Funding for Key Public Health Surveillance Programs Must Continue Amid Political and Cultural Debates
The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Nathan Myers
December 22, 2023
With the economic cost of the COVID-19 pandemic predicted to reach $14 trillion by the end of 2023, preventing the next pandemic should be a major priority of U.S. policy makers. Nevertheless, a number of key programs that provide surveillance against infectious diseases are either being defunded or otherwise ending due to a lack of funding. However, it is important to note that these are very different programs in terms of their functions and level of public and professional support.
The most controversial of these programs is DEEP VZN, an international effort to sequence the genomes of viruses in wild and domestic animals that pose a serious risk to animal and human health. Program critics deride it as wasteful and/or dangerous, arguing that resources are better spent on monitoring for viruses in the human population. Proponents of the program counter that with all the existing viruses that could spill over from animals to people it is important to understand which pose the greatest risk.
The controversy over programs like this is fueled by the on-going debate over the COVID-19 lab leak theory. The demise of the program was prompted by members of Congress pressing the USAID director to initiate a review of the program. This led the Agency to announce that programs to identify and characterize viruses capable of spillover were no longer a global health priority.
Another longstanding public health surveillance program that may cease operations due to funding issues is the Program for Monitoring Emerging Diseases (ProMED). The chief content officer of the service recently announced that the program is running out of funding and due to the exploitation of the work completed by ProMED’s mostly volunteer experts they will shut down their social media feeds and move to paid subscriptions. An external funder may be required to keep the service going, as the web site’s current host has lost money due to a lack of conference attendance post-COVID.
While ProMED is widely considered a trusted voice in public health surveillance (see their early and accurate warnings regarding COVID-19, MERS and SARS), their verification process leads to information being release slower than on sites like X. Proponents of ProMED counter that the service provides important context often lacking on social media. The ProMED moderators also find themselves increasingly in competition with artificial intelligence. It is worth noting that ProMED was considered a controversial approach in the beginning because it went against common practice that only officially collected public health data should be used in surveillance. Now ProMED finds itself struggling for support in the face of new technologies.
Two other longstanding U.S. policies related to public health surveillance are also in jeopardy due to funding concerns. The President’s Emergency Program for AIDS Relief (PEPFAR) is credited with saving 25 million lives since its inception under President George W. Bush, while AIDS continues to claim approximately 630,000 lives per year. House Republicans are currently withholding further funding for the program, arguing it supports abortion services. This is despite the insistence of those administering the program and lack of evidence. Along with testing, education and providing medications, PEPFAR is also credited with strengthening the ability of health systems to monitor for emerging threats. For example, research indicates that surveillance systems created under PEPFAR helped to mount a more rapid response during the COVID-19 pandemic.
Meanwhile, closer to home, the U.S. Congress has yet to pass the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA). Previously regarded as essential public health legislation, remaining partisan division exacerbated by the COVID-19 pandemic has led to opposition from the House Freedom Caucus. While some preparedness funding has been authorized into January 2024, lobbyists indicate skepticism about PAHPA being authorized in the near term amid rhetoric about the need to control federal overreach. Like the programs and policies noted above, disease surveillance is a key focus of PAHPA, one in need of bolstering after the pandemic. Gaps in the surveillance system could become more serious without a full reauthorization.
Underlying all of these potential reductions in funding leading to changes in the public health surveillance system are political and cultural shifts. DEEP VZN has opponents on both the right and left side of the political spectrum, as each side has proponents of the lab leak theory. The possible discontinuing of PEPFAR and PAHPA is supported primarily by conservatives who find elements of each in opposition to deeply held beliefs. The end of ProMED has less to do with ideology and more to do with information sources with a commitment to accuracy and context being supplanted by sources focused on breaking news first.
One may have differing opinions concerning each of these programs. However, if we are going to mitigate a future outbreak in order to prevent another pandemic on the scale of COVID-19, the United States must make a bipartisan commitment to build up public health surveillance. Any policy choice that could weaken the system must be based on a fact-based cost-benefit analysis, not short term political calculations or ideological purity. To act otherwise will one day come at a heavy price.
Author: Nathan Myers, Ph.D. is a Professor in the Department of Political Science and Director of the Master of Public Administration at Indiana State University. His areas of research include public policy, public health emergency preparedness, and the governance of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies and numerous related articles. Myers is a graduate of Knox College (BA), University of Illinois at Springfield (MPA), and University of Nevada, Las Vegas (Ph.D.) Email: [email protected]; Twitter: nagremye1980
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Funding for Key Public Health Surveillance Programs Must Continue Amid Political and Cultural Debates
The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Nathan Myers
December 22, 2023
With the economic cost of the COVID-19 pandemic predicted to reach $14 trillion by the end of 2023, preventing the next pandemic should be a major priority of U.S. policy makers. Nevertheless, a number of key programs that provide surveillance against infectious diseases are either being defunded or otherwise ending due to a lack of funding. However, it is important to note that these are very different programs in terms of their functions and level of public and professional support.
The most controversial of these programs is DEEP VZN, an international effort to sequence the genomes of viruses in wild and domestic animals that pose a serious risk to animal and human health. Program critics deride it as wasteful and/or dangerous, arguing that resources are better spent on monitoring for viruses in the human population. Proponents of the program counter that with all the existing viruses that could spill over from animals to people it is important to understand which pose the greatest risk.
The controversy over programs like this is fueled by the on-going debate over the COVID-19 lab leak theory. The demise of the program was prompted by members of Congress pressing the USAID director to initiate a review of the program. This led the Agency to announce that programs to identify and characterize viruses capable of spillover were no longer a global health priority.
Another longstanding public health surveillance program that may cease operations due to funding issues is the Program for Monitoring Emerging Diseases (ProMED). The chief content officer of the service recently announced that the program is running out of funding and due to the exploitation of the work completed by ProMED’s mostly volunteer experts they will shut down their social media feeds and move to paid subscriptions. An external funder may be required to keep the service going, as the web site’s current host has lost money due to a lack of conference attendance post-COVID.
While ProMED is widely considered a trusted voice in public health surveillance (see their early and accurate warnings regarding COVID-19, MERS and SARS), their verification process leads to information being release slower than on sites like X. Proponents of ProMED counter that the service provides important context often lacking on social media. The ProMED moderators also find themselves increasingly in competition with artificial intelligence. It is worth noting that ProMED was considered a controversial approach in the beginning because it went against common practice that only officially collected public health data should be used in surveillance. Now ProMED finds itself struggling for support in the face of new technologies.
Two other longstanding U.S. policies related to public health surveillance are also in jeopardy due to funding concerns. The President’s Emergency Program for AIDS Relief (PEPFAR) is credited with saving 25 million lives since its inception under President George W. Bush, while AIDS continues to claim approximately 630,000 lives per year. House Republicans are currently withholding further funding for the program, arguing it supports abortion services. This is despite the insistence of those administering the program and lack of evidence. Along with testing, education and providing medications, PEPFAR is also credited with strengthening the ability of health systems to monitor for emerging threats. For example, research indicates that surveillance systems created under PEPFAR helped to mount a more rapid response during the COVID-19 pandemic.
Meanwhile, closer to home, the U.S. Congress has yet to pass the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA). Previously regarded as essential public health legislation, remaining partisan division exacerbated by the COVID-19 pandemic has led to opposition from the House Freedom Caucus. While some preparedness funding has been authorized into January 2024, lobbyists indicate skepticism about PAHPA being authorized in the near term amid rhetoric about the need to control federal overreach. Like the programs and policies noted above, disease surveillance is a key focus of PAHPA, one in need of bolstering after the pandemic. Gaps in the surveillance system could become more serious without a full reauthorization.
Underlying all of these potential reductions in funding leading to changes in the public health surveillance system are political and cultural shifts. DEEP VZN has opponents on both the right and left side of the political spectrum, as each side has proponents of the lab leak theory. The possible discontinuing of PEPFAR and PAHPA is supported primarily by conservatives who find elements of each in opposition to deeply held beliefs. The end of ProMED has less to do with ideology and more to do with information sources with a commitment to accuracy and context being supplanted by sources focused on breaking news first.
One may have differing opinions concerning each of these programs. However, if we are going to mitigate a future outbreak in order to prevent another pandemic on the scale of COVID-19, the United States must make a bipartisan commitment to build up public health surveillance. Any policy choice that could weaken the system must be based on a fact-based cost-benefit analysis, not short term political calculations or ideological purity. To act otherwise will one day come at a heavy price.
Author: Nathan Myers, Ph.D. is a Professor in the Department of Political Science and Director of the Master of Public Administration at Indiana State University. His areas of research include public policy, public health emergency preparedness, and the governance of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies and numerous related articles. Myers is a graduate of Knox College (BA), University of Illinois at Springfield (MPA), and University of Nevada, Las Vegas (Ph.D.) Email: [email protected]; Twitter: nagremye1980
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