Does the US Need an Emergency Fund for Public Health Crises?
Policy + Politics

Does the US Need an Emergency Fund for Public Health Crises?

© Daniel Becerril / Reuters

After months of delay, it now looks as if Congress will finally approve $1.1 billion in funding to combat the spread of the dreaded Zika virus as early as next week.

Although details still need to be worked out and there are possible partisan roadblocks, the Senate is moving towards attaching the Zika funding to a must-pass continuing resolution to keep the government operating beyond the start of the new fiscal year October 1. By doing so, congressional leaders would bypass a controversy over efforts by House Republicans to restrict funding for Planned Parenthood programs in Puerto Ricco as part of the Zika spending measure.

The $1.1 billion will help domestic and international efforts combat the spread of the Zika virus. The Centers for Disease Control and National Institutes of Health would track the disease, develop a vaccine, educate the public and provide states with emergency grants. The Biomedical Advanced Research and Development Authority would research and develop rapid diagnostic tests; other money would be spent on community health centers and block grants to U.S. territories. About $175 million is targeted internationally to stop the spread of the disease. 

Related: A Deadlocked Senate Once Again Fails to Agree on Zika Funding

The Zika virus, which is spread primarily by mosquitos but also through sexual contact or blood transfusion, has been shown to cause severe birth defects, including the grotesque shrinkage of a baby’s head and brain. The Center for Disease Control and Prevention has warned that it will run out of money to help states fight the spread of the disease by the end of the month without congressional action, and federal medical researchers need more funding to continue testing of a vaccine.

One vulnerable group worldwide is the U.S. military, which has bases in some of the global hot zones. In one hopeful sign, the Walter Reed Army Institute of Research and Harvard Medical School have developed a vaccine that could be tested on humans as early as this year. 

As of Wednesday, 43 cases of Zika virus infection had been acquired within the United States. However, 18,833 people including 3,000 pregnant women in the U.S. and U.S. territories have acquired the disease locally or by traveling. Puerto Rico has been hit hardest by the outbreak that spread globally from Brazil and Latin America. Moreover, recent reports that the Zika virus had hit the Miami Beach area caused panic among some residents and political leaders and threatens to undercut southern Florida’s tourism economy.

For years, Congress has responded to natural disasters and health care crises on an ad hoc basis, often pushing through emergency appropriations measures to cope with hurricanes, floods, wildfires and threats to public health like the Ebola outbreak.

Related: Funding to Stop the Spread of Zika Tops Congress’s Agenda

Some lawmakers and policy experts have complained that this is cumbersome and often a slow-paced way to protect the lives and welfare of Americans. As the prolonged fight over Zika funding has demonstrated, political wrangling and posturing can sometimes prevent a timely response to serious public health threats.

"Up until recently, we have not really considered infectious diseases a critical component of public health preparedness and emergency response at the federal level," Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, recently told Vox.

On Thursday, House Minority Leader Nancy Pelosi (D-CA) called for the creation of a new federal emergency fund that could promptly address unforeseen public health crises, like the spread of Zika or lead poisoning in the drinking water of Flint, Michigan.

Related: The Senate Dithers Again as Zika Virus Continues to Spread

Pelosi said that the new fund would be modeled after the Federal Emergency Management Agency (FEMA), the $15 billion a year government organization that helps communities and families recover from disasters, floods and terrorist attacks. Right now there is no money specifically earmarked for responding to a public health care disaster. Instead of having to wait for a politically divided Congress to respond to the next major public health crisis, a new entity should be fully funded to react to calls for assistance from federal agencies, states and U.S. territories, according to Pelosi.

"These are emergencies, unforeseen occurrences that endanger the health and well-being of the American people just the way a natural disaster does," Pelosi said during a news conference at the Capitol, according to The Hill. "So perhaps [Democrats and Republicans] can come together to put together a flow of funds from a dedicated account for endangerment of the public welfare, similar to a natural disaster but it might be a mosquito."

The minority leader also argued that future federal aid for public health disasters should be treated as “emergency funding” and added to the overall debt, rather than as spending that must be offset by cuts in other areas of the budget.

"It is a national emergency, and we should not have to cannibalize other accounts that are very important to the well-being of the American people," Pelosi said. 

Related: Disease Target No 1: Stop Zika Before It Spreads Beyond Florida

Pelosi is not the first to propose such an approach – one that would likely encounter strong resistance from conservative Republicans who oppose adding billions of dollars more to the deficit or diminishing Congress’s control of the purse strings by creating more automatic spending.

Ron Klain, the former Obama administration "Ebola czar," is also promoting the idea of a new federal response agency equipped for a rapid response, Vox reported.

"We should have an agency doing for epidemics what FEMA does for hurricanes — and then, yes, we would have some common response items prepositioned and some immediate funds for action and contracting in the response," Klain said.

How much government do we need? Public health crises often emerge without warning, and the government response can be delayed by partisan disagreements. A well-funded, pre-existing system to respond to those crises makes sense, but the devil is in the details. How much would a public health crisis fund cost taxpayers annually, and what are the expected benefits? Who would decide when and how the money is spent? The FEMA model already exists for natural disasters, but should it be extended more broadly to public health when so many could raise their hands and qualify?