WASHINGTON — Lawmakers are getting closer to steering additional money toward the effort to cope with the Zika virus. What they do not appear ready to do is plug a gaping hole in funding for what was until recently another global health crisis, Ebola.
This spring, while waiting for lawmakers to act on Zika, the Obama administration shifted $500 million from Ebola initiatives to pay for research into the mosquito-borne virus and related measures. But as the House and Senate inch toward a Zika funding deal, there is little sign that the Ebola fund will be fully replenished, even as cases continue to flare in West Africa.
“You know this institution. Did you ever go back and try to backfill?” quipped Representative Rosa DeLauro of Connecticut, the top Democrat on the House panel in charge of health spending.
She said there have been no indications from her Republican colleagues that they will repay the Ebola money. “There’s been nothing on paper. No plan.”
Some public health advocates are also wary.
“Having seen Congress work for many years, I’m just fearful that there’s going to be a little bit of a short-term memory lapse,” said Karen Goraleski, executive director of the American Society of Tropical Medicine and Hygiene. “Another crisis will come along, it will be perceived to be a more important crisis, and the money won’t be repaid.”
Republicans say that Zika is the more immediate crisis right now and that lawmakers can always repay the Ebola money later if needed.
“If we are short for some other infectious disease that none of us can anticipate, or for Ebola, we will take care of that during the regular appropriations process,” Oklahoma Representative Tom Cole, who chairs the panel that DeLauro sits on, said recently on the House floor.
For now, Republicans seem skeptical that the Centers for Disease Control and Prevention and other agencies need all the money that was originally approved to deal with Ebola. The House Zika bill would actually shift more money from the Ebola funds to pay for the Zika response.
“Frankly, the money there may well be more than we need for Ebola,” Cole said in his floor speech.
Top officials at the CDC see Ebola’s persistence as reason enough to replenish funding to deal with the deadly disease. Congress initially approved $5.4 billion emergency funding for Ebola; about $2 billion remain. Much of the unspent Ebola money is intended to help the countries ravaged by the disease to build public health infrastructures and guard against flare-ups.
“We’re not done,” Dr. Anne Schuchat, the CDC’s principal deputy director, told STAT in a recent interview. “People think we’re done with Ebola, but of course we’re not done.”
In the last few months, Guinea and Liberia have confirmed new cases of Ebola. A recent study led by government researchers found that a 2015 reemergence of the virus in Liberia could be genetically traced back to the initial 2014 outbreak that killed thousands of people.
The finding suggests that Ebola has lived on in the epidemic’s survivors, increasing the likelihood that it will continue to appear in an area already ravaged by the virus.
“We’ve never had a situation in history with thousands of Ebola survivors in a part of the world with a very limited public health capacity,” Schuchat said. “We think viral persistence is going to continue to cause flare-ups of Ebola. We have to remain vigilant and maintain a focus.”
“These threats may be different from year to year, or month to month, but the work is predictable and we need a better way of dealing with this,” she said. “We can’t wait for the fires to support the fire department.”
There doesn’t seem to be much appetite on Capitol Hill for fully funding what the CDC says it needs for Ebola or Zika. The White House originally requested $1.9 billion for a Zika response. The Senate approved $1.1 billion, and the House passed a $622 million bill; the two chambers are now negotiating a final package.
The Senate’s Zika bill negotiated by Senators Roy Blunt of Missouri and Patty Murray of Washington does extend an olive branch, authorizing $88 million of its $1.1 billion to be used to repay the depleted Ebola funds.
But that is still just one-fifth of what the Ebola funds have lost — and there is no guarantee that the provision will survive the negotiations between the Senate and a more skeptical House for a final Zika package. The politics, the CDC is finding, are difficult.
“I think Congress does believe in this mission,” Schuchat said, “but I think the devil’s in the details.”
The Federal government initiates programs like the Ebola effort and never looks back to see if the money authorized was well spent or is still needed. So taking from Ebola to fund Zika is a good thing and should force agencies to rejustify ongoing funding. Federal Government zero-based budgeting should be done like businesses do each year to ensure that government does not grow in an uncontrolled/unmanaged manner