With a document short on detail, but sweeping in its proposals to reduce resources for longstanding programs, the President Trump releases “A Budget Blueprint to Make America Great Again“
In a “skinny” budget proposal with vast implications for medical research and public health at home and abroad the Trump administration today outlined a plan of government spending that would cut nearly a fifth of the budget for the National Institutes of Health and slash funding for the Department of State and USAID while preserving “sufficient resources to maintain current commitments and all current patient levels on HIV/AIDS treatment under the President’s Emergency Plan for AIDS Relief.”
Also promising to meet commitments to provide 33 percent of projected contributions to the Global fund, maintain support for the President’s Malaria Initiative and provide “sufficient resources on a path to fulfill the $1 billion U.S. pledge” to Gavi, the Vaccine Alliance, the plan released today offered some solace to global health response advocates, while leaving open multiple questions — on the fate of PEPFAR goals and funding, on global health security efforts and on other bilateral and multilateral responses to diseases, including tuberculosis, and on responses to domestic HIV and public health readiness.
The so-called “blueprint” offers a first brief glimpse of a radical reordering or U.S. priorities, with proposed cuts of 31 percent — or $2.6 billion — to Environmental Protection Agency funding, nearly 29 percent — or 10.9 billion — to State Department and USAID funding, and 16 percent — or $12.6 billion to funding for the Department of Health and Human Services. At 62 pages, about a third of the length of traditional White House Budget proposals, the document released today is a preview, with details, and breakdowns of how funding would be allocated, to come.
But impacts, both global and domestic, can be gleaned from explicit proposals that include eliminating the NIH Fogarty International Center which, with a $70 million budget, supports global health research partnerships between institutions investigating HIV, Ebola, and other chronic and infectious diseases in the U.S. and abroad; trains scientists to address global public health threats, and builds scientific capacities in resource-limited countries. On a domestic level the document proposes eliminating $403 million in health professions and nursing training programs, and closing programs within the Office of Community Services, providing the example of the Low Income Home Energy Assistance Program.
At the same time, in language similarly unspecific as its PEPFAR promise, the plan commits to supporting “direct health care services, such as those delivered by community health centers, Ryan White HIV/AIDS providers, and the Indian Health Service,” adding: “These safety net providers deliver critical health care services to low-income and vulnerable populations.” As with the PEPFAR promise, it leaves unclear how, and with what resources, in a landscape of decimated science and support services, that is to be done.
Stay turned. A full budget proposal is expected in May.