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Capitol Checkup: HHS diverts HIV, vaccine funds ahead of FY'20 budget request

Just as the Trump administration was preparing to unveil its plan to end HIV/AIDS in the U.S. as part of its fiscal 2020 budget, its top health official told Congress he was shifting millions of dollars away from efforts to fight the disease.

The administration wants about $300 million in new HIV/AIDS funding in fiscal 2020.

But Health and Human Services Secretary Alex Azar said he was also stripping millions of dollars away from U.S. programs that address HIV/AIDS and other diseases and redirecting the funds to respond to the growing number of migrant children his agency is charged with caring for under the Trump administration's border policy.

In all, Azar is diverting $385 million in fiscal 2019 funds, including taking $124 million away from the U.S. National Institutes of Health and $14.2 million from the Centers for Disease Control and Prevention.

The secretary does not need Congress' permission to redirect the fiscal 2019 funds.

The NIH's National Institute of Allergy and Infectious Diseases, or NIAID — the agency that leads the U.S. research efforts on HIV/AIDS — is losing about $19 million.

It was NIAID Director Anthony Fauci who initiated the Trump administration's new effort for a multi-agency approach to end HIV/AIDS in the U.S. — a plan based on ongoing work started under the Obama administration.

Azar is also diverting money that Congress had allotted to the CDC in fiscal 2019 to fight HIV/AIDS, including $438,000 from the agency's global fund.

In addition, the CDC's immunization and respiratory illnesses program is losing $1.63 million — money that is being diverted in the midst of a measles outbreak.

Azar is also taking $772,000 from the CDC's global vaccination efforts, including $171,000 that Congress had intended for measles and other vaccine-preventable diseases.

Rep. Rosa DeLauro, D-Conn., chairwoman of the House appropriations subcommittee that oversees HHS' funding, criticized Azar's move to rechannel the $385 million, saying the administration was "robbing vital health and human services initiatives in order to pay for their failed policies." She noted the administration already had taken $446 million from fiscal 2018 funding, bringing the total of diverted funds to handle the migrant children issue to about $1 billion.

The Coalition for Health Funding, a group of 110 healthcare organizations, also expressed concerns about the administration's diversion of funds from the NIH, CDC and other federal agencies.

A new budget fight

Azar is expected to be questioned about the diverted funds when he testifies at three Capitol Hill hearings this week on President Donald Trump's fiscal 2020 budget request for HHS.

The HHS secretary will first testify on March 12 before the House Energy and Commerce Health Subcommittee. He then goes before DeLauro's subcommittee on March 13 and is expected to also testify at the Senate Finance Committee on March 14.

In his past two budget requests, Trump has sought to cut the NIH's and the CDC's funding, including for HIV research.

On March 10, White House National Economic Council Director Larry Kudlow said on Fox News Sunday to expect Trump to seek a 5% cut in domestic spending and to put up another fight over funding his U.S-Mexico border wall — a demand in the last budgeting round that led to a 35-day shutdown of the U.S. Food and Drug Administration and other agencies.

More vaccine funding urged

Meanwhile, health officials and infectious disease experts called on senators at a March 5 hearing to fully fund the CDC's vaccination programs.

The CDC and state and local public health systems have been chronically underfunded, putting those agencies in a position of constantly reacting to crises without ways to pay for them, John Wiesman, secretary of health for Washington state, told the Senate Health, Education, Labor and Pensions Committee.

He noted that for every $1 spent on vaccines, the U.S. saves about $10 in costs to the nation's health system.

Ebola and other emerging threats

The value of vaccines also is expected to be discussed at a March 14 Senate Appropriations subcommittee hearing focused on the Ebola outbreak in the Democratic Republic of the Congo and other emerging diseases that could threaten the U.S.

NIAID's Fauci and CDC Director Robert Redfield are slated to testify, among other U.S. health leaders.

Over 900 people in the DRC have been infected with Ebola in the current outbreak, with nearly 600 dying so far. Since August 2018, more than 86,000 people in the DRC have received Merck & Co. Inc.'s experimental Ebola vaccine rVSV-ZEBOV.

The U.S. officials are expected to also discuss the increase in the U.S. of diseases like the Zika, West Nile and dengue viruses, whose rise in reported cases has been linked to climate change.

Sanofi dengue troubles

Meanwhile, the chances of the U.S. having a vaccine against dengue for Americans of all ages grew slimmer last week after an FDA advisory panel said Sanofi's product, Dengvaxia, should only be used in people at least 9 years old but less than 17 years.

The committee said Sanofi's efficacy data did not support use in the broader 9-to-45-years age group.

The FDA is expected to make a decision by May 1.