Feb 13, 2009 (CIDRAP News) – With money for pandemic influenza preparedness stripped from a huge economic stimulus bill that appears headed for final congressional approval, public health advocates say they have to look to the regular budgeting process for the next chance to get some pandemic funding.

The House of Representatives had included $900 million in pandemic preparedness funds in its version of the massive stimulus package, but it appeared that all but $50 million was removed by the conference committee that ironed out differences between the House and Senate versions, said Richard Hamburg, government relations director for the nonpartisan, nonprofit group Trust for America's Health (TFAH).

The House passed the $787 billion compromise bill this afternoon by a vote of 246-183, with no Republican support, the New York Times reported. The story said the Senate was expected to approve the measure this evening.

The $50 million left in the bill, listed as a Public Health and Social Services Emergency Fund, is for improving information technology security at the Department of Health and Human Services (HHS), Hamburg said. The sums removed included $420 million for pandemic flu and $430 million for biomedical advanced research and development, he reported.

Now it's back to the regular budget process for those seeking pandemic and other public health preparedness funds, leaders of public health groups say.

"Hopefully in the president's budget for 2010 there will again be funding and decisions about funding for preparedness," said Robert (Bobby) Pestronk, executive director of the National Association of County and City Health Officials. The Obama administration is expected to propose its 2010 budget soon.

Nothing left in pipeline

Hamburg said there is no more pandemic preparedness money in the pipeline for state and local public health. "The $600 million that was made available in December 2005, in the fiscal year 2006 emergency supplemental bill, the last of those dollars went out the door this past August," he said.

In addition to the cutoff of pandemic flu funding, public health agencies have seen their "all hazards" preparedness funding drop about 25% since 2005, Hamburg said.

TFAH and its partners are advocating for another $350 million specifically for pandemic readiness and additional money for other public health emergencies, he said.

Fiscal year 2009 budget legislation is still awaiting action, and it could include some pandemic money, but it would all be for federal activities, according to Hamburg.

He said President Bush's proposed 2009 budget included $507 million in one-time spending for pandemic vaccines and countermeasures, plus $312 million for annual recurring pandemic activities at HHS, but no funds for state and local activities. Hamburg expects that Congress may take up the labor and HHS funding bill, which includes that money, later this month.

Some public health money survived

Although pandemic money was stripped from the stimulus package, still included is about $1 billion to support various other state and local public health activities, according to Pestronk.

He said it appears that the sum includes $300 million for community vaccination programs and $50 million for healthcare-associated infections. Funds are also targeted for "evidence-based programs to address chronic disease and to support current and new workforce development for public health." The vaccination funds are part of the Section 317 program, a Centers for Disease Control and Prevention immunization program mainly for uninsured and underinsured children, he said.

"Overall it looks like there will be over $1 billion available," Pestronk said. "I think that while the amounts initially talked about in the Senate committee and in the full House were greater, this is still a success for the public health community."

Story of the deleted $900 million

Hamburg said the $900 million that was dropped from the stimulus package essentially represented the final installment of the $7.1 billion that President Bush proposed for pandemic preparedness back in 2005.

In his proposed 2008 budget, Bush asked for a one-time appropriation of $870 million for vaccines, antivirals, and diagnostics, Hamburg explained. But that was cut from the final budget legislation. Then last August, Bush made a supplemental budget request that included the $870 million, which was for different purposes than the $507 million that was part of the 2009 budget proposal, he said.

"So when the stimulus bill came up, our supporters in Congress saw an opportunity to take care of the $870 million request, with the assumption that the $507 million would be taken care of in the regular appropriations process," Hamburg said.

A Senate committee had approved the inclusion of $870 million in the stimulus bill, but that was removed before the full Senate voted on it. The House supported $900 million, but that was deleted by the House-Senate conference committee.

Hamburg said a number of lawmakers felt that pandemic funding should be handled in the regular appropriations process, not in an economic stimulus measure.

"Now we'll need to take a look at opportunities starting with the fiscal year 2010 funding cycle and the [proposed] budget we'll see in the next month or so," he said.

Dr. Paul Jarris, executive director of the Association of State and Territorial Health Officials, said yesterday, "We are extremely concerned about the diminishing funding for state and local preparedness as well as the removal of all funding for pandemic flu, and the decrease in funding for hospital preparedness. Along with the state budget cuts, this is a matter of losing the infrastructure created over the past several years."

Looking ahead, he said, "We will pursue everything we possibly can, but there are no guarantees. I wouldn’t' say there are any promising leads we're following right now. It seems that Congress is turning a blind eye to state and local health preparedness."