A committee studying the funding process for America’s defenses against naturally spreading and weaponized pathogens warned that as “disease outbreaks, other emergencies, and disasters continue to affect public health security, the nation must take a more businesslike approach to biodefense budgeting.”
The Blue Ribbon Study Panel on Biodefense, privately funded and established in 2014, is led by former Sen. Joe Lieberman (I-Conn.) and former Homeland Security Secretary Tom Ridge, with former Health and Human Services Secretary Donna Shalala, former Sen. Tom Daschle (D-S.D.), former Rep. Jim Greenwood (R-Pa.), and former Assistant Attorney General for National Security Kenneth Wainstein rounding out the panel.
Leadership begins with the executive branch, the report argued, from the vice president’s office to the National Security Council and Office of Management and Budget to an “allied Biodefense Coordination Council that prioritizes interagency biodefense activities and spending.” In previous recommendations, the panel said the president should establish the council with deputy secretaries from all departments and agencies with biodefense responsibilities, along with non-federal stakeholders.
They have wishes for Congress, too, like having budget committees that “consider long-term biodefense funding requirements” and a Public Health Emergency Fund “composed of no less than $2 billion in no-year money and replenished with regular annual appropriations.” Congress should establish a temporary bicameral and bipartisan Biodefense Working Group to make policy recommendations to House and Senate leaders, the report adds. And while foreign aid has become anathema to some on Capitol Hill and in the administration, the strategy calls for “sustained U.S. contributions to international programs, including the Global Health Security Agenda.”
“The process by which the government funds federal biodefense-related programs and activities precludes strategic allocation of dollars. The current system does not enable decision makers to evaluate the return on investment in existing programs, identify mission-critical gaps, or prioritize funding across requirements,” the report finds, citing budget allocations that are misaligned with the threat (like hospital preparedness “receiving pennies per person despite gaping needs” and programs of questionable worth get more funding), a murky federal interagency structure on biodefense, shortfalls in accounting and accountability, a lack of coordination between House and Senate appropriators, and unpredictable funding after years of sequestration.
“The financial impact of major biological events is staggering,” the report states. “The direct and indirect economic costs of outbreaks and the response to them now regularly extend into the billions. The costs are so high (and unaccounted for in annual budgets) that supplemental requests and appropriations have become the norm to deal with them (e.g., $7.7 billion in 2009 for H1N1, $5.4 billion in 2014 for Ebola, $1.1 billion in 2016 for Zika). As these requests increasingly become the standard means for addressing public health security crises, debate over the need for funding response heightens. Delays mount and
case counts rise: the emergency Zika supplemental took seven months to pass through Congress. Further demonstrative of the prohibitive and unsustainable nature of these costs, part of the Zika response was funded through redirection of resources from existing biodefense programs.”
The massive responsibility of biodefense is currently divvied up between 15 federal agencies, eight independent agencies (including the CIA and U.S. Postal Service), and one independent institution: the Smithsonian.
In 2015, the panel issued “A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts.” That recommended lawmakers “mandate the development of an integrated budget that allows Congress and the administration to understand how the government funds the entire biodefense enterprise.” With the passage of last year’s National Defense Authorization Act, crafting a federal comprehensive national strategy for biodefense is now the law for the first time.
That strategy should not only include the Biodefense Coordination Council, the report states, but the president should put the vice president at the political helm of the biodefense enterprise. To develop the biodefense budget, the panel recommended, the Office of Management and Budget should receive priorities from the VP, the National Security Council and Biodefense Coordination Council, and issue guidance to agencies who would report back to OMB with their needs per mission requirements. OMB would evaluate the departmental budget requests against the National Biodefense Strategy and submit the integrated request to Congress.
Here, the proposed working group would come into play; the panel recommended that congressional leaders get that formed while 2018 is still young. “Because biodefense requires broad governmental activity, the health consequences of biological events alone should not drive working group membership or chairs,” the report recommends. “Rather, leadership should appoint committee chairs, ranking members, and other members from committees with responsibility for prevention, deterrence, preparedness, detection, response, attribution, recovery, and mitigation of biological threats to sit on the BWG. Leadership must also allocate resources and staff sufficient to support the group.”
The working group’s goal should be issuing recommendations — addressing authorization reform, budget reform and appropriations reform — to congressional leaders by the end of this Congress so they can get to the business of passing a bill at the onset of the 116th Congress, the report adds; lawmakers also need to get a steady stream of future funding in place.
“Congress and the administration must renew their commitment to a BioShield SRF advance appropriation. They also need to create additional incentives to encourage private sector investment that complements government commitments,” the panel notes, acknowledging “it will take time to produce an integrated biodefense budget.”
“The entire process would mature in about three years, but could begin demonstrating value much earlier,” the report concludes.