This section focused on rapid funding mechanisms that could enable nimble and flexible grant distribution. Participants discussed strategies for designing funding mechanisms that would allow for sustainable disaster research protocols and that have the flexibility to immediately activate additional protocols during a disaster. Gwen Collman, director of the Division of Extramural Research and Training at NIH, highlighted several of the NIEHS options for funding of extramural research on disasters. The NIEHS Mechanism for Time-Sensitive Research Opportunities in Environmental Health Sciences (R21), for example, funds the collection of data when there is an unforeseen opportunity that requires rapid mobilization, establishment of a study population, and specimen collection. Another mechanism is funding through the network of NIH Centers of Excellence. Each NIH center has some discretion to move money quickly for pilot projects that meet center mandates. Centers can ask for rebudgeting of funds that are already in their core budgets or use their own pilot project fund. Additional nonfederal mechanisms and sources of funding are also discussed that could potentially be used for quick disbursement and research.
Dennis Wenger, program director for the Infrastructure Systems Management and Extreme Events program at NSF, described the NSF Grants for Rapid Response Research program (referred to as RAPID awards). According to NSF, “the RAPID funding mechanism is used for
proposals having a severe urgency with regard to availability of, or access to, data, facilities, or specialized equipment, including quick-response research on natural and anthropogenic disasters and similar unanticipated events.”1 Importantly, NSF also has a very well-organized extramural research community of disaster-science social scientists.
Proposals for RAPID are brief (two to five pages) and must include a clear description of why the proposed research is of an urgent nature and why a RAPID award would be the most appropriate funding mechanism. Before submitting a RAPID proposal, investigators must first contact the individual program officer whose expertise is closest to the proposed topic to determine whether the proposed work is appropriate for RAPID funding, Wenger explained. RAPID proposals are subject to internal merit review, and the funding decision resides with the program officer. Awards are up to $200,000 for 1 year and typically take only 1 or 2 weeks to process and award funding. Program officers are also allowed to make a decision of up to $50,000 without undergoing external peer review, giving them even greater flexibility and shortening time lines to just a few days. In contrast, the R21 mechanism Collman described from NIEHS is poised to release funding 3 months after submission at the earliest.2 However, Farris Tuma, from the National Institute of Mental Health (NIMH) at NIH, noted that within NIMH the R21 funding opportunities titled, “Rapid Assessment Post-Impact of Disaster” take approximately 8 weeks from submission to award. This includes initial peer review, second-level council review, and processing by the grants office. Once an application has been reviewed and recommended for funding, the money can flow in days. Wenger added that because NSF RAPID awards do not undergo the same rigorous external peer-review process associated with unsolicited proposals and career proposals, program officers may not spend more than a total of 5 percent of their annual budget on RAPID awards (there is no annual budget for RAPID awards).
In most cases, RAPID awards result from investigators approaching NSF about a potential proposal. In some cases, however, program officers draft a Dear Colleague Letter that is sent out broadly to the research community, calling for RAPID proposals. The Dear Colleague Letter is generally used during a major disaster, and there is usually a short deadline
1See http://www.nsf.gov/pubs/policydocs/pappguide/nsf09_1/gpg_2.jsp#IID1, D. Special Guidelines, 1. Grants for Rapid Response Research (RAPID) (accessed December 16, 2014).
2For more on the Mechanism for Time-Sensitive Research Opportunities in Environmental Health Sciences, see http://grants.nih.gov/grants/guide/pa-files/PAR-13-136.html (accessed December 16, 2014).
for proposals (2 weeks). This approach to call for proposals was used, for example, after Hurricanes Katrina and Sandy, the Indian Ocean tsunami, the earthquakes in Haiti and New Zealand, and the Fukushima nuclear disaster. As an example, Wenger said that after Hurricane Katrina, NSF received 170 inquiries about RAPID awards, 134 draft proposals were submitted, 80 were then submitted as RAPID proposals, and about 50 awards were made within 3 weeks.
Wenger said that in addition to the RAPID awards, NSF supports other initiatives that support quick response research. The Earthquake Engineering Research Institute (EERI), for example, has the Learning from Earthquakes program that is supported by NSF, and allows multidisciplinary teams of engineers, geoscientists, social scientists, and others to rapidly get on-site after an earthquake (although there is currently no health component to this program). The Natural Hazard Center at the University of Colorado, funded by NSF and other federal agencies, has a quick response program. At the beginning of the year, researchers submit brief proposals, and if an event occurs during the year that is related to a qualified proposal, funding would be approved (generally small grants of about $5,000 to assist with data collection). If the hazard or situation in the proposal does not occur during that year, researchers can apply again the next year.
Grantmakers In Health is the professional association for health foundations and corporate donors, said President and CEO Faith Mitchell.3 Association membership includes hundreds of foundations and other funding partners. Many health foundations are local, Mitchell explained. Many grew out of local nonprofit organizations, some were started by families, and some came about as a result of the conversion when a nonprofit health provider was sold to a for-profit hospital or other institution (by law, the proceeds of the sale are to be used for charitable purposes in the same area that was served by the nonprofit organization). About half of the members of Grantmakers In Health are local funders, about one-quarter are state based, and about one-quarter are national. They range from small to huge, Mitchell said. The Colorado Health Foundation, for example, provides grants to improve health and health care in Colorado and has more than $2 billion in assets.
Many of the association members are involved in disaster-related work, primarily related to response and recovery. Local foundations often see their role as serving the local community, and there is a lot of interest in community rebuilding. Many of the state and local foundations have emergency grantmaking procedures in place to provide rapid funding to organizations that are serving the immediate needs of residents in their communities. Larger foundations such as Robert Wood Johnson Foundation and others have a general interest in preparedness and often fund health-related research. Foundations also have the ability to write checks very quickly if they have to, Mitchell said, certainly more quickly than the typical government agency.
Mitchell shared several examples of ongoing work by member foundations. The New York Community Trust has been making grants to continue rebuilding neighborhoods that were hit by Hurricane Sandy. In addition to rebuilding the infrastructure of New York City, they are also using their funding to develop a disaster preparedness and response plan for elderly New Yorkers and to help protect recovery workers from injury through hazardous conditions. They also provided online legal resources for people affected by the storm and provided grant support to manage a community planning process for affected neighborhoods. The Conrad Hilton Foundation, based in California, is a national and international funder that supports immediate and longer-term assistance for people affected by natural disasters and promotes disaster preparedness. Through their Responding to National Disasters program, it awarded Harvard University $400,000 to scale up the Harvard Humanitarian Initiatives KoBo toolbox application suite. This toolbox application was designed to improve the coordination and evaluation of disaster response efforts and allows for on-the-ground, handheld, digital data collection. Another initiative is the Rockefeller Foundation’s 100 Resilient Cities Centennial Challenge. This is a $100 million commitment to provide grants to 100 cities around the world to address preparedness planning, including meeting the needs of vulnerable residents during a response. The 100 cities that receive grants also receive technical assistance and support in creating and implementing their plans, membership into a learning network of all the grantee cities, and support for hiring a chief resilience officer who will oversee the development of a resilience plan for their city. Thirty-two cities have already been selected.
In summary, Mitchell said, private foundations can move quickly, have a strong community-orientation focus, and are generally interested in applied response and recovery activities, rather than research, but there is an emerging interest in research that is directed to solving community needs.
Sarah A. Lister, specialist in public health and epidemiology at the Congressional Research Service (CRS),4 described some of the options available for funding disaster response, and the health aspects of response, from a congressional point of view. As background, Lister explained that the Anti-Deficiency Act essentially says that the federal government cannot spend money that has not been provided to it in advance through appropriations or other congressional action. There is, however, an exception that allows the government to accept volunteer services in order to preserve life and property in an emergency.5
Some specific mechanisms allow for spending on disaster response. Ideally, there would be an existing fund that is preserved until needed in emergency and disbursed only under certain conditions. There are few examples of this in the federal government. There is authority in the Public Health Service Act for the HHS Secretary to have a rainy day fund that she can access if she declares a public health emergency; however, there is no money in that fund. Although Congress did put in money in the late 1990s to be used for Y2K-related problems, Lister said it has never put money in the fund to be available for “as yet undetermined” purposes. A more realistic example is the Disaster Relief Fund administered by FEMA under the Stafford Act. When the president, at the request of one or more governors, declares that a major disaster or emergency exists (a Stafford Act declaration), FEMA can task other federal agencies with Mission Assignments, which are activities that are not already funded through their own budgets but for which they will be reimbursed from the Disaster Relief Fund. FEMA regulations for implementing the Stafford Act and providing
4CRS provides direct policy analysis and support exclusively to Congress. Although CRS reports may be in circulation, CRS does not have a public mission or a public website where the public can access reports. CRS provides authoritative expertise and analysis that is nonpartisan and neutral. CRS does not make recommendations, but does present analyses of viable options.
5Section 1342 of Title 31 of the U.S. Code can be accessed at http://www.gpo.gov/fdsys/pkg/USCODE-2011-title31/html/USCODE-2011-title31-subtitleII-chap13-subchapIII-sec1342.htm (accessed on November 10, 2014).
assistance do not explicitly address whether “ephemeral disaster research” can be justified as essential or nonessential, and arguments could be made either way, Lister added. Continuing to work with ASPR to develop clearer taxonomy related to disaster research response could be a useful path forward to aid in securing this type of funding.
Although the Stafford Act does not preclude an emergency declaration for a principally health event, Lister noted that there is only one example of using the Disaster Relief Fund for a chemical, biological, or radiological incident with a health component that did not also involve the destruction of infrastructure. This was an emergency declaration made in the response to the introduction of West Nile virus into the United States in the late 1990s. The Disaster Relief Fund was used for FEMA Mission Assignments allowing CDC and other HHS agencies to provide assistance to New York, Connecticut, and other states with outbreaks. The Disaster Relief Fund was not used for the flu pandemic in 2009. The bulk of that response, Lister said, was funded through supplemental appropriation from Congress, which was enacted about 2 months after the HHS Secretary declared the emergency.6
Transfer Authority and Budgets
The HHS Secretary and the directors of HHS agencies also have a certain amount of standing transfer authority. In their annual appropriations, Congress grants them the ability to move a small percentage of money around for uses other than the explicit allocations that Congress has provided. This transfer authority is used often, Lister said. The Secretary used it, for example, to fund implementation of the Affordable Care Act and the health care exchanges in 2013. The transfer authority is not limited to any particular purpose and could be used in an emergency if money is available, she suggested. She added that the further an agency is into the fiscal year, the less money there is available to move around for these purposes (i.e., they simply may not have 2 percent of their annual budget left in unobligated funds as they near the end of the summer).7 For example, the Substance Abuse and Mental Health Services Administration has a 3 percent reprogramming authority for disasters. However, if a new budget is not passed and continuing resolutions run for several months beyond
6For the full text of the Supplemental Appropriations Act, 2009, Public Law No. 111-32, 123 Stat. 1884-1886, see http://www.gpo.gov/fdsys/pkg/PLAW-111publ32/pdf/PLAW111publ32.pdf (accessed December 16, 2014).
7The U.S. federal government’s fiscal year is October 1 through September 30.
October 1, the agency may have no new funding to reprogram during hurricane season.
More flexibility is built into some agencies’ budgets. For example, the U.S. Food and Drug Administration (FDA) anticipates that some of its inspection resources are going to be deployed in an unanticipated manner (e.g., for inspections related to food-borne illness outbreaks), but it does not have much flexibility in its ability to do unanticipated intramural research. The CDC budget builds in flexibility to provide assistance to states and other public health entities for unanticipated events, and there is some flexibility in its ability to do unanticipated intramural research, but less so for grant making. Funding from private foundations can be used to support agency actions directly only with the permission of Congress, Lister explained. CDC, for example, has a congressionally chartered foundation with an emergency fund. Supplemental appropriations are used by Congress to address health emergencies for which assistance under the Stafford Act is insufficient or unavailable, or when inherent flexibility, transfer authorities, foundation funding, or other mechanisms fall short. However, Lister reiterated that supplemental appropriations from Congress can take some time.
In general, Lister said, there are often difficulties in finding ways to fund the health response to a disaster. In many cases, agencies would like to act, but they do not have a clear source of payment to cover their actions, or if they do have funds available, they are not necessarily available legally. It would be ideal if responders at the federal level could have more certainty about where funds might come from for immediate research that might be needed in a disaster. Lister noted that in a resource-constrained environment, Congress has been reluctant to fund the secretary’s Public Health Emergency Fund. There has also been discussion in the homeland security and disaster preparedness communities about whether it works well for the Disaster Relief Fund to be the central pot of money for all disasters, or whether each department should have its own version of a disaster relief fund. In closing, Lister noted that what is considered an emergency in terms of research may vary. For example, applied public health research, such as characterizing a new virus or developing a new laboratory test, may be “an easy sell,” while establishing a registry of exposure during an incident is a tougher sell, as this is not really research but setting the stage for future research.
As reported by Gwen Collman in her summary (see Box 7-1), some participants discussed issues surrounding the time it takes to award funding to investigators, the size of the awards, statutory issues related to the funding source, and the time frame to complete the research. With regard to access to funding, a participant suggested that the vast majority of people who are doing disaster research are not aware of the various funding opportunities described by the panelists. In addition, rapid response funding is disproportionately shifted toward infrastructure and engineering, as opposed to the full dimensions of human health. In this regard, some participants noted the need to raise awareness about the health aspects of disasters and the need to use disaster-related funds for health-related disaster research. Funders, Collman said, including FEMA and Congress, need to be educated about why disaster response research is needed and is useful. Funding is needed not only for the study of the clinical and technological aspects of response, but also for the study of organizational management (e.g., coordination, communication, situational assessment, and data sharing). In addition, disasters provide a very specific and unique opportunity to study dose and response in the environmental health field. Funding is needed pre-event to develop infrastructure and instruments and to be ready to arrive at the site as soon as possible and characterize the exposures by whatever means are appropriate (questionnaires, biospecimens, air monitoring, water monitoring), as the data dissipate exponentially as time passes.
Disaster Risk Reduction and Sustained Investment
Another suggestion was that the nation think programmatically about how to reduce disaster risk. Wenger concurred and noted that the United Nations Office for Disaster Risk Reduction is placing a greater emphasis on disaster mitigation and is developing a post-2015 framework for disaster risk reduction.8 Several participants also discussed the issue of trust in research and suggested the funding is needed to establish relationships and trust before a disaster through investing in, for example, health infrastructure in a community.
Rapid and Sustained Funding Mechanisms for Research in Disastersa
Challenges and Issues
- Time required to disburse money to applicants, size of awards, and time frame to complete research
- Awareness of sources of funding
- Coordination and implementation needs, financial support, and attention
- Funding needs before disaster: increase infrastructure, baseline data/characterization
- Statutory issues; different disaster funds or sources of funds
Opportunities for Improvement
- Other agencies replicate most successful funding models
- Holistic approaches to rapid response research
- Make sure health is front and center
- Possibilities to fund experts before the disaster and have deployable teams
Critical Partnerships and Collaborations
- Partnering with foundations that are interested in the needs of the communities in order to fill gaps that are necessary to make research impactful
- Community concerns: sustainability, strengthen health systems, and give back to the community
aThe challenges, opportunities, and partnerships listed were identified by one or more individual participants in this breakout panel discussion. This summary was prepared by the panel facilitator and presented in the subsequent plenary session. This list is not meant to reflect a consensus among workshop participants.
SOURCE: Plenary session summary of breakout panel discussion as reported by panel facilitator Gwen Collman.
There is a need for balance between making the most of the research opportunities that exist only because an incident happens and making overall improvements to the health system. If this is out of balance, the
community believes researchers come only when there is a disaster to take information away. Successful research must be couched within the need for health systems strengthening to prevent future events; otherwise, communities have little incentive to support researchers. Investing in systems and infrastructure also means that when disaster strikes, there is already some enhanced capacity of the region to respond and some baseline data (social science, medical, biological).
Various participants discussed the ability of the agencies who already support disaster research to continue to do so given budgetary constraints, and how to engage other funders and replicate other successful funding models. They suggested that a more holistic approach to funding—combining resources to provide funding across a number of areas—could help to reduce duplication and siloed efforts. Partnering with foundations that are interested in local concerns and needs can help to fill critical funding gaps as well as help to make the research experience more palatable and more useful to the community.