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The "New Normal" is a Tight Belt

Posted on by Laurie Garrett

This morning, NPR aired a report asserting that sequestration has become the “new normal” in Washington, and the Republican political leadership plans to block any attempts to cease sequestering funds not only for the remainder of FY2013, but for the coming decade. It is an analysis shared by POLITICO, which asserts $1.2 trillion will be cut from the federal budget in slow, painful slices annually, up to 2023. Every nook and cranny of the federal budget will share the pain, but three areas of concern to global health are already shouting, “Uncle!”

First, PEPFAR and all of the programs that once fell under the Global Health Initiative (which is now defunct) are currently experiencing 5 to 5.5 percent budget slashes. Each program has tried to find ways to reduce spending without cutting back on the numbers of people worldwide receiving health interventions courtesy of the U.S. government – chiefly through efficiencies and furloughs of federal employees. Thousands of employees of PEPFAR, the CDC, the Department of Health and Human Services (HHS), and other agencies will take significant pay cuts this summer and forced days off. In addition to being personal hardships for the individuals, this will undoubtedly slow down the bureaucracies for everything from processing checks to shipping drug supplies overseas. Other departments are using the furlough “kinder gentler” approach to reducing personnel costs, in order to avoid widespread lay-offs, so in thousands of ways, the interactions between the U.S. government and its counterparts or clients overseas will be lousy, featuring longer, slower lines for visas; fewer people staffing embassies; furloughs of liaison officers meant to grease wheels between the Department of Defense, HHS, Department of State, and other departments.

Awful as this may be, the executive branch of the government had until quite recently hoped that the pain would be temporary. Surely Congress would see how inane sequester was, and conjure a specific, valid national budget. But that dream has dissipated like a fog before blazing sun, and the “kinder gentler” furlough approaches may become widespread lay-offs and massive program cutbacks after October 1, when fiscal year 2014 commences. NGOs and faith-based groups involved in global health and humanitarian work are already screaming agony.

So every global health program, from Roll Back Malaria to Stop TB, will get less money after October 1 – funds that, in these times of global austerity, no other government seems interested in picking up.

 

Source: amfAR

Source: amfAR

The second area of already-experienced pain is in basic biomedical research. The National Institutes of Health and the National Science Foundation are already slowing down grants, and doing everything possible to simply stre-e-e-ech the funds o-u-u-u-t as fa-a-a-ar as possible. But come October 1, stretching won’t be enough, and hundreds of thousands of scientific research projects and training efforts will start to disappear. Among scientists, it is a grim time, and many are complaining that their ability to train and to support American graduate students is disappearing. The result is that we are handing the future of biomedical research and development to China, and a handful of other countries that are both beefing up their domestic science budgets, and subsidizing young scientists for advanced studies in the United States.

As Benjamin Corb, a spokesman for the American Society of Biochemisty and Molecular Biology, put it to POLITICO, “Ten years from now, when we’re saying I thought we were on the cusp of having a cure for cancer or the cusp of slowing Alzheimer’s or diabetes or whatever the ailment is where we hear so much promise about the research today, we’re not going to be crossing the finish line anytime soon because of this.”

Congress recently voted to cut most of the bioterrorism-related funds that surged post-9/11. These cuts are in addition to sequestration impact, and include some basic outbreak surveillance and response efforts that go well beyond terrorism. As the United States scales back, so does the World Health Organization, which recently announced a 51 percent reduction in agency spending for outbreak recognition and support.

Congress also killed the Farm Bill, which would have supported, among other things, humanitarian famine and crisis response efforts, and basic nutrition support for poor countries. The bill died largely as a result of Republican animosity toward food stamps programs, which are primarily used by poor, single mothers trying to feed their families in the United States.

The third way the pain of sequestration is already being felt for health is inside the United States, at the state levels, where federal support for hundreds of programs have been cut or eliminated. For example, two years of budget cuts to the CDC, coupled with sequestration, have eliminated support for 50,000 public health positions across the fifty states, territories, and large cities. Most of these now-lost positions were for disease surveillance, outbreak response, and public health laboratories. This renders the United States more vulnerable to everything from tuberculosis carried by visitors, to food contamination outbreaks. And the world is left more vulnerable to diseases like E.coli:0157 hemolytic uremia, which has been exported via contaminated American seed and foods to other nations.

We have been warning that this sorry time was approaching – as far back as 2007. After the 2008 financial crash, it was obvious an austerity era was coming, and now it is here. Supporters of global health, food security, and development efforts have two choices: Figure out how to keep the same numbers of people alive, fed, and well with less money every year; or start fighting for a sane Congress. Both options are terrible.