Health Security Volume 15, Number 4, 2017 ª Mary Ann Liebert, Inc. DOI: 10.1089/hs.2017.0047 Federal Funding for Health Security in FY2018 Crystal Watson, Matthew Watson, and Tara Kirk Sell This article is the latest in an annual series analyzing federal funding for health security programs. It examines proposed funding in the President’s Budget Request for FY2018 and provides updated amounts for FY2017 and actual funding for FY2010 through FY2016. The proposed FY2018 budget for health security–related programs represents a significant decrease in funding from prior years and previous administrations. In total, the President’s proposed FY2018 budget includes $12.45 billion for health security–related programs, an estimated decrease in funding of $1.25 billion, or 9%, from the estimated $13.71 billion in FY2017 and an 11% decrease from the FY2016 actual funding level of $13.99 billion. Most FY2018 health security funding ($6.67 billion, 54%) would go to programs with multiple-hazard and preparedness goals and missions, representing a 14% decrease in this funding compared to FY2017. Radiological and nuclear security programs would receive 20% ($2.48 billion) of all health security funding, a slight decrease of 2% from the prior year. Biosecurity programs would be funded at $1.53 billion (12% of health security funding) in FY2018, a decrease of 6% compared to FY2017. Chemical security programs would represent 3% ($389.7 million) of all health security funding in FY2018, a 9% decrease from the prior year. Finally, 11% of health security funding ($1.39 billion) would be dedicated to pandemic influenza and emerging infectious diseases programs, the only category of funding to see an increase (3%) above FY2017. his article is the latest in an annual series ana- To organize this analysis, US federal funding is divided Tlyzing federal funding for health security programs.1-14 into 5 domains critical to strengthening health security: It examines proposed funding in the President’s Budget Request for FY2018 and provides updated amounts for Biosecurity: Federal programs focused on prevention, pre- FY2017 and actual funding for FY2010 through FY2016. paredness, and response to attacks on civilians with bio- Health security is a ‘‘state in which a nation and its logical agents and accidental releases of biological material; people are prepared for, protected from, and resilient in Radiological and Nuclear Security: Federal programs thefaceofhealththreats.’’15,16 Building health security focused on prevention, preparedness, and consequence for the nation is the responsibility of multiple agencies in management of radiological and nuclear terrorism and the US federal government and of state, tribal, territorial, large-scale radiological accidents; and local governments and the private sector. To better Chemical Security: Federal programs focused on pre- Downloaded by Johns Hopkins Univ e-journal package from online.liebertpub.com at 08/11/17. For personal use only. understand and define the federal role in health security, vention, preparedness, and response to large-scale this analysis aims to identify health security–related acute chemical exposures of civilian populations, both programs in public health, health care, national security, intentional and accidental; and defense and to report funding levels for that ongoing Pandemic Influenza and Emerging Infectious Diseases: work. Federal programs focused on preparedness and Crystal Watson, DrPH, MPH, is a Senior Associate; Matthew Watson is a Senior Analyst; and Tara Kirk Sell, PhD, MA, is a Senior Associate; all are at the Johns Hopkins Center for Biosecurity, Baltimore, Maryland. 1 FEDERAL FUNDING FOR HEALTH SECURITY IN FY2018 response to large, naturally occurring, and potentially The authors recognize that this is not a perfect ac- destabilizing epidemics; and counting of all of the federal health security work. Analysis Multiple-Hazard and General Preparedness: Federal of agency budgets and programs included in previous programs focused on multiple hazards or on building years resulted in a number of program additions and a few infrastructure and capacity to respond to large-scale changes in the categorization of programs. As a result, health threats. funding totals for different areas of health security and agencies included may be difficult to compare with pre- vious years’ articles. However, funding comparisons can General Methods be made between fiscal years within this article. Federal funding amounts were analyzed from FY2010 This analysis of federal health security funding documents through proposed funding for FY2018, using information funding levels for health security–related programs. It sepa- from FY2018 federal agency budget materials as well as rates funding for health security into categories based on budget documents from prior years. Sources for this anal- the major focus of the program being included. Choices ysis include federal agency ‘‘Budgets in Brief,’’ agency regarding how an individual program is categorized can be congressional budget justifications, and personal contacts difficult because of limited publicly available information with agency representatives to obtain and track program describing the programs or identifying program-level fund- funding. For the purpose of this analysis, programs have ing amounts. been categorized according to whether they focus on bio- Efforts are made each year to obtain funding information defense, chemical hazards, radiological/nuclear hazards, down to the program level in order to be as accurate as pos- pandemic influenza and emerging infectious diseases, or sible. However, in some cases, funding for specific programs multiple-hazard and general preparedness. Programs have cannot be separated from larger line items, and so those line been categorized based on their major focus, as described in items are either included in their entirety or are included in the budget documents or on program websites. Summary ta- ‘‘multiple-hazard and preparedness’’ section of this analysis. bles for program funding in each category are provided in this article, with more detailed tables available online (see supplemental material at www.liebertonline.com/hs/). This analysis of federal health security budgets prioritizes Overall Findings programs supporting prevention, preparedness, and response, as well as related research efforts. Specifically, research pro- The President’s proposed FY2018 budget for health grams that support either medical countermeasure (MCM) security–related programs represents a significant research and development (R&D) or threat/risk characteriza- decrease in funding from prior years and previous tion efforts were included in the analysis. Prevention programs administrations. In total, the President’s proposed explicitly targeted at preventing large-scale accidents or ter- FY2018 budget includes $12.45 billion for health rorist attacks with chemical, biological, or radiological agents security–related programs, an estimated decrease in are also included. Finally, federal emergency preparedness and funding of $1.25 billion, or 9%, from the estimated response programs are included if they focused on protecting $13.71 billion in FY2017 and an 11% decrease from the health of US citizens in large-scale health emergencies. the FY2016 actual funding level of $13.99 billion. The analysis excluded programs focused on routine pro- Most FY2018 health security funding ($6.67 billion, vision of health care, occupational health and safety, or 54%) would go to programs with multiple-hazard warfare between nation states. In addition, the analysis ex- and preparedness goals and missions, representing a cluded programs focused on protecting the warfighter with 14% decrease in this funding when compared to no stated or likely civilian applications now or in the future. FY2017. Radiological and nuclear security programs Specific inclusion and exclusion criteria and methods ap- would receive 20% ($2.48 billion) of all health se- plied to each domain are detailed in each respective section curity funding, a slight decrease of 2% from the prior of this analysis. year. Biosecurity programs would be funded at $1.53 billion (12% of health security funding) in FY2018, a Biosecurity Program Funding Downloaded by Johns Hopkins Univ e-journal package from online.liebertpub.com at 08/11/17. For personal use only. decrease of 6% compared to FY2017. Chemical se- curity programs would represent 3% ($389.7 million) of all health security funding in FY2018, a 9% de- This section focuses on funding for federal programs aimed at crease from the prior year. Finally, 11% of health prevention, preparedness, response, recovery, and mitigation security funding ($1.39 billion) would be dedicated of deliberate biological threats against the US civilian popu- to pandemic influenza and emerging infectious dis- lation, and of accidental releases of biological threat agents eases programs, the only category of funding to see an from a laboratory. In total, the President’s proposed budget increase (3%) above FY2017 (see Figures 1 and 2). includes $1.53 billion in FY2018 for programs solely devoted to civilian biodefense. The FY2018 proposed budget would 2 Health Security WATSON ET AL Biosecurity $1,529.3 (12%) Multi-Hazard and Preparedness $6,671.6 (54%) Radiological/Nuclear Security $2,476.6 (20%) Pandemic/Emerging Chemical Security Infectious Diseases $389.7 (3%) $1,386.2 (11%) Figure 1. FY2018 Federal Health Security Funding by Program Focus (in $millions) represent