When Harris County, Texas, recorded its first case of Zika in January, Dr. Umair Shah, the executive director of the state’s public health authority, began to put together a response team. He brought together epidemiologists, doctors, and communications specialists. He upgraded laboratories to improve testing and tracking, and set up educational efforts to teach children about mosquitoes. He and his team were proactive, he says, expecting that the virus would eventually start being transmitted locally. But while his fears have been confirmed, his efforts haven’t received financial support from the government. As a result, his colleagues are feeling spread thin. “Our team is tired,” he says. “We need dollars from the federal system today. Mosquito season is now.”
The number of confirmed cases of Zika in U.S. territories has risen to nearly 7,500, and the virus has been found in every state. If caught by pregnant women, it can result in serious birth defects, most notably microcephaly. (Two cases of Zika-related microcephaly—a condition in which a newborn’s head is abnormally small—have been reported in Texas; one of those infants died this week.) But those fighting the disease are suffering the consequences of a congressional squabble over Planned Parenthood and Confederate flags. That, in turn, has exposed gaps in the U.S.’s ability to contain outbreaks of any kind, raising the possibility that we’re one medical crisis away from an even more serious disaster.
In June, Democrats blocked a $1.1 billion Zika bill when Republican lawmakers tacked on a host of unrelated provisions. Now, few resources have been allocated to fighting the disease. In April, the administration identified $589 million that could be spent on Zika, including up to $510 million of existing resources that had been approved to fight Ebola, according to a spokesman for the Centers for Disease Control and Prevention (CDC). On Thursday, the White House announced it would shift an additional $81 million from existing programs. Some states, like Florida, have also been using their own funds.
But the political stalemate on new spending has hampered the medical community’s response. Public health officials can’t buy the materials they need, while, in labs across the country, research has been delayed. Last week, Sylvia Burwell, the secretary of Health and Human Services, wrote to the chairs of the appropriations committees that government agencies, including the National Institute of Health (NIH), the Biomedical Advanced Research and Development Authority (BARDA), and the CDC, would soon exhaust their resources to fight Zika. The CDC, she noted in the letter, will not be able to implement necessary mosquito control programs. “Without additional funding as requested in the president’s request for an emergency supplemental, our nation’s ability to effectively respond to Zika will be impaired,” she wrote.
At the National Institute of Allergy and Infectious Diseases (NIAID), for example, a lack of funds means that promising vaccine work may be delayed. Director Anthony Fauci has begun testing a number of possible vaccines in small, phase one trials. But “unless we get new money from the Congress soon, mid-to-late August,” he says, the agency won’t be able to roll out preparations for a larger trial in Latin and Central America. The agency needs money soon if it wants to staff the clinics, recruit participants, and meet its goal of producing a vaccine by 2018. The impact may not be felt right away, he says, but it will have “a deleterious effect for the long-range future.”
Some scientists have had to find alternative ways to support their work. At Johns Hopkins, Andrew Pekosz, a professor of molecular microbiology and immunology, secured a small private donation to study the disease. The money isn’t enough to hire a new employee for his lab, he says, so instead he’s added a few extra hours to his workweek. He fits Zika into his daily schedule as the head of a lab studying the flu, timing his experiments so that he can tend to them between 5 p.m. and 7 p.m. He estimates that about 100 labs have started Zika research in the last twelve months. Many have made the disease their primary focus. But more often, research is picked up by one or two people as a side project. “A number of my colleagues were trying to do crowdfunding,” he says.
Scientists and public health officials warn that this patchwork response might have larger consequences for the country’s preparations for other diseases. By shifting funds around without making long-term plans for new diseases, the country is ultimately less prepared for future epidemics.
Much of the money for combatting Zika has been repurposed from existing funds. “Robbing Peter to pay Paul” is a phrase that comes up frequently in interviews.
In Harris County, for example, Dr. Shah’s team includes a doctor who normally focuses on chronic disease like diabetes. Now, they have to set that work aside to deal with the current crisis. “Everybody has been taxed by Zika,” he says. “The pie is the same size, but we’ve had to cut it up in different fashion.”
At NIAID, Dr. Fauci has spent $20 million of repurposed funds from his own agency, taking money from projects on malaria, influenza, and tuberculosis. He also received $47 million in money diverted from Ebola research funds. This kind of funding shift, he says, is not common. Usually his agency is able to obtain money in emergency situations, but such funding has dried up as Congress has grown more polarized and the GOP has started to demand offsetting cuts.
Indeed, as scientists and public health officials struggle to contain Zika, work on other illnesses has been delayed. For Pekosz, the diversion of funds has slowed down his work on influenza, a disease that remains among the leading causes of death in the United States. “We have at least two projects on hold simply because money we thought was coming in was diverted to Zika,” he says.
At the CDC, borrowing funds from the Ebola response team means sacrificing important steps that might prevent a future outbreak. “The funds we’ve borrowed from are essential to find and stop Ebola as embers of the epidemic continue to smolder in West Africa, to respond to new cases and clusters of Ebola, and to build each country’s capacity to detect and respond to health threats,” Tom Frieden, the head of the CDC, wrote in a recent editorial. Dr. Fauci agrees: “You don’t want to take your eye off the ball with Ebola. It could easily resurge.”
Without more long-term public health funding, some warn, the country will be lurching from one epidemic to the next. “Behind all this has been a pattern or a situation we’ve gotten ourselves in nationally,” says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness. “Our ability to rapidly respond to any crisis has been hampered by the way we fund or don’t fund.”
Dr. Redlener points to reduced funding for hospital preparedness, which has declined by more than 50 percent in the last twelve years. Public health emergency funding, he says, is down by a third. “Public health funding has been low-hanging fruit,” he says. “Every year, that program takes a hit.” As a result, health departments operate on shoestring budgets across the country, he says.
“We’re not ready in terms of money to support the things that do require scientists working on problems, as well as public health officials trying to control a major outbreak,” he notes. “What we’re dealing with are these random acts of response that are prompted by the crisis of the moment. We might get by from crisis to crisis and we may not.”