21st century health threats need optimal budgeting — health security is a national issue
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Bombs, bullets and, most recently, bytes, tend to dominate our national security thinking. But bugs must also be added to that list. As Bill Gates recently warned the Munich Security Conference, a pandemic — whether caused by a terrorist or nature itself - is one of the three biggest threats we face. National security is health security.

A critical element of our preparedness for 21st century threats must be to develop and stockpile effective medical countermeasures, such as vaccines, antibiotics, and other antidotes. President Trump’s 2018 Budget Blueprint doesn’t comment on this, but it does create a new public health emergency response fund — a step in the right direction.

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Medical products take years to develop; however, we expect them immediately when a threat appears. We can’t wait to develop a treatment after the fact. Historical disease outbreaks and attacks using biological and chemical agents have demonstrated the importance of having medical products available quickly to save lives.

 

Nearly a century ago, the Spanish Flu killed up to 50 million people worldwide. More recently, epidemics of severe acute respiratory syndrome (SARS), pandemic influenza, and Ebola, coupled with events such as the 2001 anthrax attacks and rapid advances in dual use technology and synthetic biology, remind us that the question is not if but when the next health security threat will appear.

The anthrax attacks, in particular, are quite vivid in our memories as we were both Senators on the Hill when mail containing spores of the anthrax-causing organism came our way and many of us and our colleagues were instructed to take preventive antibiotics.  

Just last month, North Korea’s Kim Jong-nam was assassinated using the chemical nerve agent, VX, adding to a concerning trend of terrorists’ use of chemical weapons in the Middle East.

For the last decade, there has been bipartisan commitment in Congress to work with pharmaceutical manufacturers to develop and purchase medical countermeasures for a national stockpile that is ready if and when it is needed.  

The program, called Project BioShield, creates a government market for these life-saving products by allowing the secretary of Health and Human Services to use funds to purchase countermeasures that are in development. Including this year, Project BioShield will have purchased between 16 and 20 innovative medical countermeasures to protect the American public against chemical, biological, radiological, and nuclear threats. The program has worked.

However, while the original funding for Project BioShield was made through a 10-year, $5.6 billion advance appropriation, funding for the last few years has been through annual funding as part of a 5-year, $2.8 billion authorization.

This has led to large swings in funds allocated for buying medical countermeasures, thereby making the system more vulnerable and eliminating the stability needed for our private sector partners who depend on government assurances of a market before developing these important treatments. Specifically, Congress is on track to appropriate $1.5 billion over the last four years, leaving a $1.3 billion shortfall in 2018.

We believe that Congress and the administration must do more to support the development these products. Thanks to the Biomedical Advanced Research and Development Authority (BARDA), which works with bio-pharmaceutical manufacturers to develop countermeasures, many new treatments for threats such as anthrax, smallpox, Ebola, and Acute Radiation Syndrome may soon be mature enough for purchase under Project BioShield.

Congressional leaders should consider different budgeting strategies to stabilize the medical countermeasures ecosystem. One option could be forward funding Project BioShield for two or more years to provide more clarity and predictability in the government’s plans.

A second alternative could be to return to advance appropriations as part of the reauthorization of Project BioShield in 2018. Perhaps a shorter timeframe than the original 10 years would allow Congress to feel that they retain the necessary oversight required to ensure proper stewardship of taxpayer dollars in this fiscal climate. An additional idea could be to move the Project BioShield appropriation back to the Department of Homeland Security (DHS) account, where it resided between 2004 and 2010.

We believe strongly that leadership and robust communication between the legislative branch, executive branch, and the private sector are critical to ensuring progress and sustainability for our nation’s medical countermeasure ecosystem. Few issues today have greater global security and public health implications.    

Tom Daschle is a former U.S. Senate Majority Leader and a co-founder of the Bipartisan Policy Center. Judd Gregg is a former U.S. Senator from New Hampshire who served as Chairman and Ranking Member of the Senate Budget Committee.

 


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