CQ Weekly has a long, excellent story now up at CQ.com (the full piece available by subscription only) on bioterrorism research, and the impact that this new imperative has had on the National Institutes of Health in the last 4-5 years:
The institutes will receive about $1.7 billion this fiscal year alone to build labs, conduct basic research and subsidize private-industry efforts to develop drugs. In the process, the administration is transforming NIH from a civilian research institution, focused mainly on curing naturally occurring diseases, into an essential cog in the nationâ€™s homeland defense system, one that is increasingly geared to defending against man-made biological threats.
The emphasis on bioterrorism comes at a cost, however, according to a growing number of scientists and public health experts, who worry that the work is siphoning resources from research on AIDS, bacterial pneumonia, malaria and other punishing afflictions that claim millions of lives every year. The scientists are concerned that the heavy spending might prompt some researchers to rearrange their priorities so as to follow the grant money â€” a familiar scenario in federally funded research.
The article takes an especially close look at the National Institute of Allergy and Infectious Diseases (NIAID), which has been responsible for the vast majority of bioterror related research within NIH. It raises the key question as to whether this new focus has weakened other medical research areas or, by a “rising tide lifts all boats” logic, has strengthened these other fields.
I would be concerned about the possibility of bioterror research crowding out other areas, if not for this key fact:
Advocates and lobbyists working on cancer and dozens of specific diseases became accustomed to generous budget increases during a five-year period between fiscal 1998 and fiscal 2003, when Congress doubled NIHâ€™s total budget.
I find it hard to believe that any part of NIH is in dire financial straits, given that every single entity within it has had at least an 80% cumulative budget increase in the last eight years, according to this chart (not password-protected) that accompanies the story. With a growth rate like that over such a relatively short period, no one should be complaining.
The article does raise one very thought-provoking question: how do we know whether we’re spending enough money on bioterrorism related research?
Without knowing how severe the risk may be on the ground, budget-watchers cannot say with assurance that 38 percent is too much â€” or too little â€” a slice of the NIH pie….
Coherent progress is a much tougher order of business in bioterror research. It doesnâ€™t have a tightly defined set of research objectives of the sort specified for something like a new space vehicle or improved hurricane-warning system. And again, no one has a clear fix on the true scale of the threat.
The reason why we don’t have a good fix on the scale of the threat isn’t for lack of effort; it’s because there are so many variables that are difficult to measure and/or unknowable. For example, consider the following variables that feed into the risk and investment equation:
- What’s the chance that terrorist groups will attempt a bioterror attack with a serious agent in the United States in the next decade? Is it 1%? 5%? 30%? A percentage point of difference at the low end of this scale has a huge impact on any risk assessment.
- If there is an attack using agent “X”, what are the likely consequences? No deaths? 10 deaths? 5,000 deaths? 1,000,000 deaths? A large variance in estimates is to be expected in many scenarios, given the way that outbreaks and epidemics can “tip” and expand logarithmically from a minor incident to a full-scale national crisis.
- How is the value of the investment in research affected by investments in other layers of the biodefense system, such as hospital capacity, disease surveillance, and citizen education?
- If general microbiological research has the potential to improve defenses against evolving or future biological threats, how does that impact upon the value of current, directed research?
None of these questions are easy to answer or estimate. Given this fact, I think we have no choice but to decide funding levels partially on the basis of intuition, as discomfiting as that might be to some people.
Overall, a very good story, and hopefully one that CQ will open up for broader readership in the next few days.