The cuts to the US public health funding under the Trump administration have weakened the capacity of the country to respond to outbreaks. Sharmila Devi reports.
The spread of COVID-19 has thrown a spotlight on US President Donald Trump's record of public health cuts and scientific brain drain from his administration as the USA responds to the threat of a global pandemic.
The 2021 budget put forward by Trump on Feb 10—only 11 days after WHO declared the outbreak of COVID-19 a public health emergency of international concern—proposed drastic cuts to funding that could limit preparedness for pandemics in the USA and abroad. Trump proposed a 16% cut in funding to the Centers for Disease Control (CDC) and a 40% cut in the US contribution to WHO, as well as reductions for programmes such as the Supplemental Nutrition Assistance Program and Medicaid, which provide assistance to US citizens with low income. Although the budget is unlikely to pass the Democrat-controlled House of Representatives, public health professionals and analysts say the Trump administration has weakened institutions necessary to prepare for and prevent the spread of infectious diseases.
“This administration has shown a pattern of cutting science funding”, Linda Blimes, senior lecturer in public policy, told The Lancet Infectious Diseases. “If you look at every budget since his first in 2017, Trump has requested draconian cuts to bodies such as the CDC. Although the Congress has restituted some of this funding, what has happened is the administration has still chipped away.” The overall level of appropriations for CDC programmes relevant to infectious disease control was 10% below what the USA spent in 2016 adjusting for inflation, she said.
More than 1600 scientists, or 1·5% of the total federal scientific workforce, have left the federal government during the first 3 years of the Trump administration, the Washington Post reported in January.
“It's very demoralising to have an administration always trying to cut programmes because it doesn't seem to realise their inherent value to national and global health”, Rebecca Katz, director of the Centre for Global Health Science and Security at Georgetown University, told The Lancet Infectious Diseases.
Concern about government attempts to prevent or restrict scientific research, education or discussion prompted the launch of the Silencing Science Tracker in 2018 by Columbia University's Sabin Centre for Climate Change Law and the Climate Science Legal Defence Fund. The list has grown quickly to more than 400 cases and includes actions ranging from government censorship to budget cuts since 2016. The US administration was also seeking to cut more than $85 million in funding for the National Centre for Emerging and Zoonotic Infectious Diseases.
Meanwhile, even if the president's proposed budget cuts were overturned, they would still have a negative impact through, for example, lost time as staff prepare for contingent emergencies and inefficient programme implementation, according to a study last year by Catholic Relief Services that reported that “Despite clear and unwavering Congressional support for international assistance, agencies are often required to use these severed request levels in their planning and strategy development for specific sectors, making programming on the ground difficult and planning confusing”.
Public health systems were further weakened in 2018 after a reorganisation led by John Bolton, former national security adviser. After he eliminated the National Security Council's (NSC) global health security and biodefense directorate, Tim Ziemer, the NSC's senior director for global health security and biodefense, left the White House. He was a widely respected public health expert and he has not been replaced.
The Congress approved $8·3 billion in emergency aid on Mar 5 to deal with COVID-19 but there was concern over Trump's appointment of Mike Pence, his vice-president, to lead the response because of his anti-scientific views. In 2000, the year Pence was elected to the House of Representatives, he wrote on his web site: “Despite the hysteria from the political class and the media, smoking doesn't kill”. As governor of Indiana, he also slashed funding for programmes to cut smoking and help people quit.
During a visit to the CDC on Mar 6, Trump dismissed any criticism of the government's handling of the outbreak of COVID-19 and stressed the availability of diagnostic tests despite widespread reports to the contrary. He said he completely understood all the issues around the virus, saying: “People are surprised that I understand this stuff. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability” the Washington Post reported.
© 2020 Flickr/Elliott P