By Janet Marroquin
At the Aspen Security Forum this past July, homeland security adviser Thomas Bossert reassured the country that the White House would fill the void of a comprehensive biodefense strategy “as soon as we can.”
Under the Biodefense Strategy Act signed into law in December 2016, the Trump administration is required to produce a new strategy for biodefense as a joint endeavor by the secretaries of Defense, Health and Human Services, Homeland Security, and Agriculture. This congressional requirement solicited an initial briefing on the strategy no later than March 1, 2017 and a formal strategy due to Congress no later than 275 days after December 23, 2016. More than nine months past due, we may finally have been given a small sneak preview of biodefense policy within the US National Security Strategy. Unfortunately, as the year comes to a close, there is still no mention of an anticipated release date and biodefense experts are left wondering about the future contours of biodefense strategy.
Upon examination of the proposed FY 2018 federal budget, the initial outlook for biodefense did not look very good. The significant decrease in federal spending on public health agencies suggested a decrease in priority for public health and thus a decrease in health security. According to the Congressional Review Service, the proposed budget for the CDC in FY 2018 represents a decline of 17% from the estimated FY 2017 budget. Biodefense-related programs within the CDC all saw a negative trend in spending compared to the estimated budget allocated this year, regardless of previously rising or declining trends.
(in Million Dollars)
|2017 Estimated Budget (in million dollars)||2018 Proposed Budget (in million dollars)|
|Emerging & Zoonotic Diseases||582||585||514|
|Public Health Scientific Services||491||489||460|
|Public Health Preparedness & Response||1413||1405||1266|
Similarly, NIH saw a decline of 21.5% in federal spending for FY 2018, with the National Institute of Allergy & Infectious Diseases (NIAID) also experiencing a steep decline in funding despite a previously positive trend.
|Program||2016 Budget (in million dollars)||2017 Estimated Budget (in million dollars)||2018 Proposed Budget (in million dollars)|
An important reform present in the proposed FY 2018 Federal budget is the call to dismantle the Academic Centers for Public Health Preparedness under the CDC and the distribution of its funds among state governments to support state-led public health preparedness. Interestingly, this action seems to contradict expert recommendations to the federal government for the development of a centralized approach to health security.
The initial budget proposal also called for closing the National Biodefense Analysis and Countermeasures Center (NBACC). Fortunately, it is Congress that controls the purse strings and has the last say in the finalized federal budget. Heavy lobbying by scientists and law-enforcement resulted in amendment of the proposal to reverse the September 2018 closure of NBACC, thus exhibiting the powers at play and illustrating the influence that various stakeholders have in biodefense policy.
Furthermore, there is still some good news for the biodefense budget. In spite of the proposed cuts to NIH and the CDC funding, there is no proposed change in federal spending for BARDA and there is even an increase of about 3% on pandemic influenza programs, underscoring a support for public health emergency funds and DoD measures against biological threats. It is also imperative to keep in mind that the proposed federal budget is only representative of priorities for the fiscal year 2018 and is not necessarily indicative of an overarching biodefense strategy. As such, non-fiscal factors must also be considered.
Recent U.S. participation in the Global Health Security Agenda confirms support for global health security, contrary to the proposed decrease in global health spending under the CDC for FY 2018. At the United Nations General Assembly, President Trump expressed approval of the GHSA in his remarks to African leaders, “we cannot have prosperity if we’re not healthy. We will continue our partnership on critical health initiatives.” On that note, Secretary of State, Rex Tillerson, praised the Agenda and extended support a few weeks prior to the GHSA Summit in Kampala, “while we’ve made tremendous progress since GHSA was launched in 2014, considerable work remains. That is why the United States advocates extending the Global Health Security Agenda until the year 2024.”
Biodefense scholars have expressed concern about the Trump Administration’s ability to develop an effective, coherent strategy in light of political division between and within parties, budget cuts to biodefense-related agencies, and the administration’s general anti-science attitude. Though it remains unclear of what the Trump Administration will include in the new biodefense policy, recommendations from various advisory councils such as the President’s Council of Advisors on Science and Technology, the National Security Council, the Blue Ribbon Study Panel on Biodefense and the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, all seem to have the following items on their holiday wish list for biodefense strategy:
- A single, centralized approach to biodefense (i.e. a federal council dedicated to coordinating efforts against biological threats)
- A comprehensive strategy that encompasses human and animal health (i.e. One Health)
- An interdisciplinary approach to health security, inclusive of all stakeholders (i.e. policy makers, scientists, health experts, etc.)
- Defense against both global and domestic biological threats
- A proactive policy preventing the misuse/abuse of advancing biotechnology
The new National Security Strategy supports an international, One Health approach to biosurveillance, biomedical innovation, and improved emergency response in “protecting the homeland and the American people”. Accordingly, the administration must now produce a biodefense strategy that effectively protects the American people from biological threats. May the force be with the secretaries of Defense, Health and Human Services, Homeland Security, and Agriculture in granting us a unified and comprehensive biodefense strategy!
 Kirby, “The Trump’s administration’s misaligned approach to national biodefense,” 386.
 U.S. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response, “Fiscal Year 2018 Budget-in-Brief: Public Health and Social Services Emergency Fund,” Accessed December 17, 2017, https://www.phe.gov/about/ofpa/Documents/bib-2018.pdf
 Kirby, Reid, “The Trump’s administration’s misaligned approach to national biodefense,” Bulletin of the Atomic Scientists 73, no. 6 (November 2017), 382-383.
Blue Ribbon Study Panel on Biodefense. A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts – Bipartisan Report of the Blue Ribbon Study Panel on Biodefense. Hudson Institute: Washington, DC, October 2015.
Hourihan, Matt and David Parkes. “Deep Cuts for NIH, Other Life Sciences in FY 2018 Budget Plan.” June 15, 2017. https://www.aaas.org/news/deep-cuts-nih-other-life-sciences-fy-2018-budget-plan
National biodefense strategy, U.S. Code 6 (2016), §104.
Watson, Crystal, Matthew Watson, Tara Kirk Sell. “Federal Funding for Health Security in FY2018.” Health Security 15, no. 4 (August 2017): 351-372. https://doi.org/0.1089/hs.2017.0047
U.S. Congress. Senate. Committee on Homeland Security and Governmental Affairs. Biodefense Strategy Act of 2016 (to Accompany S. 2967). 114th Cong., 2d sess., 2016. S. Rep. 114-306. I-12. https://www.congress.gov/114/crpt/srpt306/CRPT-114srpt306.pdf
U.S. Library of Congress. Congressional Research Service. Public Health Service Agencies: Overview and Funding (FY2016-2018), by C. Stephen Redhead, Agata Dabrowska, Erin Bagalman, Elayne J. Heisler, Judith A. Johnson, Sarah A. Lister, and Amanda K. Sarata. R44916. 2017.
U.S. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. “Fiscal Year 2018 Budget-in-Brief: Public Health and Social Services Emergency Fund.” Accessed December 17, 2017. https://www.phe.gov/about/ofpa/Documents/bib-2018.pdf