As U.S. House and Senate Appropriation Committee members prepare to set funding levels for health and human services that include medical research during the fiscal year ahead, 679 clinicians and researchers as well as leaders of 416 organizations working to prevent, treat and some day end the impact of HIV, have added their names to letters telling Congress the fight is not over yet.
Three and a half decades after AIDS was recognized, but less than two decades since the scientific advances that made living with HIV possible for the by then millions of people around the world who were infected, and just as the trajectory of the global pandemic has begun to turn, this, the letters say, “is the time to prioritize, not curtail, HIV/AIDS research.”
The letters came after word circulated last week of a possible agreement in the House of Representatives to cut 10- to 20 percent of the HIV research funding allocation for the National Institutes of Health.
Concern also stems from an exchange during a Senate Health, Education, Labor and Pensions Committee hearing in March as Sen. Bill Cassidy (R-La) questioned NIH director Dr. Francis Collins on allocations of medical research dollars:
” . . .in your testimony, you mentioned the great success that we have had with HIV in terms of eradicating. I’ll point out that it still seems to be 10 percent of your budget. And the Alzheimer’s dementia, I think, is what $800 million now and HIV is $3 billion, which is 10 percent of the NIH’s budget . . .” Sen. Cassidy said, adding “I would again push that if HIV/AIDS as you mentioned is substantially addressed — still problems but substantially — and Alzheimer’s dementia is balloon [sic] . . . we should start shifting more aggressively resources from that which has been addressed to that which we are confronting. . .”
(In Dr. Collins’ testimony, what he had actually said in his one mention of HIV was: “HIV/AIDS treatment and prevention may now enable us to envision the first AIDS-free generation since the virus emerged more than 30 years ago.”) In addition, the HIV organizations’ letter to Congress notes: “there remain over one million people living with HIV in the U.S. and almost 50,000 Americans become newly infected every year. Globally, there are more than 35.3 million people living with HIV, the great majority of them in sub-Saharan Africa.”
The letter also urges sustained funding for research for answers to a spectrum of diseases, saying “The race to find better treatments and a cure for cancer, Alzheimers, heart disease and other diseases, and for controlling global epidemics like HIV/AIDS, viral hepatitis, tuberculosis and malaria, all depend on a long term investment strategy for health research at NIH.”
It is not the first time that perceptions that diseases must compete for dollars in a spending environment where medical research has not been prioritized (between fiscal year 2003 and fiscal year 2015 the NIH budget dropped by almost 30 percent, the letters note) has raised concerns. Last year, during a House hearing on fiscal year 15 allocations, National Institute of Mental Health Director Thomas Insel said: ” . . . when you compare autism to AIDS, it’s really quite extraordinary. So as you said . . .$160 million is being spent in 2012, it’s a little more than, but that’s basically the autism figures. . . AIDS affects about a million people in the United States — do you want to guess what the AIDS budget is for research at the NIH? It’s $3 billion. We’re talking about $160 million for a disorder that affects at least as many children as are affected by — as affected with AIDS in the entire country . . .”
The letter from HIV researchers and clinicians cautions against basing research allocations on disease burdens: “Research investment to contain and control the spread of deadly infectious diseases,” it says, “must be a priority to advance public health and protect global security.”