Federal health agencies say they need a big funding bump to prepare for future emergencies

Rebuild our ability to handle public health emergencies

Sarah Boden

Public health decisions are made by this clown

Federal agencies tasked with planning for and responding to public health emergencies say they need a big bump in funding to prepare for future pandemics and antimicrobial resistance, as well as chemical, biological, radiologic, or nuclear threats. 

The multiyear budget, released July 15, proposes an allocation of $53.3 billion over the next three fiscal years: 2027, 2028 and 2029. If funding remains flat, the allocation will be $20 billion, or $33.5 billion less than requested. 

The Administration for Strategic Preparedness and Response (ASPR), the federal government's leading health security agency, says the budget is based on agency professional judgment. 

"These investments will strengthen our ability to develop, manufacture, and deliver lifesaving medical countermeasures when they are needed most," said John Knox, ASPR's principal deputy assistant secretary and interim leader, in an ASPR news release. 

The proposed budget comes at a time when many have criticized the federal government's deep cuts to preparedness efforts amid the recent hantavirus outbreak and ongoing Ebola outbreak in Africa.

Most funds would go to biomedical R&D 

ASPR received the lion's share of the proposed budget. Specifically, it requests $33.2 billion for the next three years to fund ASPR's Biomedical Advanced Research and Development Authority (BARDA), which develops and acquires medical countermeasures, including vaccines, therapeutics, and diagnostic tools. If funding remains at 2026 levels, BARDA will receive $5.3 billion, or $1.8 billion per year. 

BARDA funding would jump from $1.8 billion for fiscal year 2026 to $13.7 billion in 2027, $8.5 billion in 2028, and $11.0 billion in 2029. ASPR funding for the Strategic National Stockpile for housing drugs, vaccines, and other supplies for emergencies would increase from $750 million this year to $2.1 billion in 2027 and 2028 and $2.3 billion in 2029.

The budget also proposes a funding boost for preparedness at the Centers for Disease Control and Prevention (CDC). Over the next three years, the allocation would be 388% higher compared to if funding remained flat. The budget also recommends just a 2.8% increase for the National Institutes of Health (NIH), and flat funding for the Food and Drug Administration (FDA).

These three agencies, along with ASPR, are part of the US Department of Health and Human Services (HHS), and each plays a role in responding to emerging public health threats. 

With highly pathogenic avian flu, for example, the budget says that the NIH would support vaccine trials and studies of new therapeutics, ASPR would improve and sustain domestic manufacturing capabilities of these vaccines, and the CDC would monitor for emerging viruses.

The budget doesn't outline a cohesive action plan for emergency preparedness, said Prashant Yadav, a senior fellow for global health at the Council on Foreign Relations and an expert in medical countermeasure manufacturing, procurement and distribution. 

Diffused responsibility and insufficient coordination create competing interests among agencies, which, Yadav argued, prevent the federal government from setting clear priorities, especially if Congress doesn't grant the full budget request.  

"It will require making some tough choices," he said.