U.S. President Donald Trump’s announcement of his intention to reduce funds to numerous government departments has many worried. One primary target of the cuts is the National Institutes of Health (NIH). Attempts were also made to repeal the Affordable Care Act (ACA) (often referred to as Obamacare) though a revolt amongst the republican party saw this result in failure.
One element of defunding Obamacare is the proposal to phase out the Prevention and Public Health Fund (PPFH) by 2018. The fund was created within the ACA with a goal “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs”. The fund is a major contributor to the funding of the Centers for Disease Control and Prevention (CDC).
The PPFH, created in 2010 as part of the ACA, provided $932 million USD to healthcare programmes in 2016. Of this, $891 million was contributed to the CDC. This provides 12 percent of the CDC’s overall budget.
This mass defunding presents a huge concern across bipartisan lines. Oklahoma Republican Congressman Tom Cole, who oversees a key panel on the budget of the CDC voiced his concerns on Statnews. At this stage he believes it too early to tell whether the Trump administration will provide financial backing from elsewhere to fill the void.
The CDC is more important to the average American than the Defense Department, according to Cole. Due to the scope of the cuts, a shocking number government agency and department will be impacted. Concerningly many of these cuts are within education and health schemes. Included amongst the cuts are: AmeriCorps, the Senior Community Service Employment Programme, AIDS relief funds, education, and housing and urban development. Cole went on to say,
“You’re much more likely to be killed in a pandemic than you are in a terrorist attack, so you need to look at it that way. Those investments are extraordinarily important for the protection of the country.”
Other government figures, however, do not speak so highly of the CDC and the Public Health Fund. Republican Congressman Andy Harris, a former physician, refers to it as a “slush fund”, used by the Secretary of Health and Human Services for whatever he wishes.
Others have concrete examples of alleged wasteful spending. Republican Congressman Tim Murphy of Pennsylvania says that misuses of the fund include: $7.5 million toward a programme in Nashville, Tennessee, to provide pet speying and neutering free of charge and $1 million to for urban gardening in Boston. He says that $235,000 went to Waco, Texas, offering residents massage therapy, aerobic, kickboxing and Zumba classes, kayaking and paddle boarding.
These outlets of spending could, in very vague terms, be argued to be related to health concerns of the public, though there may be more reasonable ways to use a fund intended for public health.
In defence of the fund, many of the projects are entirely relevant to healthcare. In 2016 California received a $2.7 million grant from the fund help cut down on tobacco use, $12 million was donated to programmes to help reduce hospital-acquired infections and $1 million went to New York to prevent elder abuse. The largest investment of the fund at $300 million, and one which Trump has been opposed to for years, is immunisation.
The defunding or repealing of Obamacare – and so the removal of the PPHF – comes with repercussions. As the primary beneficiary of the fund, the CDC stands to lose a lot from its removal — nearly a billion dollars. A third of this directly funds vaccination drives.
The cuts would come at a time when the anti-vaccination movement is becoming more strident, with falls in the number of children being vaccinated. This has led to a resurgence in diseases such as measles which had previously been eradicated.
Further cuts are being proposed directly to the NIH, with cuts amounting to $6 billion, or a fifth of the institute’s budget set to take place. Cuts of this scale, a full twenty percent of the budget, do more than just slow down projects or slightly reduce the funding across the board. It is entirely likely if the financing of the department is reduced by such a degree, it may be forced into deciding which programmes it can afford to continue and which it must close down.
Biomedical research may be one of the areas hit hard by this cut as many academic institutions across the US depend on funding from the NIH. The US is a world leader in medical research, with a number of prestigious academic institutions, to jeopardise this is a move that could dethrone the US as a world leader in research.
This is not to say that research conditions in the US are currently perfect. The NIH has come under criticism on many occasions for the focus of its spending. Until recently, and since the early 90’s, ten percent of its budget was assigned to AIDS research. While a worthwhile cause, it is no longer sharing the burden of the mortality rate it once did. This has resulted in diseases that are much more common, such as Alzheimer’s, or currently shown to be more deadly, such as heart disease, having comparatively small budgets. On many occasions it has led to scientists very loosely interpreting what falls under AIDS research to focus on other issues.
However, a cut such as this could be felt globally. To slow down advances in medical technology may reduce the level of advancement on a worldwide scale, as many institutions collaborate with US universities. It may also result in the universities of other nations taking the reigns. American scientists may find funding abroad, allowing for their research to continue.
As part of the cuts the Fogarty International Center will be abolished. The centre spends $69 million annually on the research of global health as well as encouraging collaboration between health research institutions in the US and in other nations. Cuts might deal a major blow to international healthcare research.
Senator Bernie Sanders says the cuts to health budgets will “cause pain to the people Trump promised to help”. The effects may be more far reaching than this, causing setbacks in medical research, as well as the potential for re-emergence of vaccinated diseases, possibly on a global level.