How the U.S. Government Can Budget and Focus on Real Threats
to Our Health
As President Trump taunts and brags about his military might
to Korean dictator, Kim Jong Un, getting obliterated by accurately fired and
sustained nuclear warheads is still unlikely. Even less likely is the “star wars”
technology where U.S. defense missiles can intercept and consistently disable
nuclear missile attacks. The Trump budget proposed a 54 billion increase for
the military and Congress approved 700 billion for military spending in
September.[1] This
chart shows the primary allocations:
U.S. 2017 Proposed Defense Budget
Program
|
Pentagon
|
Financing Wars
|
Baltic States
|
Israel
|
$ Allocation
|
640,000,000,000
|
60,000,000,000
|
500,000,000
|
705,000,000
|
To achieve this target, Congress will approve a deficit
budget and make gargantuan cuts in many other programs. Here is a shortlist of
programs targeted for cuts which directly impact your health and well-being:
Programs targeted for cuts:
- Centers for Medicare and Medicaid (your health care)
- Environmental Protection Agency (clean air and water, protection from chemical hazards)
- Health and Human Services (medical research, public health disease surveillance)
- Department of Education (access to school-based nurses in public education)
- U.S. State Department (where we can travel, restrictions)
- Homeland Defense Department (biological and chemical weapons defense)
Most alarming are the cuts to the Homeland Defense
Department for biological and chemical weapon defense, which absorbed a 28%
budget cut in May 2017 and further cuts are slated for 2018. [2] Programs to detect and respond to biological
threats are being stripped, just when we need them the most.
The National Urban Security Technology Lab in New York,
considered the national leader for developing systems to detect biological
threats is slated for a complete shutdown of the department.[3]
The October 2015 Blue Ribbon Committee on National Biodefense found the United
States is underprepared for biological threats. The nation does not give
biological threats the same attention it affords other threats. (Deadliest
Enemy-Our War Against Killer Germs, 2017, pp. 139-140)
For more information, do read The Fink Committee Report,
which made seven recommendations for biosecurity, especially for experiments
involving recombinant DNA.[4] A
committee of experts made the following recommendations:
- Establishing criteria for biological (dual-use) research
- Create a code of conduct for scientific research
- Develop strategies and guidelines for communication of bio research
- Advise on the use and regulation of synthetic genomes
- Foster international cooperation for dual-use research
- Improve response rates for deliberate attacks
- Publication of scientific research continues to be debated, out of fear the methods could be adopted by terrorists
Top security threats to any country are in order of
precedence: (Deadliest
Enemy-Our War Against Killer Germs, 2017, p. 300)
- Pathogens capable of creating epidemics, of which influenza is currently the greatest risk, because it can be spread through the air and the strains change all of the time.
- Antibiotic resistant coronaviruses like SARS or MERS, of which there are very few treatments still effective.
- Mosquito acquired diseases like
Zika and yellow fever have moved northward and in 2016 there were 7,373 cases
of Zika within the United States and its territories.
- Bioterrorism, which includes transmitting small pox or some other epidemic through the mail or by some other means to a targeted community[5]
- Diseases which continue to have a major impact on the world’s health include: tuberculosis (including treatment resistant TB), AIDS, viral hepatitis, bacterial pneumonia, and malaria.
Why We Need to Work Together Across the World
Trump Administration isolationist policies will harm the
health of Americans, because we rely on other countries to supply our
medicines, medical supplies, and many other products of strategic importance.
First, it would take years for production facilities in the U.S. to scale-up
and offset the loss of global suppliers. Secondly, because all companies now manufacture
in a just-in-time basis, there are no longer large supplies of products in
warehouses and this includes pharmaceuticals. In the past, I have written about
critical shortages of drugs in our hospitals, and this would be exacerbated in
an epidemic.[6]
For example, much of our pharmaceutical and medical supply chain comes from
India and China, so if a bird influenza epidemic dramatically impacts their
populations, it would disrupt supplies for the United States and other
countries. The 2009 bird flu epidemic which emanated from China was identified
as a strain of the deadly 1918 Spanish flue which is estimated to have killed 100
million people. (Deadliest
Enemy-Our War Against Killer Germs, 2017, p. 259) Finally, we really
are all in this together and a plague in a distant land eventually finds its
way to our shores, so we need to fight disease together. The Trump
Administration’s philosophy of denying immigration won’t prevent epidemics,
which microscopically flit through the air, on the wings of birds, and
inconspicuously in airplane or shipping cargo bays.
To quote from public health expert, Michael Osterholm, in a
2015 TED Talk, Bill Gates asserted, “If anything kills over 10 million people
in the next few decades its most likely to be a highly infectious virus rather than a
war.” (Deadliest
Enemy-Our War Against Killer Germs, 2017, p. 50) Both Gates and Osterholm observe that the
world tends to minimize the threat of infectious disease. There have been
thirty influenza pandemics since the sixteenth century. This is a poor way to
prepare for public health epidemics and the ability of our infection fighting
drugs has become exhausted, due to antibiotic resistant bacteria. Cipro is now
one of the few drugs left which is effective against the flesh-eating bacteria.
In India, where there are less restrictions on antibiotic use for animal production,
there is currently bacteria which is resistant to all known treatments. And if
this isn’t enough to make you forsake meat, Trump has approved the importation
of Chinese chicken, which is not subject to inspections like the USDA.[7]
Microbes not Missiles
Of the deadliest foes to human kind plague is the most
feared, because it can strike silently and there may be no available treatment
as the disease wipes out your community. While all the President’s men rush to
meet enemies in bunkers throughout the globe, the real threat will come to our
soil as virulent bacteria, without warning.
What You Can Do
- Urge your elected officials to provide the necessary funds for public health preparedness as our lives hang in the balance. Now is NOT the time to cut funding for Health and Human Services research. We need to allocate one billion dollars annually on development of new more effective vaccines, especially for influenza.
- Support a new collaboration between government and private drug companies to create an efficient reliable pipeline for immunizations. Immunizations are not economically viable for drug companies to produce, but we must create incentives for them to do so.
- Support and expand the Coalition for Epidemic Preparedness and Innovations (CEPI) This will give us a fighting chance of being ready for the next pandemic.
- Encourage your congressmen (women) to fully implement the recommendations of the Blue-Ribbon Panel on Biodefense.[8]
- Establish an international organization to minimize the risk of intentionally created mutations used as pathogens for scientific purposes from falling into the wrong hands.
- Educate others on the importance of public health departments and their initiatives to prevent disease, from immunizations to disease surveillance and planning. Cuts to the Health and Human Services Agency hurts local health departments.
Please do read the riveting Deadliest Enemy-Our War Against Killer Germs, though it may make
you curl up in a fetal position, with a blanket over your head. And this is the
healthpolicymaven signing off encouraging you not to sign blanket hospital
authorizations. Stipulate that for which you consent and that which is not
permitted (out of network anesthesiologists for example).
Further Resources
Here is a list of other organizations which are working to
understand and prevent infectious diseases:
One Health examines the domestication of animals for food
and work and how infectious diseases or zoonotic illnesses sprang from that.
Bill and Melinda Gates Foundation is working to eradicate
malaria and other tropical diseases and is devoted to public health initiatives
in developing countries, especially Africa.
President’s Emergency Plan for Aids Relief (PEPFAR) was created
by George W. Bush and combats AIDS worldwide.
National Institutes of Health (funded through Health and
Human Services Agency) underwrites global research on health issues, including
the H5N1 influenza virus.
National Science Advisory Board for Biosecurity (NSABB)
researches and reviews microbiology, infectious diseases, laboratory biosafety,
biosecurity, public health, and bioethics.
National Academy of Medicine (formerly Institute of
Medicine) is an influential physician-led organization which has brought
changes to hospitals for patient safety, especially for infection prevention,
and a reduction in preventable patient deaths.
Centers for Disease Control and Prevention is a national
organization for research and communication on public health threats, funded
through the Health and Human Services Agency.
Works Cited
Olshaker, M,
Osterholm, M. (2017). Deadliest Enemy-Our War Against Killer Germs.
New York, New York: Little, Brown, and Company, March 2017
