Appropriations Bills Address Many Ongoing Needs, but Fail to Meet COVID-19 Challenges and the Growing Threat of Antimicrobial Resistance

The Senate Labor, Health and Human Services and State and Foreign Operations Appropriations bills released by the full committee on Nov. 10 provide needed resources to address infectious diseases in the United States and abroad, including funding to help bolster influenza preparedness and response and continue the administration’s initiative to end the HIV epidemic. However, the bills still lack the expanded investments needed to combat the ongoing fight against COVID-19 and the growing crisis of antimicrobial resistance.

The Labor, Health and Human Services Appropriations bill does respond to critical ongoing priorities. Increased allocations to essential infectious diseases responses for fiscal year 2021 include:

A $5 million increase to address opioid-related infectious diseases at CDC;

$615 million for CDC’s Center for Global Health, a $44.157 million increase over FY2020, including $228.2 million for global public health protection at the center, a $45 million increase over FY2020;
A $50 million increase over FY2020 for pandemic influenza preparedness;

A $266.345 million increase for the National Institute of Allergy and Infectious Diseases and level funding for antimicrobial resistance research at the institute;
A $2.663 million increase for the Fogarty International Center at the National Institutes of Health;
$611.7 million in overall funding for the Biomedical Advanced Research and Development Authority to help support medical countermeasure innovation, including antibacterial research and development;

Increased funding for the Ending the HIV Epidemic initiative at HHS, including a $60 million increase in funding over FY2020 for CDC activities for prevention services, a $50 million increase for the Ryan White HIV/AIDS Program and an $87 million increase for community health centers;
Language proposed by IDSA directing the Agency for Healthcare Research and Quality to conduct infectious diseases diagnostic outcomes research.

In light of the growing threat of antimicrobial resistance and the release of the second iteration of the National Action Plan for Combating Antibiotic Resistant Bacteria, which acknowledges a need for additional resources to address this crisis, the bill falls unacceptably short in allocations for:

The Antibiotic Resistance Solutions Initiative, with level funding of $170 million, when more is needed to help states and local health departments prevent, detect, contain and respond to multi-drug resistant infections and support antimicrobial stewardship;
The Advanced Molecular Detection initiative at CDC, with level funding of $30 million, when more is needed now to help CDC, state and local health departments rapidly detect emerging pathogens and integrate next-generation sequencing in the COVID-19 response;
The National Healthcare Safety Network at CDC, with level funding of $21 million, when more is needed to support reporting of key data, including antibiotic use and resistance data.

We thank the Senate Appropriations Committee for the following increases in the State and Foreign Operations bill:

$275 million for global health security at USAID, a $175 million increase over FY2020;
$325 million for the USAID global TB program, a $15 million increase over FY2020;
$785 million for the USAID global malaria program, a $15 million increase over FY2020.

Level funding in the bill for other critical global health programs under the Department of State, particularly the President’s Emergency Plan for AIDS Relief, fails to address the challenges the COVID-19 pandemic has posed in expanding access to HIV testing, lifesaving HIV treatment and other services for orphans and other affected communities. More resources are needed to counteract the pandemic’s impacts on efforts to control HIV, tuberculosis and malaria and protect the gains made against the biggest infectious disease killers globally.

Now more than ever, patients, as well as our nation’s health and safety, are depending on Congress to provide increased funding to address infectious diseases. The Infectious Diseases Society of America will continue to urge Congress to pass an omnibus funding bill for FY2021 that will enable us to meet the historic challenges we face with resources commensurate with the tasks ahead.