The Biden administration, in its waning days, is allocating $306m to respond to public health threats from bird flu, a move applauded by public health experts as the H5N1 outbreak continues to expand among people and animals in the US.
As the outbreak intensifies, the US should continue investing in pandemic response like wastewater monitoring, vaccine manufacturing and distribution, rapid test development and other pressing needs to curtail the outbreak, experts say.
But it’s not clear whether the incoming Trump administration will continue such work.
About $183m of the new funding will go toward pandemic preparedness writ large, especially treatment, at the regional, state and local level, while $103m will be spent monitoring people who have been exposed to the bird flu virus. Another $8m will go to test manufacturing and distribution, and $11m is set aside for research on how to combat H5N1.
“These investments are critical to continuing our disease surveillance, laboratory testing and monitoring efforts alongside our partners at USDA,” Xavier Becerra, secretary of the US Department of Health and Human Services (HHS), said in a statement.
The new funding will be distributed within weeks and because the money has already been appropriated, it cannot legally be reversed if the incoming Trump administration lays out diverging priorities.
While the Biden administration has spent about $1.8bn responding to bird flu so far, the majority of those funds have gone to the US Department of Agriculture (USDA) to address the outbreak among animals.
About $360m of those funds have gone toward human health in this outbreak, which means the new allocation nearly doubles the total amount committed to curtailing bird flu in people.
“I’m thrilled to see this funding made available and I hope that the new administration leans into it to strengthen our ongoing monitoring of the spread of the disease and our ability to stay alert for human cases,” said Megan Ranney, emergency physician and dean of the Yale School of Public Health.
Steps like monitoring the virus in milk and producing more antiviral medication could have been more effective earlier to curtail the outbreak, she said.
“I worry that the virus is already widespread amongst animal reservoirs in the US, so there’s a little bit of luck now in whether or not it turns into a pandemic,” Ranney said. “It could have potentially been averted had we acted more aggressively six or nine months ago.”
Awarding funding to regional, state and local health departments is particularly important because “that seems to be an important catalyst to take action”, said Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health.
“It’s often federal action of some sort, usually in the form of money, that gets states activated,” Nuzzo added.
Improving communication and data-sharing between local entities like healthcare professionals, businesses and school leaders is key for understanding patterns of disease in communities, Ranney said: “Who’s getting sick from what, when and why?”
There was a “long list” of actions needed to respond to this outbreak and to prepare for potential worsening scenarios, with initiatives like monitoring wastewater for pandemic-potential pathogens “top of mind”, Nuzzo said.
Nuzzo noted that “there’s some question about the funding and whether that will be continued” and “wastewater surveillance not only needs to be continued but needs to be expanded”.
Other forms of monitoring for the virus also needed to be supercharged, Nuzzo said. “We are in flu season now, so our strategy for finding cases has to shift, and that will require more H5N1-specific testing, not just testing for flu A.”
While some at-home flu tests exist in the US, they are prohibitively expensive and not widely available. Creating affordable, accessible rapid tests for H5N1 could help ascertain and prevent spread, Ranney and Nuzzo pointed out – especially if the virus mutates for sustained transmission between people.
“If it could spread easily between people, we would be in a pandemic, and it would be around the globe in a matter of weeks,” Nuzzo said.
In the meantime, she said, “we need to do more to protect farm workers”. That includes offering H5N1 vaccines, whether through an emergency use program or a clinical trial, to people at risk of getting sick.
“This is a nasty virus that nobody wants to get. It is a great blessing that the farm workers have not gotten sicker,” Nuzzo said. “But we have seen that this virus retains the potential to make people severely ill.”
The first death in the US from the highly pathogenic avian influenza occurred in Louisiana earlier this month.
Samples of the virus showed a worrying set of mutations that probably occurred over the patient’s course of illness, similar to mutations seen in the 13-year-old girl who has been hospitalized because of bird flu for the past two months in British Columbia, Canada.
“It’s another reminder of how important it is for us to be planning ahead in case of the worst-case scenario and also to try to avert the worst-case scenario,” Ranney said. “We shouldn’t be waiting until the worst happens to act.”
Trump’s pick to lead the HHS, Robert F Kennedy Jr, has for decades staked out anti-science positions, particularly against lifesaving vaccines. Kennedy has also encouraged raw milk consumption during this outbreak.
“We’re going to give infectious disease a break for about eight years,” Kennedy said of infectious disease research last November.
But pandemics are happening with increasing regularity, especially in a changing climate. And a major part of responding to them goes beyond science or funding.
“We need public leaders, health officials and community groups to work together to create trust,” Ranney said.