April 12, 2021 – President Joe Biden signaled his administration’s public health priorities in an outline of the fiscal year 2022 (FY 22) budget released last week. These proposed investments include substantial increases in funding for the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), creation of a new biomedical research agency within the National Institutes of Health, a doubling of funding to fight the opioid crisis, and replenishment of the Strategic National Stockpile of medical supplies.
Although an April 9 budget outline sent by the Office of Management and Budget to Senate Appropriations Committee Chairman Sen. Patrick Leahy (D-Vt.) provides only the highlights of the Biden plans and few particulars, it is the first glimpse into how he plans to invest in public health, pandemic preparedness, the opioid crisis and clinical research. In a presidential transition year, presentation of the full budget for the coming year, which starts Oct. 1, generally is delayed by a few months.
These proposed investments include $131.7 billion in discretionary funding for the Department of Health and Human Services (HHS), including 21st Century Cures and program integrity activities – an increase of nearly 24 percent. According to the proposed budget request summary, this increase is designed to build on the response to the COVID-19 pandemic “by prioritizing investments to prepare for future public health emergencies and advance global health security.” It “addresses the opioid crisis; expands biomedical capabilities; promotes health and social service equity; expands access to child care and early learning programs; strengthens social services; supports survivors of domestic violence; and invests in civil rights enforcement.”
“This initial budget outline reflects a more robust investment in the federal government’s public health agencies and in biomedical research,” noted Jon Bigelow, executive director of the Coalition for Healthcare Communication. “This is especially noteworthy when seen in context with the American Rescue Plan passed last month (which provided an extra $500 million for the FDA) and the initial proposals for the upcoming infrastructure legislation (which reportedly will include up to $150 billion in federal spending on research, much of it touching on health.”
To strengthen the national and global readiness for the next public health crisis, the Biden administration is seeking to rebuild and expand the country’s ability to prevent, detect and respond to emerging and future biological threats. That priority includes:
- A discretionary finding request of $8.7 billion for the CDC, an increase of $1.6 billion over 2021 levels. This is “the largest budget authority increase for CDC in nearly 20 years and is needed to restore capacity to the world’s pre-eminent public health agency,” the summary states.
- $905 million for the Office of the Assistant Secretary for Preparedness and Response (ASPR) for maintaining and replenishing its Strategic National Stockpile and preparing for chemical, biological, radiological and nuclear threats. Additionally, the Biden administration states it would “make investments to enhance the FDA’s organizational capacity,” although the amount of those investments and exactly what they would be used for are not provided in this 58-page document.
Among other proposed FY 22 budget priorities in the public health arena are:
- Promoting biomedical research and establishing the Advanced Research Projects Agency for Health (ARPA-H). The discretionary request includes $51 billion for the National Institutes of Health (a $9 billion increase over 2021 funding level), which includes $6.5 billion to establish ARPA-H. ARPA-H’s mission would be to focus on cancer, diabetes, Alzheimer’s disease and other diseases, and its purpose would be to “drive transformational innovation in health research and speed application and implementation of health breakthroughs,” the summary states. This office would be an important part of Biden’s previously stated goal of working to cure cancer, which took the life of his son Beau.
- Investing $10.7 billion (an increase of $3.9 billion over 2021) to fight the opioid crisis.
- Investing $670 million with the stated goal of ending the HIV/AIDS epidemic.
- Promoting health equity by addressing racial disparities ($153 million, up from $3 million in 2021) and investing in services for American Indians and Alaska Natives ($8.5 billion, up by $2.2 billion).
A more detailed budget proposal is expected next month. The relevant House and Senate committees will then hold hearings over the summer on the various proposals.