrategy.pdf
  5. Centers for Disease Control and Prevention. Transcript for CDC Telebriefing: Zika Summit Press Conference, 21 April 2016. [Internet] [Cited May 13 2016] Available: http://www.cdc.gov/media/releases/2016/t0404-zika-summit.html
  6. Kinner K, Pellegrini C. Expenditures for public health: assessing historical and prospective trends. Am J Public Health. 2009;99: 1780–91. doi:10.2105/AJPH.2008.142422
  7. Mundel T. Honing the Priorities and Making the Investment Case for Global Health. PLoS Biol. Public Library of Science; 2016;14: e1002376. doi:10.1371/journal.pbio.1002376
  8. Siedner MJ, Gostin LO, Cranmer HH, Kraemer JD. Strengthening the detection of and early response to public health emergencies: lessons from the West African Ebola epidemic. PLoS Med. Public Library of Science; 2015;12: e1001804. doi:10.1371/journal.pmed.1001804
  9. Sikka V, Chattu VK, Popli RK, Galwankar SC, Kelkar D, Sawicki SG, et al. The Emergence of Zika Virus as a Global Health Security Threat: A Review and a Consensus Statement of the INDUSEM Joint working Group (JWG). J Glob Infect Dis. 8: 3–15. doi:10.4103/0974-777X.176140
  10. The White House Office of the Press Secretary. Letter From The President – Zika Virus [Internet]. [cited 13 May 2016]. Available: https://www.whitehouse.gov/the-press-office/2016/02/22/letter-president-zika-virus

 

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