WASHINGTON — Public health experts have a warning for Congress: don’t treat emergency coronavirus aid like business as usual.
Partisan bickering has often frustrated lawmakers’ attempts to speedily approve emergency spending packages. Congress, for example, dawdled for seven months because of an acrimonious fight over funding for Zika in 2016. That left health departments around the country cash-strapped and forced to cut back on existing public health programs, like responding to STD outbreaks. The long delay left the federal government no choice but to plunder funds meant for cancer research, heart disease, and fighting HIV to pay for their response efforts.
No one knows if the debate over coronavirus funding, which has captivated Capitol Hill this week, will devolve quite as spectacularly as the one that took place around Zika funding. Bipartisan negotiations are ongoing in earnest.
But there’s no agreed-upon funding amount yet — and not even a draft of the legislation. The Trump administration has already suggested diverting funds from other public health initiatives to pay for at least half of its outbreak response, a move that Democrats vehemently oppose. And some Democrats have begun to talk about including more contentious requirements in the aid package — policies that might touch on partisan issues like drug pricing or border wall funding.
Public health experts warned that delaying coronavirus aid could have an even bigger impact on their ability to respond than it did during the height of the Zika outbreak. Already, Centers for Disease Control and Prevention officials have warned that the virus could spread rapidly in the U.S. and disruptions to daily life could be “severe.”
“Whenever these outbreaks happen in the middle of a political season, [emergency funding] gets delayed,” said J. Stephen Morrison, the senior vice president and director of the Global Health Policy Center at the Center For Strategic and International Studies, a Washington-based think tank.
“People are going to have to be very, very cautious and careful in trying to protect this response from getting stuck in toxic politics,” he added.
Tom Frieden, the former director of the Centers for Disease Control and Prevention under President Obama, suggested that past funding fights underscored the need for more permanent allocations.
“We can’t have this constant amnesia. We have cycles of panic and neglect,” he said.
Obama requested roughly $2 billion in Zika funding in February 2016, but it wasn’t until late September of that year that a funding bill finally made it to his desk.
Even before Obama’s request, the CDC had already warned pregnant women not to travel to the countries that had already reported outbreaks of the virus. The World Health Organization had declared a public health emergency. Blood banks were turning away donors that had traveled to Zika-impacted countries and photos were flooding news services of babies born in Latin America with microcephaly, a condition where the skull is smaller than normal.
Obama urged the House to reauthorize his relatively modest $2 billion package “expeditiously.” But the process was anything but.
Almost immediately, House Republicans, who then held the majority, insisted that the Obama administration should instead repurpose the millions of dollars they had appropriated for the U.S. Ebola response in December 2014.
Negotiations in the Senate seemed smoother. But when a final funding bill emerged in June, it was laden with provisions Democrats deemed “poison pills” — including a provision that would block Zika funding from going to Planned Parenthood clinics, despite the fact that many of these clinics were providing Zika-related services.
Senate Democrats were so enraged that they voted three separate times to block the Zika package from becoming law — depriving their own party’s president the funds desperately needed to fight Zika.
Underscoring how the conflict became so protracted and tense, then-House Speaker Paul Ryan (R-Wis.) penned an op-ed in USA Today that implored Democrats “to drop politics and put the public’s health first.”
Then-CDC Director Frieden and National Institute of Allergy and Infectious Diseases Director Anthony Fauci wrote their own op-ed in the Washington Post imploring Congress to pass a funding bill — an exceptionally political move from the country’s top public health officials.
Faced with a congressional stalemate, the federal government ultimately transferred more than $600 million in existing funds allocated to the National Institutes of Health and the CDC to pay for Zika response. In April, the CDC also took $44 million in promised funding for local health departments and redirected it toward Zika control measures. Even Michigan, which was responding to the Flint water crisis, lost funding.
All told, it took Congress seven months to allocate $1.1 billion dollars.
“This is why people hate Congress,” remarked Sen. Tim Kaine (D-Va.) at the time.
Experts said that such a similar delay, now, would have a greater impact on public health than the 2016 fight did.
There are already more than 60 cases of coronavirus spread across the U.S., including the first case that wasn’t linked to travel to an area that has already reported an outbreak or contact with an existing case. Federal officials have warned that the virus could begin to spread in the United States.
That stands in sharp contrast to the Zika outbreak, which primarily only impacted tropical climates. While there were 5,168 total cases of Zika reported in the U.S. in 2016, most were linked to travel outside the country. There were only 224 cases reported to be caused by mosquito bites in the U.S. and all of those cases were reported in two states: Florida and Texas.
In fact, when the Obama administration first requested funding to aid Zika response, there had only been a smattering of diagnosed Zika cases in the U.S.
“With Zika, we knew it was a very specific geographic location of where we were going to have to be focusing our efforts,” said Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials. “With Zika, there were a lot of areas that were really focused on it, but it wasn’t necessarily something that every community had to work on.”
According to Casalotti, in response to the coronavirus outbreak, Chicago has already spent $350,000 on the response, and expects to spend $150,000 more each week. Riverside, Calif., which recently quarantined roughly 200 people, spent $1.3 million. And Los Angeles has estimated it will need $7.5 million over the next year to respond to coronavirus.
State and county health officials insist that they need new funding and that existing funds simply can’t be used to respond to coronavirus.
“We still have flu, we still have people with tuberculosis, we still have restaurants that need inspecting, people still have STDs, pulling from those programs to fund coronavirus … does strain a system that is already pretty strained,” said Michael Fraser, the executive director of the Association of State and Territorial Health Officials.
Casalotti said it’s critical funding comes in soon.
“People are operating day-to-day with a question mark,” she said. “Public health is used to getting stuck in political crossfires. … What we really hope is that people can come together.”
State and local health officials made their own plea to the government for additional funding earlier this week.
“We would like to think that public health can be pretty nonpartisan,” said Fraser.
His group and three others wrote to Capitol Hill earlier this week warning that any delay in funding would “severely impact the necessary response to this public health emergency and delay efforts to appropriately secure the public health of our nation.”
In Washington, top appropriators have said they’re hoping to hold a vote on a coronavirus aid package early next week. Congressional leaders are eyeing a package that falls much closer to the $8.5 billion funding level suggested by Senate Minority Leader Chuck Schumer than to the Trump administration’s much lower $2.5 billion request. Trump also said at a press conference this week he’d accept whatever level Congress appropriated.
Trump proposed spending about $535 million in funding that had previously been allocated to fight Ebola. Schumer, in contrast, detailed entirely new spending, including $1.5 billion in funding for the CDC, $3 billion for the Public Health and Social Services Emergency Fund, $2 billion for state and local health departments, $1 billion for USAID emergency funds, and $1 billion for vaccine development.