On Friday, National Institutes of Health Director Francis Collins told the Huffington Post that we should have been better prepared to handle Ebola. “Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready,” Collins said, noting that federally funded scientists have been working on a vaccine since at least 2001.
The NIH head didn’t point fingers at either party, and it’s doubtful he was intentionally politicizing Ebola. (More likely, he was just highlighting the obvious: The less money the NIH has for research, the less research it can do.) You can’t say the same for a whole lot of other people in Washington. Hillary Clinton and Elizabeth Warren have both suggested that U.S.-led efforts to combat the Ebola outbreak have been hampered by the sequester and the years of budget cuts that preceded it. That attack moved from the implicit to the explicit when a little-known liberal group ginned up Beltway headlines with an attention-grabbing “Republican cuts kill” ad campaign—at which point the Democratic Congressional Campaign Committee picked up the ball and ran with it.
Louisiana Gov. Bobby Jindal, meanwhile, returned fire for Republicans, arguing that the issue isn’t how much the federal government spends on medical research but how it spends the cash. “Bike lanes and farmer’s markets may indeed help a community,” Jindal wrote in reference to the type of federal programs the GOP loves to laugh at, “but they would do little to combat dangerous diseases like Ebola, SARS, or anthrax.”
This isn’t a new debate, and both parties are playing to type: Democrats are saying we should have spent more, Republicans that we should have spent better. In hindsight, both arguments have merit. Given a do-over knowing what we do now, Congress would almost certainly beef up funds for Ebola research and prevention. If you look at the record, though, it’s hard to argue that either party displayed much foresight prior to Ebola’s arrival on American shores. President Obama’s 2015 budget request—unveiled this past spring—kept NIH funding largely flat. On the GOP side, it’s impossible to imagine that Republicans, with their preference for keeping research money at home, would have rerouted funds from bike lanes to Ebola at a time when the disease was other countries’ problem.
A quick look at the federal budget makes it clear that the NIH and their fellow experts at the Centers for Disease Control and Prevention are being asked, by both parties, to do more with less. Since the NIH began working on an Ebola vaccine in the early 2000s, the institute’s roughly $30 billion budget has held relatively steady, losing about $5 billion worth of spending power to inflation over that time. The CDC’s emergency preparedness budget has been cut roughly in half since 2001, from about $1 billion in 2001 to $585 million in 2013. Total federal spending on Ebola research, meanwhile, dropped from $59 million in 2006 to $42.5 million in 2013, according to Bloomberg News.
There’s no way to know for certain whether Collins’ answer to his own hypothetical is correct. But given that the NIH hopes to begin clinical trials on an Ebola vaccine by December, it’s certainly plausible to think that timeline could have been accelerated if more money had been thrown at the problem.
More money wouldn’t have just meant more vaccine research. It could have also helped test more mundane hospital procedures that could prove vital in stopping Ebola’s spread. Unfortunately, as Wired’s Maryn McKenna has detailed, that type of secondary research doesn’t make for good stump speeches or Senate stemwinders:
Infection prevention is a science of tiny details, all of them granular, almost none of them interesting to anyone outside the field. Granular means not just figuring out which protective equipment workers should wear in which situation—not as obvious as you would think, because the more you load them with gear, the more tired and distracted they become—but also determining the best ways to keep up their expertise in putting the equipment on and taking it off. It means designing room sinks so that bacteria don’t splash back out of the drain, and figuring out where to put shelves so nurses aren’t distracted on the way to the sink to wash their hands, and whether to focus on handwashing at all, or just encourage glove-wearing all the time.
The federal government is now scrambling to reroute resources to combat Ebola—both in West Africa, where the outbreak has already claimed more than 4,000 lives, and in the United States, where it has claimed one. The Pentagon, with Congress’ blessing, will spend $750 million in contingency funds to help build field hospitals and train health care workers in the hardest-hit countries. The CDC is redirecting personnel and resources to Dallas—where Thomas Eric Duncan died last week and where a nurse contracted Ebola while treating him—and ramping up training for health care workers throughout the country.
At the NIH, meanwhile, Collins suggested that the agency is doing essentially the same thing, refocusing the dollars “that would’ve gone to something else” and spending them on Ebola research. The institute did not respond to requests for information about just how much money it has reallocated—or from which programs that funding is coming—but it stands to reason that every extra dollar the institute spends on Ebola research is a dollar that it won’t have to spend researching the next Ebola, whatever that may be.
The current Beltway blame game takes as a given that it would have been better to spend a little more preparing for Ebola than to spend a whole lot more reacting to it. If Congress doesn’t put that lesson into practice, lawmakers risk getting caught up in a fight they should’ve had a long time ago at the expense of one they should be having now. This is the most pressing issue for our politicians right now: how to fund efforts to stop the current epidemic while making sure we don’t pay for it with money that is needed to avoid the next one.