Medical staff carry James Dorbor, 8, suspected of having Ebola, into a treatment facility in Monrovia, Liberia. Source: NBC News

Sorry Bob Barker, This Price is NOT right

What Tom Price doesn’t understand about preparedness

On March 29, 2017, Tom Price, Secretary of the U.S. Department of Health and Human Services (HHS), told congress that “emergency preparedness and response” is a priority at HHS, despite Trump’s “America First” budget that proposes a decrease of $15.1 Billion in the HHS budget. The National Institutes of Health (NIH) is the agency that faces the biggest cuts within HHS — $5.8 Billioin — a 20% cut in their budget versus the previous year. This is a troubling proposal.

Tom Price, Secretary of the U.S. Department of Health and Human Services

It is not immediately clear what the total impact will be at HHS, but the Trump budget eliminates the Fogarty International Center’s $70 million budget that funds research at 100 universities around the country; the only NIH program that has a focus on global health issues. In the past, Fogarty grants were responsible for improving the fight against HIV/AIDs, polio, tuberculosis, and yes, even Ebola. This center has trained hundreds of clinicians: nurses, pharmacists, dentists, and biomedical researchers from countries such as Brazil, Peru, China, India, Vietnam, Thailand, Uganda, Zimbabwe, Ivory Coast, Kenya, the Democratic Republic of Congo, and Sudan. Over 95% of those who trained in the United States returned to work in their home countries or chose to work in organizations such as the World Health Organization, UNICEF, and the United States’ Centers for Disease Control and Prevention.

True, these programs may benefit other countries, but there is a strong case to be made that these programs have thwarted potential outbreaks and prevented the spread of disease to the United States.

In 2014, the United States wasn’t concerned about the Ebola epidemic in West Africa, until Mr. Duncan was diagnosed in Dallas, TX — and that's a problem. As one of the leading countries in medical research, the United States cannot afford to wait to address emerging health issues. As was demonstrated in 2014, the next outbreak is essentially a plane ride away.

“We must remember that global health is local health.”

TED: How Pandemics Spread

History of Infectious Disease

This graphic provides graphical representation of deaths due to various infectious disease outbreaks in the United States. Van Panhuis, Willem G. et al. “Contagious Diseases in the United States from 1888 to the Present.” The New England journal of medicine 369.22 (2013): 2152–2158. PMC. Web. 30 Mar. 2017.

The graphic above depicts deaths due to various infectious disease outbreaks in the United States. However, we must remember that global health is local health. In 1910, Manchuria experienced the largest plague outbreak of the 20th century Approximately 60,000 people died. Plague is still seen today in some parts of Africa with occasional outbreaks. The Pandemic Influenza outbreak in 1918 killed an estimated 50 million people, including 675,000 Americans. The Human Immunodefiency Virus (HIV), the virus that causes Autoimmune Deficiency Syndrome (AIDS) has caused more than 25 million deaths with an estimated 35 million cases today. Severe Acute Respiratory Syndrome was a hot international topic in 2003 — resulting in 8,000 cases and 774 deaths. In 2009, the world experienced a global H1N1 influenza pandemic that killed an estimated 575,000 people. These are just a handful of examples that illustrate the importance of medical research. Today, an estimated 23,000 deaths and more than 2 million illnesses occur due to anti-microbrial resistant infections in the United States alone.

Doshi, Peter. “Trends in Recorded Influenza Mortality: United States, 1900–2004.” American Journal of Public Health 98.5 (2008): 939–945. PMC. Web. 30 Mar. 2017.

Above is a graphic illustrating the deaths due to influenza. It should be noted that this graph does not include all deaths due to influenza because influenza deaths in adults are not reportable — only pediatric deaths. As you can tell, there is an upward trend in deaths over time. Couple that with the growing distrust in vaccines and there is a recipe for a potential public health disaster.

Preparedness Encompasses All Facets of Public Health

The work conducted at the NIH is vital to the prevention and mitigation of current and future diseases. Secretary Price must realize that public health emergency preparedness is much more than getting medication to people following a bioterrorism event or providing vaccine during a H1N1 outbreak. Public health preparedness is a culmination of many programs that HHS funds and involves all disciplines of public health. For example, public health practitioners must incorporate functional needs, pyschological first aid, epidemiological investigations, environmental health and even health policy considerations into their preparedness programs. The Trump Administration’s proposed HHS cuts will not only hinder research, but make the health of Americans more vulnerable — especially if the HHS budget cuts last for years to come.