On Ebola Funding, Don’t Forget Lessons from the AIDS Epidemic | Commentary

Posted November 18, 2014 at 2:10pm

A well-founded sense of urgency gripped the recent Senate Appropriations Committee hearing about the proposed $6.2 billion emergency funding bill to combat the Ebola epidemic. Lives are being lost as Congress deliberates.

Yet it comes as no surprise that we are scrambling to react. As Sen. Tom Harkin, D-Iowa, noted, experts have warned for decades that Americans were at risk from emerging viruses and emphasized the need to build public health infrastructure and provide sustained research funding — to “stop the viruses before they become epidemics.”

So here we are.

It sounds all too familiar. A disease caused by a poorly understood virus is making headlines. For most victims, death is cruel and almost always certain. The initial devastation is largely confined to a community distant from mainstream America. Many of our elected officials, while expressing concern, see no reason to commit the necessary funding to understand the disease.

In the mid-1980s, when I established the first HIV/AIDS clinic at the Minneapolis Veterans Affairs Hospital to care for people with that mysterious new virus, there was little we could do other than diagnose the condition and provide supportive care. We held our patients’ hands and later went to their funerals. We joined growing voices to demand public investment in medical research that would find desperately needed answers. But research cannot be flipped on like a light switch. The response was reactive and the wait for answers seemed interminable. The antiviral drugs that would transform treatment and patients’ lives were still years away. People kept dying.

But political activism changed the course of AIDS, prompting a national conversation about medical research. Soon the commitment to research transcended the AIDS epidemic. Congress enacted bipartisan legislation that doubled federal investment in research in the early 2000s.

During that time, federal funding supported many exciting projects, including one that produced a vaccine for another mysterious virus — Ebola — that proved to be 100 percent effective in monkeys. However, that vaccine was never tested on humans.

Government funding that was so robust in 2003 has languished in the intervening years. Federally funded research, adjusted for inflation, has experienced a 20 percent decline in purchasing power over the past decade. The Ebola vaccine, which potentially could have been ready for licensing by 2011, sat on the shelf.

Scientists now predict tens of thousands of new Ebola cases by the end of January 2015 under most favorable circumstances, and more than a million cases under worst circumstances.

Had the Ebola vaccine been allowed to go forward with human testing, the disease might not be on the front pages today. The National Institutes of Health’s Dr. Anthony Fauci told the Senate last week that clinical trials of the first Ebola vaccine will not be completed before the middle of 2015. And there is no guarantee that it will be effective. How many lives will be lost because this research was not done earlier?

This question should guide Congress as it votes on emergency funding proposals. Lawmakers should remember the larger lesson of sustaining medical research at a level that would enable America to cope with future emergencies. Harkin put it succinctly when he said, “We must stop chasing diseases after the fact.”

To their credit, Sens. Orrin G. Hatch, R-Utah, and Elizabeth Warren, D-Mass., have proposed an annual increase in the budget of the NIH of $1 billion for each of the next 10 years. Yet even if such legislation were enacted, it would not restore NIH’s purchasing power to 2003 levels.

How much funding is enough? It’s time for us to have that national conversation once again. We do not know what the superbugs of tomorrow will look like. But we do know that novel pathogens will emerge or existing ones will mutate, and that as global travel and migration inexorably increase, disease knows no border. It is time for us to stop chasing at AIDS and Ebola from behind, and take stock of our capacity to commit.

Such conversations are never easy, particularly in a political environment in which cutting taxes and slashing the budget seem to be the only items up for discussion. But consider: Front-line doctors and nurses can now do little more than provide palliative care for patients with a distressingly fatal disease. People live in fear of contagion from their neighbor, and patients are stigmatized the moment they fall ill. We have been through this before. As we cope with the current crisis, let’s make sure that it does not happen again.

Claire Pomeroy is president of the Albert and Mary Lasker Foundation.