The Disease Slush Fund

By Greg Mercer

This week, House appropriators introduced legislation which would increase NIH funding to $33.3 billion, which is $1.3 billion more than this year’s funding. It would also set aside $390 million for the federal Zika response. STAT’s Dylan Scott has the full story.

This bill comes as an alternative to the emergency funding fight that’s sprawled across the last few months. Republicans have argued that funding for disease relief should come about through the normal appropriations process.

The emergency funding fight, currently on hold for a Congressional recess, started with the Obama administration’s request for $1.9 billion for Zika relief. Since then, proposals and counterproposals have ping-ponged back and forth between houses of the legislature, with the administration drawing on leftover Ebola money to fund the Zika fight. The Senate approved $1.1 billion in funding in May; House Republicans offered $622 million. Senate Democrats blocked a compromise bill for $1.1 billion—$750 million of which was drawn from cuts to other government expenditures—on June 28th. Democrats cited measures inserted by Republicans to cut Affordable Care Act funding (and the removal of a provision to ban flying of Confederate flags at federal cemeteries).

Back in April, FiveThirtyEight’s Maggie Koerth-Baker compared the emergency Zika funding battle to a slush fund for infectious disease. It’s an apt comparison, especially as the Obama administration, absent Congressional financial assistance, drained funds originally appropriated for Ebola to fight Zika, only the latest infectious disease in a time when global infectious disease outbreaks (and varieties) are on the rise. The United States has certainly established itself as a global force in combatting epidemics, providing financial and military assistance in the West Africa Ebola outbreak. The Zika funding fight though, has been particularly brutal. It’s easy to cry government dysfunction and partisanship, and there’s certainly plenty to go around, but there’s another more perverse relationship at play, too. At the end of the day, infectious disease outbreaks just don’t align with legislative cycles. Epidemiological response requires forecasting, detective work, and some guessing. Government agencies might be funded by the fiscal year, but there’s no telling what the CDC, NIH, and others will have to fight next, not how big that fight will be. The best case scenario, perhaps, is influenza, which utilizes half a year of careful surveillance to identify dominant strains and manufacture vaccines before Northern-Hemisphere flu season arrives. Zika and Ebola though, can emerge rapidly, producing calls for help overnight.

Consider the controversy and outrage over the public health response to Flint, Michigan’s lead crisis, a situation that arose more of less entirely because of policy. Now consider an enemy that follows no human schedules. Whether funding arrives in the form of an emergency bill or the regular appropriations process, infectious disease relief in its current form will always see that now-familiar fight over just how much is needed, and how badly. Disease will stay partisan for as long as we allow it to.

Iceland, Horses, and Hendra: Greg thinks about infectious disease when he’s supposed to be on vacation

By Greg Mercer

I recently visited Iceland, which in addition to being naturally beautiful and having weird day/night cycles thanks to its latitude, is something of an ecological paradise with an excellent renewable energy record. I was surprised to learn about their horses and the restrictions placed upon them, partially for the prevention of disease.

The Icelandic horse is notable for being fairly small (pony-sized, but don’t call it a pony), adaptable, hardy, and having 5 types of gaits, a detail which is basically meaningless to me but is apparently of great significance to horse dressage enthusiasts. My companions and I stopped at a stable, where one of the breeders told us about the breed, its history, and its unique international commerce status. I haven’t met too many horses but these ones seemed pretty nice.

Icelandic horses are popular around the world, and are frequently exported to foreign buyers for work or show. Imports of horses to Iceland, however, are banned. Once they leave, they can’t go back home, and horses born outside the country aren’t allowed in. Allegedly, this has been the case for about a thousand years. It’s hard to pin down a start date for that, but the policy is in effect today. There are two reasons for this: Icelandic horses are prized for being purebred and having a heritage that dates back to Viking settlers. They’re the only breed of horse in Iceland, so maintaining these traits is easy. Presumably the 80,000 horses in the country are enough to avoid a population bottleneck (I must reiterate that I am no horse expert).

But the import ban also guards against disease. Iceland has few natural horse diseases, and the breeder I spoke to said that Icelandic horses are frequently unvaccinated, which would be very unusual in the rest of the world. When they’re exported, they have to be treated as if they don’t have any immune protection. The import ban prevents foreign diseases from entering the country (via other horses, anyway).

Horse vaccines are big business. Throughout the rest of the world, horse owners can vaccinate their horses against West Nile Virus, Influenza, Potomac Horse Fever, Rabies, and other diseases. It makes a lot of sense: horses represent a major investment. For a horse owner, the cost of vaccination could be a fraction of the financial loss from a fatal horse disease. Plus, people tend to like their horses, and want to keep them from getting sick.

Even if you aren’t a horse dressage enthusiast or otherwise equine-inclined, horse diseases are no joke. Consider Hendra virus: Named for the suburb of Brisbane, Australia, where it was first isolated, Hendra is a Henipavirus, in the same family as Nipah virus. It’s found in Australia, Southeast Asia, India, and Madagascar. It can be transmitted from horses to humans via exposure to a horse’s bodily fluids, tissues, or excretions, and can prove fatal in both humans and horses. It’s likely that horses are exposed to the virus from the urine of flying foxes, a type of large bat. The details of the fatal Brisbane outbreak are detailed in David Quammen’s excellent book, Spillover.

This is all to say that Icelandic horses have a unique situation. As long as no new equine diseases enter the country, it’s more or less a closed system. The Icelandic Food and Veterinary Authority takes this equilibrium very seriously, offering warnings about foreign disease and guidelines for preventing infection.