As the Administration prepares to ask Congress for an emergency $1.8 billion to support the Zika response, I’m reminded again that the United States is the de facto first responder to infectious disease outbreaks of public health importance. The US government has the technical know-how, financial and logistical resources, and political support to act quickly and save lives.
Historically, the US government has organized this response into disease-specific buckets. Likely inspired by the successful models of PEPFAR and the President’s Malaria Initiative, both the Administration and Congress seem agreed to ask for and execute funding on a disease-by-disease basis, and on an emergency basis. In 2003, it was for the creation of PEPFAR to fight the AIDS crisis. In 2005, it was for establishing PMI to eradicate malaria. Last year, Congress approved a $5.4 billion supplemental for the response to Ebola. This year, it looks to be the fight against the Zika virus that captures attention and appropriations.
But emerging viruses and infections like Zika, Ebola, and flu are not unpredictable emergencies, they are near certainties. It’s only the exact pathogen, timing, origin, and scale that are uncertain.
We need to act on this certainty by organizing and financing our global health response differently, anticipating rather than reacting to the latest events, when it is almost always later than optimal for saving lives and money. Emergency budget requests, disease-specific and separate appropriations processes, earmarked budgets, and stove-piped implementation mean that when a new outbreak occurs, we find ourselves playing catch-up and missing opportunities for the kind of ongoing and synergistic investments in public health preparedness that could make a real difference.
The Institute of Medicine has already made the case for investing in global health security and preparedness in many different ways, with the latest installment here. At the broadest level, this means investing in strengthening public health systems—which includes dedicating budget dollars to effective surveillance systems, lab networks, vector control, and other epidemiological and technical capabilities as well as regular, independent evaluations of the system to monitor progress and guide improvement.
But there’s another reason to stop the madness: as a result of the ad hoc and dispersed accountability for spending, it’s difficult to track how much of the Ebola supplemental appropriated by Congress was actually spent and where. And when it comes to the funding pledged from around the world during the height of a crisis, we may be at a loss to determine whether the money materialized at all.
The US government needs to lead and invest permanently in public health preparedness and outbreak response, both domestically and overseas. Ditch the ad hoc interagency task forces and emergency budget requests. Instead, let’s get our act together and build a whole-of-government permanent response.
Don’t let this crisis go to waste; use the emergency supplemental to respond to Zika and to whatever the next health emergency may be.