Authorizes the sale of $5.5 billion in general obligation bonds to fund research on stem cells.
What the Measure Would Do
Proposition 14 would authorize the state to sell $5.5 billion in general obligation bonds to fund stem cell research and develop related medical treatment. The funds would go to the California Institute for Regenerative Medicine (CIRM). Up to 9.5% of the bond revenue would support administrative uses. Prop 14 would dedicate $1.5 billion for grants focused on Alzheimer’s disease, Parkinson’s disease and other diseases affecting the brain and nervous system. The remaining funds would be used for grants for other stem cell research programs, clinical trials, initiatives to partner with undergraduate students and other programs.
The measure also changes CIRM operations and governance by increasing the number of independent oversight members from 29 to 35; creating a new advisory board focused on improving patient access to stem cell treatments; and limiting the total number of CIRM full-time staff. Prop 14 further requires that any revenue generated by stem cell-related inventions funded by the bonds would be directed to help pay for patients’ medical treatments. Finally, the measure would also require that CIRM provide research facility grants and fellowships to California State University, California Community Colleges and the University of California.
The Legislative Analyst’s Office estimates the total cost of the measure, including interest, to be $7.8 billion. This would amount to an estimated $260 million per year from the state’s General Fund, over a 30-year repayment period. Prop 14 would limit the amount of bonds the state can sell each year, with the goal of spreading bond sales over at least an 11-year period. The measure also requires that interest payments for the first five years be paid by revenue from the bond sales. Beginning in 2026, interest repayments would be made by the General Fund.
Stem cells are the building blocks of life, multiplying in the embryo into hundreds of different cell types. Considered the most promising type of stem cells for medical treatments, human embryonic stem cells were first isolated in the lab in 1998. The discovery created a new field of scientific study, but ethical concerns led to federal restrictions on funding for research. In 2004, California voters approved Proposition 71, which created a state-funded stem cell research program. The measure established the California Institute for Regenerative Medicine (CIRM) to oversee the program and disburse $3 billion in bond revenue for research grants. Grants have primarily been used for treatment development and clinical trials. Other grants have funded basic stem cell research and, to a lesser extent, research facilities and fellowships for medical students.
CIRM funding hasn’t resulted in any FDA-approved stem cell treatments, despite high expectations. However, treatments have been developed for a range of diseases and conditions. CIRM-funded work at the University of California, Los Angeles successfully cured infants with fatally compromised immune systems. CIRM has also supported developing treatments for fatal blood cancers, for reversing paralysis and treating type 1 diabetes.
Prop 71 required that CIRM grant recipients who sell their resulting inventions share a portion of their revenue with the state. The state began receiving income from these inventions in 2017, which now totals $350,000. Additionally, CIRM has been criticized in the past for governance and oversight issues.1
In 2009 President Obama signed an executive order opening up federal funding for stem cell research. The National Institutes of Health now spends more than $1 billion on stem cell research annually, including around $300 million annually solely on human embryonic stem cell research. CIRM has a current partnership with NIH to fund research on sickle cell disease.
The bond funding accounts for almost all of CIRM’s revenue, and as of October 2019, all but $132 million of the bond money had been spent. The agency has put a plan in place should the measure fail: Most staff will be laid off by the end of the year and a reduced budget will be enacted to manage the existing grants.
Some argue that stem cell research to date has primarily generated expensive therapies for very rare diseases. On the other hand, stem cell research holds promise in treating sickle-cell disease, a somewhat common and debilitating disease that primarily affects Black people. Stem cell research in HIV could lead to breakthroughs for the LGBTQ community. And some argue that making these investments in research could lead to major advancements on much more common diseases like diabetes that disproportionately impact people of color. Prop 14 also includes allocations to increase access to clinical trials and to bring down the cost of treatments.
Another consideration is that CIRM funding has primarily gone to well-endowed universities in the Bay Area and that public dollars could be better spent on other health care priorities.
Prop 14 was placed on ballot by signatures collected by the group Californians for Stem Cell Research, Treatments & Cures. As an initiative statute, it requires a simple majority (50% plus one vote) to pass.
- Prop. 14 delays the state making repayments on interest for five years, providing some relief in the midst of an economic downturn and decreased state revenues.
- The measure includes requirements to expand clinical trials and research to parts of the state with little access to these treatments historically.
- The state is facing historic budget cuts, potentially to core services like education. Stem cell research may not be the best use of public dollars at this time.
- Bond revenues are better suited to major capital investment and not to ongoing programmatic needs, as this measure proposes.
- CIRM has faced repeated criticism over conflicts of interest on its large governing board. Instead of addressing them, this measure would further increase the size of the board.
- This measure intends to lower the cost of stem cell treatments, funded by revenue from the sale of treatments and inventions. Given the small amount of revenue the state has received from inventions in the past, Prop 14 may not adequately fund this important goal.
In 2004, California created a first-of-its-kind medical research agency and in the years since, CIRM has funded important clinical research and solidified the state’s place in a global field. This work is still important. However, CIRM was created at a time when no federal funding existed and now the landscape has changed. The federal government awarded $2.1 billion in funding for stem cell research in 2019. At the same time, California faces significant fiscal challenges and potential cuts to essential services like education and health care, as well as persistent challenges like homelessness and housing affordability. In our current circumstances, the state should prioritize the security and well-being of its residents today, and CIRM should pursue other sources of revenue for this important work.
1. A 2009 report from the Little Hoover Commission (the state’s non-partisan government watchdog) and a 2013 report from the Institute of Medicine called for reforming grant review processes, creating an external advisory board and changing the relationships between the board and staff. At one point, over 90% of grants had gone to institutions linked to members of CIRM’s 29-member board.