A day before the opening of the joint annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, the HIV Medical Association, and the Pediatric Infectious Diseases Society in Washington, DC, about 70 infectious diseases and HIV specialists, researchers and clinicians came to town for a day of educating their legislators.
It was the first day of the official federal fiscal year, which, however, on Tuesday had yet to begin; in a repeat of previous years’ patterns, Congress, which had finalized its funding for 2019 late in the year, had yet to agree on funding for 2020. In the meantime, the government was running on a temporary agreement to continue operating under the previous year’s funding allocations — a continuing resolution.
While much better than no agreement, and a shutdown of government offices that had hampered health services for weeks at a time in 2018 and 2019, the continuing resolution left the support for new programs — including the administration’s Ending the HIV Epidemic initiative, as well as increases for existing programs for global and domestic public health and research — included in a House bill — up in the air. It also left open an opportunity for experts, who confront the consequences of gaps in health services and research daily, to explain the importance of funding and policies shaping responses to infectious diseases in the year to come.
“You’re not here to change people’s minds,” Dr. Bill Powderly, a former president of the Infectious Diseases Society of American told the experts before they headed out. “You’re here to inform them.”
They called it the Big IDea — a day of Infectious Diseases/HIV Education and Advocacy — on issues that include the growing global threat of infections resistant to current antibiotics and other antimicrobial medicines, cost and compensation issues discouraging new physicians from entering infectious diseases and HIV specialties, and the new initiative to end HIV as an epidemic — which could not begin until it is funded.
Some of these issues remain abstract, in varying degrees. While antimicrobial resistance has the easy potential to affect anyone, for example, to those not on the front lines of fighting infections, its consequences might seem like a distant threat. In fact, the impacts of antimicrobial resistance are more likely to be felt as a tsunami, Dr. James Hughes, a Decatur, Georgia-based infectious diseases physician explained to a congressional staffer — inescapably overpowering the gains of modern medicine, if they are not attended to now. All of the physicians had stories to tell of patients successfully treated for other iillnesses, including cancer — succumbing to infections that could no longer be effectively treated. The DISARM act — which requires hospital stewardship to protect the effectiveness of existing antibiotics and better antibiotic reimbursements to spur research for new ones — legislation informed by infectious diseases physicians and scientists, the visiting specialists told staffers, is one of the answers.
Issues surrounding the costs of attaining a medical education and the relatively low compensation allocated by the Centers for Medicare and Medicaid Services for the care provided by physicians specializing in infectious diseases, would seem to have less widespread ramifications. But the disconnect between the extra training required for infectious diseases physicians and the lower compensation was discouraging new physicians burdened with medical school debt that would take decades to pay from pursuing the specialty. The consequence — with fewer physicians entering the field, the number of experts in field that was becoming only more critically needed is dwindling, Dr. Carlos del Rio who treats patients in Atlanta, told a Senate staff member. One result — recently he treated a patient who had been transferred to from a hospital in a city two hours away where no infectious diseases physician was available. The better outcomes for patients treated for infections by specialists in the field, the burden for patients and their families when appropriate care is not available were among reasons to support student loan repayments for physicians providing services that also include HIV care, as well as to use Congressional oversight of Medicare and Medicaid reimbursements to provide improved compensation for those in the field.
In some ways, the initiative to end HIV as an epidemic in the United States could be seen as having the broadest appeal. Launched by a Republican administration, supported by a Democrat-led House in its spending bill, the plan would end HIV has a public health threat by 2020. A “PEPFAR for the United States,” Dr. del Rio, called it, citing the U.S. President’s Emergency Plan for AIDS Relief that has saved millions of lives and averted millions of HIV infections around the world. The U.S. has the most severe HIV epidemic of any developed country, he noted, with the southern states at the center, and his state, as well as the city where he practices, the “center of the center.” While preventing the transmission of the virus from women living with HIV to their babies during pregnancy has long been possible, and has led to the certified elimination of mother to child transmission in several countries, babies continue to be born in this country with HIV, Dr. Ann Chahroudi, a pediatric infectious diseases physician from Georgia told legislative staff. Still, the immediate fate of the plan remains uncertain — with the jurisdictions it would support applying for funding that has yet to be allocated by a final spending agreement.
For a long day’s work, the rewards seem unlikely to be immediate for the Big IDea participants. In the long run — perhaps in the next year, the stories they shared are more than likely to pay off in public health progress. As it is, the visiting doctors, clinicians and researchers delivered thanks for sponsored bills, funding, support throughout the day at offices they visited. Still, as staffers in those offices noted, while a lot is going on in Washington lately, not much (at least not much that will immediately advance public health) is getting done.