By Robert R. Slater, Jr., M.D., F.A.C.S.

The COVID-19 pandemic has alarmed and outraged many and has impacted the world in astonishing ways. There has been a lot of focus on some subsections of the problems encountered. Tragically, the bulk of the debate has missed one key element in the crisis.(1) It has missed the opportunity to demand more from our leaders in the medical profession as a whole and even more so from our political leaders at all levels to invest more in biologic research so that this kind of debacle never happens again.

The 1918 flu was the world’s worst pandemic on record, killing an estimated 50-100 million people worldwide, and 675,000 in the US.(2) Recently, it was reported that a woman survived being infected by the respective causative viruses in both that historic pandemic and the current COVID-19 crisis.(3) Tragically, not nearly enough has changed in our ability to treat victims of such viral illnesses in more than a century. Treatment focuses on supportive care while the infected host battles the disease and either survives or succumbs. That is appalling and ought to be a source of embarrassment for our scientific community but even more so for those who control the purse strings and determine the amount of money spent on basic science and medical research.

It is clear the current pandemic pandemonium has impacted the lives of millions and killed well over a hundred thousand, just in this nation alone. The hope is that this debacle will NOT be repeated over and over again, but the sad fact is that not enough has changed in over 100 years, since the flu epidemic wreaked havoc on earth’s inhabitants in 1918.

It is instructive to consider a few facts that help put this deplorable situation in perspective. Consider for a moment the astounding difference in the amount of money spent on military expenses versus the amount spent on medical research in this country alone.

The total budget request for the National Institutes of Health (NIH) for fiscal year (FY) 2021 is approximately $39 Billion.(4) The mission of NIH is to “seek fundamental knowledge about the nature and behavior of living systems and to apply that knowledge to enhance health, lengthen life, and reduce illness and disability.”(4) That includes research and development of vaccines.

When looking at NIH funding adjusted for inflation, the purchasing power peaked in FY2003, and then declined fairly steadily for more than a decade until back-to-back funding increases were provided in each of FY2016 through FY2020. The FY2021 budget request would provide a program level that is 13.0% below the peak FY2003 program level.(5)

Instead of steadily increasing the funding of the NIH over the years to adjust for inflation and the cost of doing more and more advanced research, there have been many years in which NIH budgets suffered cuts. That tragedy has been bipartisan in nature. Under the current administration, the budget has been increased very slightly each year, but this year that increase was mostly in response to the pandemic. On March 17, 2020, the Office of Management and Budget submitted an amendment that would increase funding for the National Institute of Allergy and Infectious Disease (NIAID) by $440 million relative to the original request. The purpose of this additional requested funding was “to ensure [NIAID] has the resources beginning October 1, 2020, to continue critical basic and applied research on coronaviruses and other infectious diseases”.(6) Additional funding was requested this year for the Centers for Disease Control and Prevention (CDC) for activities such as Immunization and Respiratory Diseases, Emerging and Zoonotic Infectious Diseases, Global Health, Public Health Preparedness and Response, and the Infectious Diseases Rapid Response Reserve Fund.

The budget for the entire Department of Health and Human Services is designed to support the government-wide implementation of the National Biodefense Strategy. HHS is tasked with multiple objectives including advanced research and development of medical countermeasures against chemical, biological, radiological, nuclear, and infectious disease threats, and pandemic influenza. However, amidst the total budget, there is a call for spending a total of only $2.7 billion for biodefense and emergency preparedness capacity. The total budget is $1.2 trillion dollars but of that, most is spent on current healthcare expenses such as Medicare and Medicaid. Only 7% ($87 billion) is available for all other discretionary spending, including any research that might be funded.

In comparison to that, consider the amount the US spends on the military. There are many ways to analyze that. For example, it is notable that for fiscal year 2021, the budget just for acquisition (Procurement and Research, Development, Test, and Evaluation (RDT&E)) funding requested by the Department of Defense (DoD) totals $243.4 billion, and the request for aircraft alone is $57 Billion and for missile systems is $33 Billion.(7)

The single largest defense program expenditure will be for the 5th generation F-35 Joint Strike Fighter jet airplane, each one of which costs $144 million. For FY 2021, the Department of Defense requested $21 billion for missiles and munitions, representing 9% of the Investment budget request. Instead of cuts in spending, there has been an increase of 137% from the amount funded in FY 2015.(7)

Yes, it is true that scientists have made some limited progress in understanding infectious diseases and medical conditions, and often have managed to do that on shoe-string budgets. Maurice Ralph Hilleman (1919-2005) was a Montana State University alumnus and a microbiologist who specialized in vaccinology. He developed more than 40 vaccines, an unparalleled record of productivity. Of the 14 vaccines routinely recommended in current vaccine schedules, he developed eight: those for measles, mumps, hepatitis A, hepatitis B, chickenpox, meningitis, pneumonia, and H. influenza.(8)

Hilleman is credited with saving thousands of lives with his vaccine developed for the 1957-58 flu pandemic. That virus killed 2 million people worldwide and about 70,000 in the US but some estimated a million Americans would have died without Hilleman’s vaccination campaign.(9) And he did all of that while being consistently under-funded and while overworking his teams, demanding an exhausting 7-days/week work schedule and mandating testing of new vaccines on the researchers themselves if they wished to continue in his laboratories.(8) That is behavior that would never be tolerated today. Is that really what it is going to take to continue making progress in the battle for public health? Unless there is more money spent on research, that may well be true.

All of this is not to say we need to cut spending on the military defense of this great nation. Rather, it is a wake-up call to alert the nation to the disparity in expenditures in systems that destroy life and the medical science research needed to preserve and improve life. For every dollar spent on destructive machines, we would do well to spend a dollar on basic research in medicine. Now is the time to press ALL politicians to commit to spending as much on biological and basic science research to preserve and protect life as they spend on military weapons and nuclear holocaust machines that will destroy life and the whole planet along with it. We can and must do better: biology over bombs.

Robert R. Slater, Jr., M.D., F.A.C.S. is an Orthopaedic Surgeon in private practice in Sacramento County (California) and is a Clinical Professor of Orthopaedic Surgery at the University of California – Davis. He graduated in 1985 with Honors from Stanford University with a BA in History. He earned his MD at the University of Wisconsin – Madison and then did his residency in Orthopaedics at the University of North Carolina – Chapel Hill, followed by a fellowship in upper extremity surgery at UC-Davis. Recent leadership positions include being President of the Western Orthopaedic Association 2016-2017.

He can be reached at:  rslater96@gmail.com

REFERENCES

1. Romeo A: COVID-19: learn, innovate and inspire the next generation to be prepared. Orthopedics Today. 2020; 40(4):3-6
2. Shelden P: What 1918 Spanish Flu death toll tells us about COVID-19 coronavirus pandemic. MedicineNet Health News. Available at https://www.medicinenet.com/script/main/art.asp?articlekey=228841. Accessed 5/13/20
3. Dvorak P: COVID-19 is the second pandemic this 107-year-old artist has survived. Washington Post. 2020; 5/7/20. Available at https://www.sfgate.com/news/article/Covid-19-is-the-second-pandemic-this-107-year-old-15254666.php. Accessed 5/13/20
4. Collins F: NIH Budget Request, FY2021. Available at https://officeofbudget.od.nih.gov/pdfs/FY21/br/1-OverviewVolumeSingleFile-toPrint.pdf. Accessed 5/5/20.
5. National Institutes of Health (NIH) Funding: FY1995-FY2021. From the Congressional Research Service. Available at https://fas.org/sgp/crs/misc/R43341.pdf. Accessed 5/13/20
6. Letter to Michael R. Pence, Vice President of the United States and President of the Senate, from Russell T. Vought Acting Director, Office of Management and Budget, March 17, 2020. Available at https://www.whitehouse.gov/wp-content/uploads/2020/03/Letter-regarding-additional-funding-to-support-theUnited-States-response-to-COVID-19-3.17.2020.pdf. Accessed 5/13/20.
7. UNITED STATES DEPARTMENT OF DEFENSE FISCAL YEAR 2021 BUDGET REQUEST. Available at https://comptroller.defense.gov/Portals/45/Documents/defbudget/fy2021/fy2021_Weapons.pdf . Accessed 5/13/20
8. Montana State Microbiology Department press release: Maurice Hellman: the man who saved millions. https://www.montana.edu/mbi/hillemansymposium.html. Accessed 5/13/20.
9. Searcy M. The Man who developed 40 vaccines. The University of Chicago magazine. 2019; Fall issue.https://mag.uchicago.edu/science-medicine/man-who-developed-40-vaccines. Accessed 5/13/20.