Drawing Borders Around a Borderless Specialty

As practitioners in infectious diseases (ID) know, ID is the one specialty that cannot be practiced within the borders of a country, state, or even continent. Neither pathogens nor vectors respect political or geographic borders, so we require cross-border networks to track new pathogens, resistance mechanisms, and outbreaks.

This is why a rule proposed by the Office of Management and Budget (OMB), a massive rewrite of federal grantmaking, is so concerning. Most of the narrative has focused on the legitimate concerns about how it would affect universities and “science.” However, the impact on ID in particular could be dramatic. Surveillance is the cleanest example. The proposed rule would generally restrict research awards to domestic investigators and groups and prevent spending on collaborative international efforts without explicit authorization, which includes a sign-off by a political appointee. International surveillance helps identify tomorrow’s local problems, as we have witnessed time and time again. It also shows companies which resistance mechanisms should drive future drug development; more than 99% of all approved drugs have funding from the National Institutes of Health for their development.¹ The US has already left the World Health Organization.

Blocking these types of collaborations without an appointee’s permission does not prevent waste; it creates a bureaucratic barrier to our earlywarning system. This not only prevents the approval of grants that are already reviewed by scientists but also discourages the development of new collaborative efforts in the first place. We have already seen what can happen when a broad rule is open to interpretation.

The Antimicrobial Testing Leadership and Surveillance (ATLAS) database, sponsored by Pfizer, recently pulled the US isolates from public view. The website cites the US Justice Department’s Bulk Sensitive Data Rule (28 CFR § 202.202), which was written to prevent “countries of concern” from receiving access to Americans’ sensitive personal data, primarily related to genetics and protein expression and the samples that could enable that.² The interpretation that this necessitates the removal of US data from ATLAS is a cautious one. The SENTRY program of antimicrobial resistance (AMR) surveillance, run by JMI Laboratories (now part of Element), has not reached the same conclusion; US isolates remain viewable on its microbiology visualization platform.³

The vagueness in the Bulk Sensitive Data Rule has led to different interpretations and reactions by these 2 entities, one of them removing access to an important resource and chipping away at what we have available to monitor and counter AMR. The OMB rule would affect this much more directly, making research efforts to conduct AMR surveillance significantly more difficult. The ways we share what we learn will also be affected by OMB’s rule. It would prohibit the use of federal grants to cover publication costs without specific agency approval. Nobody, including me, loves article-processing charges or open-access fees, and the model deserves a reform-minded hard look. However, in our current model, funding of open-access publications allows new knowledge to spread further and faster across the world, particularly to institutions and countries with limited library resources.

This information restriction is furthered by requiring advanced approval for conference and professional society costs, constraining personal communication of scientific findings. The restriction of knowledge exchange this creates will also limit knowledge creation. Most attention on the OMB proposal has justifiably focused on the insertion of political appointees into the granting process, as it creates a chilling vision of taking US science from scientists. Vulnerable areas of ID research include broad swaths of what we do: vaccine research, HIV treatment and prevention, harm reduction strategies, and social determinants of health. We cannot even predict what future areas could be affected; perhaps they will not be developed as a generation of research is skipped.

Each of these concerns from the OMB action is significant and requires pushback, but what is bigger than the headline is the pattern. Our specialty is under assault in ways that are not immediately obvious. No single rule is the story. The story is a borderless specialty being fenced in piece by piece while we argue about the pieces.

References

1.Galkina Cleary E, Jackson MJ, Zhou EW, Ledley FD. Comparison of research spending on new drug approvals by the National Institutes of Health vs the pharmaceutical industry, 2010-2019. JAMA Health Forum. 2023;4(4):e230511. doi:10.1001/jamahealthforum.2023.0511

2. ATLAS. Accessed September 4, 2026.
https://atlas-surveillance.com/login

3.JMI Laboratories. Accessed September 4, 2026.
https://sentry-mvp.jmilabs.com/