Public health officials are growing more and more concerned about the Zika virus as its true impact in South and Central America becomes clear. In January, the World Health Organization said Zika could be on the verge of spreading throughout the Americas. Health organizations in the U.S. are upping their efforts to develop a vaccine and eradicate the virus, and the White House has asked that money be appropriated to help make this happen.
But as certain as death and taxes, Republicans in the House of Representatives have emerged to slow this process to a crawl. GOP lawmakers have met these calls to action with indifference masquerading as fiscal responsibility. Congressional action on the issue has stalled, and the only alternative for those who want to fight a Zika outbreak is to subtract funding from other pressing priorities.
In one sense, this isn't surprising. For years, House Republicans have made a habit of bumbling from one crisis to the next without a plan (unless you count "shut down the government" as a plan, and you shouldn't). But the response to the Zika virus seems deeply strange when you think about the Ebola outbreak of 2014, when Washington lawmakers fell all over themselves to take action.
Don’t get me wrong: It’s good that Zika hasn’t touched off the kind of wild-eyed fearmongering that we saw with Ebola. But some officials have gone way too far to the other extreme, with House Republicans essentially shrugging off an issue they really ought to take seriously.
A tale of two viruses
Ebola is a horrifying sickness that's brought real devastation to West Africa, but Americans' panic over the virus never quite matched up with the facts. Yes, Ebola has proven hard to eradicate. We don't have a vaccine yet. And once a person contracts the virus, treatment is difficult, sometimes impossible. People with Ebola often die brutal, harrowing deaths.
At the same time, the virus is quite cloddish, epidemiologically speaking. It spreads primarily through body fluids -- and while it can travel via saliva in certain circumstances, it's much more commonly transmitted through blood, feces and vomit. The disease is at its most beastly in environments that lack basic sanitation and hygiene. It’s likeliest to spread among people who live in such conditions, and among the medical professionals who treat them. The front lines of the war on Ebola are in West Africa.
When the disease came to the U.S. two years ago, things unfolded in a textbook manner. A Liberian national named Thomas Eric Duncan was diagnosed with Ebola in Dallas, and two of the nurses who treated Duncan contracted the disease as well. (A physician with Médecins Sans Frontières, returned to New York City after assisting with the concurrent Ebola outbreak in Guinea, also contracted the disease during this time.) In the end, Duncan succumbed to the disease while the rest of the afflicted survived.
Zika isn't as deadly as Ebola, but it could pose a far worse problem than Ebola ever did. It's primarily a mosquito-borne virus (though it can also be transmitted sexually), which means it can spread much faster than Ebola, and it's often asymptomatic. The most dangerous thing about Zika is that it can lead to severe birth defects, such as microcephaly, in the fetuses of pregnant women who contract the virus. It can also cause an auto-immune disorder called Guillain-Barré syndrome. These are serious conditions that alter people's lives and put long-term strain on the health care system.
As The Atlanta Journal-Constitution reported last month, Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, and Dr. Ed McCabe, medical director of the March of Dimes, have given lawmakers some specific warnings with regard to Zika:
“Without additional resources we won’t be able to get the resources we need to get to the state and local levels to provide Americans with the protection they deserve,” Frieden said.
Congress has said the CDC should use any remaining Ebola funds to fight Zika, but Frieden and others said that would not be sufficient.
“Shifting money from crisis to crisis will have us chasing our tails,” said Dr. Ed McCabe... “We have a few short months to stop Zika from gaining a foothold in the U.S. If we don’t the consequences will be dire.”
But a lot of people on Capitol Hill don't seem to care.
Rifts open as Congress struggles to respond
The Senate has been more active than the House in helping public health officials confront Zika’s potential onslaught. As The Hill reported last week, Republicans in the Senate are working with their Democratic counterparts to direct money toward anti-Zika efforts. Democrats in both chambers are backing President Barack Obama’s request for funding. And many lawmakers in the South -- the region that might first bear the brunt of a Zika outbreak -- seem to understand the need to be proactive on this issue. (Florida Senator Marco Rubio has been a key ally in the effort to secure the $1.9 billion requested by Obama.)
The Senate is closer to passing a $1.1 billion bill -- a move that House Democrats are threatening to oppose for being half a loaf. But Democrats in the House still seem to grasp the seriousness of the situation better than Republicans, who appear more or less content to kick the Zika can down the road to October, when the request for funding might be considered as part of the normal appropriations process.
The views of the House GOP caucus can be summed up by the remarks of Rep. Tom Cole (R-Okla.). Per CBS News:
Cole chairs an appropriations subcommittee considering the administration's request.
"We do believe the NIH, and we do believe the CDC," Cole told CBS News. "But have to use the resources that we have wisely."
Cole added he wasn't "going to put a date on it," but expected more funds to be available "before the end of the fiscal year," which is October 1.
House Minority Leader Nancy Pelosi (D-Calif.), though, has pointed out that waiting until October to move on Zika funding would actually mean waiting a lot longer than that:
"We need the money now," House Minority Leader Nancy Pelosi told CBS News. "The budget process takes a long time -- it will be practically nine months before we could get any other money, and there's no guarantee that you have the money at the end of the year."
Robbing Ebola to pay for Zika
House Speaker Paul Ryan (R-Wis.), though, has endorsed the idea of waiting. “The money's in the pipeline," he told CBS last month. "Our appropriators are going to address this issue -- if the need ever arises, our appropriators will address it in the appropriations process."
When Ryan mentions “money in the pipeline,” he’s talking about funds that have already been allocated to fight the Ebola crisis. Obama has, in fact, diverted some of this money to fight Zika as a short-term stopgap. But administration officials have warned that this won’t be enough to combat a Zika outbreak. And public health officials say that depriving the Ebola eradication effort is going to “set back work in West Africa” and delay the development of a vaccine.
The interesting thing about this Ebola funding -- the money that House Republicans say could be easily diverted to mount an attack against Zika -- is where it came from in the first place. Its roots lie in an earlier era, when a more motivated House GOP aimed to demonstrate its responsiveness in the face of an emerging crisis. Back then, congressional Republicans didn’t delay or dither, as they are doing now. In fact, they crowed about how active and involved they were, and frequently accused the White House of being unprepared and slow to respond.
Back in October 2014, House Majority Leader Kevin McCarthy (R-Calif.) seemed to grasp what needed to be done to fight the Ebola virus. “We’ve got to go to the core of the problem, solve it there and invest in a vaccine and a treatment to cure it once and for all,” he said during an appearance on "Face the Nation." McCarthy pointed out that his caucus was working with the Obama administration to secure timely allocations of money to spur the fight. As he put it, the “safety of the troops” was one of the paramount concerns.
And McCarthy was eager to brag about how House Republicans were responding. On Oct. 16, 2014, he approvingly retweeted a “list of actions House committees have taken in response to the Ebola outbreak" from then-Speaker John Boehner (R-Ohio), lest anyone think House Republicans weren’t taking the matter seriously.
Those actions included a short-term continuing resolution with provisions for Ebola containment, a $50 million appropriation to “support Operation United Assistance, the Department of Defense-led mission to combat the Ebola outbreak,” a $700 million appropriation to the same effort two weeks later, and numerous hearings and statements pertaining to the U.S. public health response and global efforts. There was no foot-dragging, no talk of delay.
Now, however, McCarthy’s sense of urgency is nowhere in evidence. As The Hill reported last week:
Leaders of appropriators in the House and Senate have said publicly that they want to provide funding to fight Zika, but they are increasingly divided over how it is structured and whether it can wait until later this year.
On Tuesday, House Majority Leader Kevin McCarthy (R-Calif.) said he would prefer to handle the funding through the regular appropriations process, pushing the debate over emergency dollars until the new fiscal year begins on Oct. 1.
It was bad enough that McCarthy was ruling out emergency measures, but as Politico further noted, pushing the question of Zika funding to October only creates further uncertainties:
It’s unclear what legislative vehicle a Zika deal would hitch a ride on. Republicans typically prefer to make such allocations in the annual spending bills, per McCarthy’s Tuesday statement. But it is unclear that Speaker Paul Ryan (R-Wis.) will be able to pass appropriations bills on the House floor given steadfast conservative opposition to spending levels.
There’s also a question of whether the money will be pinned as “emergency” spending, which allows appropriators to ignore budget caps that constrain other types of spending. McCarthy deferred on that question Monday. And he wouldn’t say whether the new spending would be offset, as conservative groups have demanded.
And what of Ryan? In 2014, he was quick to urge officials to “stay ahead of the Ebola outbreak.” He was equally quick to criticize the White House’s efforts, calling the appointment of Ron Klain as “Ebola czar” an “inside, crony type of selection.” (Klain actually ended up doing an admirable job.) At the time, it was reported that Ryan was mainly concerned about the government’s competence.
Now, Ryan's endorsed the view that the money appropriated to fight Ebola would be better spent on Zika -- an approach that essentially transforms the response on both fronts into sad half-measures that have public health experts worried. “The administration has a bit of a track record of over-requesting,” Ryan has said, failing to mention how his own colleagues, during the Ebola crisis, made sure such requests got fulfilled and were happy to take credit once they were.
Gambling with House money
Although his current plan basically comes down to "rob Ebola to pay Zika, and fall short in both cases," Ryan is casting his approach as evidence of shrewd leadership. But the speaker actually has a record of helping to deny public health professionals the tools they need.
Sequestration cuts came as a bitter blow to public health agencies in 2013. Those cuts forced the National Institutes of Health to slash its budget by $1.55 billion, and subtracted $13 million from the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, which has been leading the U.S. effort to eradicate Ebola in West Africa. The CDC ended up recovering some of those funds a year later. But as The Huffington Post’s Sam Stein reported, Ryan’s budgeting has injured the CDC in ways that go beyond just sequestration:
If you move back the timeline a bit, you see that investment in the CDC has still fallen dramatically. The agency’s current budget, in fact, is nearly $600 million lower than it was in 2010.
- 2010: $6.467 billion
- 2011: $5.737 billion
- 2012: $5.732 billion
- 2013: $5.721 billion
- 2013 (after sequestration took effect): $5.432 billion
- 2014: $5.882 billion
While some of the funding was restored after the budget agreement between the House and Senate in early 2014, “there is still a gap between FY14 and FY10,” the Senate aide noted.
House Republicans may not understand this, but they're taking a huge chance on at least one public health crisis right now -- possibly two. Rep. Mark Meadows (R-N.C.) declared last week that “the Ebola battle is now completed” -- a claim for which there is no real basis. And as Politico’s Dan Diamond reported, when Obama was forced to to divert funding from the Ebola fight to help prop up the Zika response, House Republicans took a “victory lap”:
"We are pleased to hear today that federal agencies are heeding our call," House Appropriations Chairman Hal Rogers (R-Kent.) said in a statement. "These resources -- which the agencies already have on hand -- will help stop the growth of this devastating disease around the world, and prepare for and protect against outbreaks within our borders."
Rogers is signing his name to a number of promises while simultaneously starving the efforts to deliver on them. He’ll be among those with much to answer for if Zika gains a foothold in the U.S. or if Ebola re-emerges as a potent threat.
'Scarier than we initially thought'
As medical experts learn more about the Zika outbreak, their anxiety has only escalated. As USA Today reported last month, Dr. Anne Schuchat, principal deputy director of the CDC, says that Zika has “been linked to a broader array of birth defects” and has a greater “potential geographic range” than previously believed.
"Everything we look at with this virus seems to be a bit scarier than we initially thought,” Schuchat said. She was seconded by Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases, who said, "I'm not an alarmist and most of you who know me know that I am not, but the more we learn about the neurological aspects [of Zika], the more we look around and say this is very serious."
According to a report recently published by the United Nations’ High-Level Panel on the Global Response to Health Crises, “the high risk of major health crises is widely underestimated, and the world’s preparedness and capacity to respond is woefully insufficient.” It's precisely for this reason that Frieden, the CDC director, wants to act against Zika now. To that end -- and with the support of the White House -- he’s asked Congress to “approve a $1.9 billion request from the White House, $828 million of which would go to the CDC’s Zika effort.”
It really is amazing to compare the current situation to 2014. Then, lawmakers were ready to establish travel bans and quarantine medical professionals in the name of stopping Ebola. They demanded a czar and then lambasted the one they got. Most importantly, in less than a three-month span between Sept. 30 and Dec. 10, Congress managed to pony up $5.4 billion for the medical community to fight the disease.
Now, House Republican leaders are dilly-dallying, taking an incredible gamble with public health and courting a potential crisis that their colleagues in the Senate, their Democratic counterparts, the White House and the public health community all believe can and should be thwarted by acting now, before it’s too late.
How, exactly, will we know when it's too late? Amy Pope, the White House’s deputy homeland security adviser, said earlier this year that “if we wait until the public is panicking, until we see babies being born with birth defects, we have waited too long.” Should things get to that point, one imagines the finger-pointing and the excuses, at least, will come as quickly as anyone could want.