US HEALTH BODIES REAP FUNDS FOR BIOTERRORISM 



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Last Updated

18 Dec 2002

Source: The Lancet 359 (9308), March 2, 2002.

WASHINGTON

US health bodies reap funds for bioterrorism

By Daniel S Greenberg

Pumped up by fears of bioterrorism, budgets are booming for the three major health agencies of the US government--the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC). Much of the growth in bioterrorism activities, however, is at the expense of their conventional research and health-related programmes.

In Washington's bureaucratic wars, the three health organisations are on increasingly uncertain ground, with NIH and FDA headed by acting leaders throughout the year-old Bush administration. Several institutes at NIH are also headed by acting directors, or soon will be. Last week, Jeffrey P Koplan, director of the CDC, widely criticised for his seemingly indecisive response to the anthrax attacks last autumn, announced his resignation. On a variety of issues, from stem-cell research to new government restrictions on open publication of potentially menacing scientific data scientific leaders and the administration differ sharply.

Even as the White House endorses a huge increase for NIH, scientists and Congressional guardians of research are repeating previous warnings about growing imbalances among the scientific disciplines. They cite in particular an NIH budget that is about five times that of the National Science Foundation (NSF), which is responsible for support of non-medical research in universities. And they are looking on warily as the administration develops what it describes as performance criteria for all government agencies, including those that support basic research. Courtesy and the rituals of mutual respect prevail in relations between the Bush administration and the scientific community, but disharmony is evident.

The leadership gap at NIH is enmeshed in the nasty politics that inevitably shadow government activities related to reproductive biology. The president's reportedly anguished decision to restrict federal funding of stem-cell research to some 60 existing stem-cell lines conflicted with the recommendations of the National Academy of Sciences and other scientific organisations. Amid reports of a "litmus test" for the NIH directorship, the position has remained unfilled. The appointment of an FDA commissioner has been immobilised by the pharmaceutical industry's fears of a tough regulator and Senator Ted Kennedy's preference for a reincarnation of David Kessler, an appointee of the first President Bush, who brought down the tobacco industry and stiffened drug regulation.

A big budget increase for NIH was politically predestined by a 1998 Congressional commitment, endorsed by Bush during the presidential campaign, to double the NIH budget over 5 years, with an installment of US$37 billion next year bringing the total to $275 billion. For NIH's beneficiaries, in medical centres and universities, the growth is welcome, and now attention is turning to keeping it up beyond the 5-year span. The retired Republican Representative from Illinois, John Porter, who led the doubling movement, has suggested annual increases of 10% to keep NIH growing and vigorous. But in other regions of the scientific enterprise, NIH is seen as the hog in the trough, prospering at the expense of research that is not so easily salable to the public as the pursuit of cures for dreaded diseases.

While saluting the fiscal good fortune of biomedical research, Representative Sherwood Boehlert (Republican, New York), chairman of the House Science Committee, noted that "the NIH budget is now larger than that of the rest of the civilian science agencies put together, and just the increase in the NIH budget is larger than the research budget of NSF". Another consequence of the Bush budget is an increase in the military's share of federal funds for research and development, to 52%, thus reversing the civilian-defence parity that was achieved several years ago after a long decline in the Pentagon's post-Cold War dominance of research and development funds.

About half of NIH's $37-billion increase will be devoted to bioterrorism programmes, principally at the National Institute of Allergy and Infectious Diseases, whose longtime director, Anthony Fauci, is frequently reported to be a leading candidate, though a reluctant one, for the top job at NIH. Fauci, at least so far, seems satisfied with his present position, in which he serves as the government's leading public spokesman on the medical aspects of bioterrorism.

Under the president's budget, Fauci's institute would receive $4 billion next year, putting it second in the NIH family of institutes to the $47 billion of the National Cancer Institute. At the perpetually short-funded FDA, most of a small budget increase would be devoted to bioterrorism programmes.

Although the fearfulness, unknowns, and presidential attention accorded to bioterrorism stifle wide debate about the government's newly evolved health-research priorities, a few dissenting voices are heard, particularly about increases in bioterrorism programmes and cuts in traditional activities at the CDC. "We will be very concerned if we are funding one thing at the expense of another", Georges C Benjamin, president of the Association of State and Territorial Health Officials, told the New York Times. "If you really want to push people toward better health", he added, "you have to keep these programs in place". NIH's Fauci has expressed strong agreement with that sentiment, pointing out in a recent address that anthrax killed only five people at the end of last year, while thousands die annually from AIDS, influenza, and other infections.