On December 13th, President Obama signed the 21st Century Cures Act into law. This law provides $6.3 billion for cancer cure research, and to address the growing opioid drug abuse epidemic. The Act also allows for a more streamlined approval process for the FDA to bring new drugs and medical devices to the market. While increased funding for health initiatives SHOULD have me dancing on my desk, I am underwhelmed by what this Act will do to improve public health. I am also concerned that the cuts made to existing initiatives to fund this Act do more to undermine the improvement of health in this country than to better it.
Funding cures by cutting disease prevention programs
As the name indicates, the focus of this Cures Act is to fund research and initiatives that promote the creation of cures for diseases such as cancer and Alzheimer’s. In order to fund this new initiative, Congress cut funding from several existing public health programs, most notably $3.5 billion from the Prevention and Public Health Fund, which was developed under the Affordable Care Act to prevent diseases like Alzheimer’s, chronic illnesses like heart disease and diabetes, and to promote increased vaccination. It seems counter-intuitive to gut a program that is trying to prevent illnesses from occurring in order to fund a program to find cures for the illnesses the former was trying to prevent altogether. I guess there is consolation in hoping the many people who will develop cancer and Alzheimer’s now due to the cuts in strategies that could prevent their illnesses will at least have a greater shot at being cured of their affliction… that is, if they live long enough to reap this “benefit.” To me, cutting prevention programs – which have proven records of efficacy and public health benefit, and that will likely tick up the prevalence of certain illness in the coming years – to fund the possibility of developing disease cures that could be 20 days or 20 years down the line, is just plain wrong.
Funding the POSSIBILITY of cures while Americans are still being denied cures that are already available: The ongoing Hepatitis C treatment access struggle
While Congress is throwing money at programs that might produce much-needed cures for illnesses at some point in the future, the legislative body continues to underfund and largely ignore supporting programs that will get already-existing cures into the hands of millions of sick Americans whose lives could be permanently improved by these therapies. Curative drugs for Hepatitis C – a disease that affects more that 4 million Americans – already exist. However, many still face numerous financial and procedural roadblocks to accessing these drugs. The poor, uninsured or underinsured are still being denied prescriptions for these drugs until their liver damage progresses to a more critical state. Medicaid programs continue to restrict access to Hepatitis C drugs to their recipients if they aren’t yet “sick enough” to warrant receiving treatment.
The Cures Act allocates $1 billion over the next 2 years for the treatment of those with opioid addiction. Injection opioid abuse is strongly correlated with increased risk and higher rates of Hepatitis C infections. It is not enough to just treat the addiction: there must also be services available to meet all of the health care needs of those in addiction recovery, including their Hepatitis C infection. The lack of discrete references to any plans to increase support for Hepatitis C initiatives as part of these new public health programs, despite the direct relationship between injection opioid abuse and high rates on HCV transmission, gives me little reason to feel encouraged that resources allocated for Hepatitis C services will improve.
This is NOT THE WAY to secure the nation’s health
The government MUST stop the piecemeal funding of public health programs, and invest in comprehensive strategies that provide long-term solutions and make the most efficient use of limited resources to maximize the reach and impact of the initiatives. It also cannot continue to throw money behind the latest politically popular issue before effectively resolving existing public health needs. The support of public health programs cannot ebb and flow with political transitions. It must remain consistent, especially when initiatives show proven efficacy and benefit. It is the moral and legal responsibility of the government to protect the health of the people, and our leaders need to let this obligation, rather than political influence, rule their decision-making at it relates to funding and other allocations for public health initiatives.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.