Contagion: Help Congress Protect the CDC’s Outbreak Investigation Budget

This is a joint post with Kate McQueston.

Coming your way in September, Contagion is a star-filled movie about a global bird flu outbreak complete with scary music, frequent deaths, and breakdown of public order… the usual fare.

This is a joint post with Kate McQueston.

Coming your way in September, Contagion is a star-filled movie about a global bird flu outbreak complete with scary music, frequent deaths, and breakdown of public order… the usual fare.

But dramatic soundtracks aside, there are good scientific and security reasons to fear novel viruses like H5N1 and an uncoordinated, fragmented and ineffectual response. A 2010 study examining the initial response of health care institutions found that over half of hospitals included in the study neglected important infection prevention measures during the crisis. The New England Journal of Medicine cites that one month following the release of the H1N1 vaccine only 7 percent of high-priority adults had been vaccinated. According to the same study, nine months following the pandemic, 39 percent of survey respondents said the government response was fair or poor— with 54 percent of respondents stating that the federal government was doing a poor or very poor job of providing the country with adequate vaccine supplies.

In response to these kinds of concerns, the U.S. Government recently released a low-profile but extraordinarily important policy document entitled: Promoting Global Health Security: Guidance and Principles for U.S. Government Departments and Agencies to Strengthen International Health Regulation Core Capacities Internationally.

While lacking a decent title, this document is the first National Security Council document to acknowledge that the U.S. apparatus to respond to a public health emergency of international concern is fragmented, split among many agencies and lacking key capacities. The document offers guidance on how the US can best implement revised international health regulations in key areas including human resources, surveillance, laboratory strengthening, and outbreak response. It also defines areas where the US could scale up its core capacities efficiently and effectively.  But all this may not be as simple as it seems. For example, the goal of maintaining one trained field epidemiologist for every 200,000 people is vastly complicated by the fact that this responsibility is spread across the Field Epidemiology Training Program (CDC), the Biosecurity Engagement Program (DOS), Global Disease Detection Program (CDC), Global Emerging Infections Surveillance and Response System (DOD), Emerging Pandemic Threats Program (USAID), and the Cooperative Biological Engagement Program (DOD).  No wonder the response to H1N1 was fragmented.

The fact that the USG is working to scale up and better coordinate their response to global public health emergencies is great news. But guess what? They can’t do it with less funding. The already extremely cheap CDC program to investigate and track novel disease outbreaks ($37.8 million in 2010) has been cut by almost 10 million in the Administration’s pre-debt crisis 2012 budget proposal. Currently just one million is budgeted for the program’s Operations Center which sends deployments to investigate novel diseases—the kind that translate so well to the silver screen.  Maybe what is actually frightening is that the money we spend on investigating these new diseases is less than two percent of the 60 million dollar production costs of the Hollywood blockbuster . Who knows what will happen now?

So I’m glad Contagion is around and that it’s scary and sensational. The movie’s release is beautifully timed to coincide with the budget process – I hope there’s a free screening on the Hill and that Matt Damon and Gwyneth Paltrow do some lobbying around it.

But in the meantime, don’t forget to wash your hands.