When Policy Undermines Public Health: The Human Cost of Funding Cuts

Policy decisions are drastically reshaping public health, and the consequences go far beyond budgets, threatening years of scientific progress and affecting the health of the people these programs were designed to serve.

At a local level, San Francisco has seen a decrease in harm reduction resources for drug users as a result of a new mayoral candidate with a different approach to treatment. 

On a federal level, the NIH has suffered budget cuts and the restructuring of many of its institutes as a result of the current administration, leading to the loss of funding for many research projects. 

These changes have a direct impact on people’s lives, their work, and on future health outcomes.  

Dr. Erin Wilson, a UCSF professor and senior research scientist at the San Francisco Department of Public Health, discussed the loss of harm reduction resources for drug users in her talk on Stalled Progress in Getting to Zero HIV Infections in San Francisco. 

Wilson demonstrated the correlation between the increased adherence to anti-retrovirals in people with HIV and an increase in overdose deaths in San Francisco. 

Wilson explained that the apparent increase in adherence to antiretroviral treatment coincided with fluctuations in overdose deaths. As harm-reduction programs in San Francisco were cut, overdose deaths increased, including among people living with HIV. 

These deaths reduced the overall population of people with HIV, making treatment adherence appear to improve even as the number of people consistently taking antiretrovirals declined. Wilson linked this decline in treatment adherence to lower rates of viral suppression and increased HIV transmission in San Francisco.

So, instead of getting closer to its goal of getting to zero new HIV infections, San Francisco has actually moved in the other direction, with new legislation decreasing harm-reduction funding and thus, impacting treatment adherence and HIV transmission. 

This raises a pressing question: What scientific background or expert advice are policymakers relying on to allow them to make decisions that carry such drastic consequences for public health?

On a federal level, the National Institutes of Health (NIH), the primary federal agency responsible for biomedical and public health research, has undergone significant  changes since the current administration came into office. 

Grants for global health involving foreign countries and foreign work have been sparse, with many many restricting funding to research conducted at U.S. institutions.. 

The implications of this are enormous, with some research projects operating in foreign countries for decades being suspended over lack of funding. 

At UCSF, several researchers have expressed the workarounds they’ve had to develop, including setting up UCSF-affiliated satellite offices in countries where they previously conducted research, allowing them to continue using grant funding there. 

The loss of research impact as a result of these changes, along with the additional time researchers must spend developing workarounds before they can even begin their work, has caused devastating consequences for scientific progress and the lack of care from the federal government is alarming. 

Wilson showed the direct health impacts of changes in policy at the local level, and changes in federal policy will only exacerbate these adverse outcomes in disease transmission.