The American Society for Microbiology (ASM), representing over 40,000 members in the microbiological sciences, supports the recommendation of the Centers for Disease Control and Prevention (CDC) Coalition to fund the CDC at a level of $7.9 billion in fiscal year 2003. The Coalition's budget proposal will strengthen CDC's programs in infectious disease, surveillance, control and prevention, will help to rebuild the nation's public health system, and will improve the role of public health in national security.
The CDC plays a critical role in reducing death, illness and disability, both in the United States and globally. Increased funding for the CDC is warranted in fiscal year 2003 to sustain and expand the CDC's ability to respond promptly and effectively to outbreaks of new and emerging diseases, public health threats, national preparedness for a potential bioterrorism attack, and a growing international presence in combating infectious diseases. New resources are critical to ensure that CDC has a well trained, well staffed, fully prepared public health work force; expanded laboratory capacity to produce timely and accurate results for diagnosis and investigation; strengthened epidemiology and surveillance to enable rapid detection of health threats; and improved information systems to communicate, analyze and interpret health data and to provide timely and accurate public access to health information.
The United States and other countries face increasing threats and challenges from infectious diseases. Infectious diseases persist as the third leading cause of death in the United States.Worldwide they cause 25 to 30 percent of the more than 50 million deaths each year.Chronic diseases are linked increasingly to infectious agents, including more than 30 microbes to date.The cost to both human health and economic resources continues to spiral upward.
Infectious disease problems around the world are inextricably linked because an infectious microbe that emerges in any part of the world has the potential to spread across borders, especially because of increased international travel and trade. The CDC has an increasing role to play in responding to new, highly dangerous, drug-resistant or reemerging diseases detected anywhere on the globe. More than 35 newly emerging infectious diseases have been identified since 1973. Disease outbreaks endanger US citizens at home and abroad, threaten US armed forces and exacerbate political instability in nations. CDC must also respond to established diseases, such as HIV/AIDS, tuberculosis, and malaria, which continue to cause high morbidity and mortality.
The threat of the use of biological weapons is increasing. The CDC's role in national bioterrorism response and preparedness was tested in its response to the tragedy of September 11, 2001, and the bioterror event caused by anthrax mailed through the postal system. Public health workers from CDC, including microbiologists, epidemiologists, and others responded with immense dedication, skill and sacrifice to addressing a complex, difficult and unprecedented situation involving epidemiologic and forensic investigation and a high level of public concern. Adequate resources will be needed for CDC to further define, develop and implement public health capacities at local, state and federal levels to prepare for, respond to and recover from a deliberate disease attack on US citizens.
Responding to Infectious Diseases and Emerging Infectious Diseases
The ASM recommends that $260 million be allocated in fiscal year 2003 to implement fully the high priority CDC strategic plan to prevent emerging infectious diseases, which is currently funded at a level of $164 million. In 1994, the CDC launched the first phase of a nationwide program to revitalize the national capacity to protect the public from infectious diseases. The second phase of CDC's effort was released in l998, with the publication of the strategy for "Preventing Emerging Infectious Diseases: A Strategy for the 21st Century." In March, 2002, CDC announced its new "Global Infectious Disease Strategy, which includes specific items to address the need for a more international strategy to control infectious diseases. Additional resources will be needed for the implementation of the proposed activities.
CDC's efforts to prevent and control emerging diseases support a multi-layered, interconnected approach of disease surveillance, epidemic investigations, scientific research and training, and public education.Recently the CDC established seven domestic and global surveillance networks to detect and monitor various emerging diseases, provided epidemiologists to advise the global antimalaria campaign, and deployed specialists to nations now faced with outbreaks of Ebola hemorrhagic fever, hantavirus pulmonary syndrome, and other emerging viral diseases. The agency predicts that an influenza pandemic could kill between 90,000 and 210,000 people just in the United States, and that of all emerging infections, influenza could be the most serious threat to public health.In response, the CDC conducts domestic and worldwide surveillance of the disease, in collaboration with the World Health Organization, to facilitate early detection and response to influenza.
About 75 percent of CDC funding reaches state and local health departments to collect information and to implement health programs.More than 3,000 county, city, and tribal health departments and 59 state and territorial health departments, receive funding through the CDC. CDC has significantly expanded state capabilities to monitor new pathogens like hepatitis C virus and West Nile virus. In the United States, foodborne diseases affect an estimated 76 million victims each year and cause up to 5,000 deaths.The CDC last year provided training to all state health departments in DNA fingerprinting of bacteria causing foodborne illnesses, especially E. coli O157:H7, Salmonella typhimurium, and Listeria monocytogenes, part of the PulseNet network that quickly recognizes foodborne outbreaks throughout the nation.
The ASM recommends $25 million in new funding in fiscal year 2003 for CDC to implement the interagency Public Health Action Plan to Combat Antimicrobial Resistance, which was released in 2001. The CDC has joined with the FDA and the NIH to lead a new national effort against antimicrobial resistance. Antimicrobial resistance is increasing and the emergence of antimicrobial resistance among just six common bacteria adds about $660 million annually to U.S. hospitalization costs.The CDC has established clinical guidelines for health professionals on improved antimicrobial use and initiated state-level surveillance systems to track this growing problem. New activities proposed in the Action Plan to increase antimicrobial surveillance, prevention and control and extramural research to expand the peer-reviewed applied research program depend on an infusion of new funding.
Guarding Against Bioterrorism, Building National Security
The ASM endorses the FY 2003 proposed $1.6 billion for the CDC's Bioterrorism Preparedness and Response Program.The proposed budget includes: $940 million to upgrade state and local capacity, including training, laboratory, surveillance and epidemiological capacity, and communication and information systems; $300 million to enhance the National Pharmaceutical Stockpile; $100 million for efforts to counter the effects of smallpox; $l8 million for anthrax research and evaluation; $120 million for biosecurity improvements and facilities; and $159 million to upgrade CDC's emergency response and preparedness efforts, including increasing biological and chemical laboratory capacity, rapid response teams, Epidemic Intelligence Service officers and the Emerging Infectious Diseases Laboratory Fellowship Program.
The deliberate release of pathogenic microorganisms is no longer a hypothetical possibility, but a potent and grim reality.The CDC already had begun extensive bioterrorism-related research and planning before the anthrax release last fall, including expansion of vaccine and pharmaceutical stockpiles and research to develop better diagnostics and treatments for suspect pathogens.The CDC also categorized lists of possible bioterrorism agents based on their potential lethality, to better advise local health authorities and focus federal resources.Following the attacks, CDC responded by initiating a 24-hour Emergency Operations Center, activated nation wide information networks for health officials, and deployed an unprecedented number of Epidemic Intelligence Service officers and other staff to New York City and elsewhere.The ASM applauds the rapid and effective reaction by the CDC to these horrendous events, but remains concerned about deficiencies identified by the CDC within the public health system.
The FY 2003 budget request will assist with efforts to repair weaknesses in public health programs.The nation's ability to respond to a bioterrorist attack, which unlike an explosive or chemical attack can unfold gradually and silently, depends on the preparedness of its public health infrastructure and medical care systems.The number of deaths and serious illnesses in a bioterrorist attack is directly related to the speed and accuracy with which doctors and laboratories can correctly diagnose and report their findings to public health authorities. Programs are needed to specifically train medical and laboratory personnel. There is also a shortage of laboratories with the capability to identify biothreat agents. With new resources, the CDC will be able to expand its comprehensive and coordinated emergency planning and training program, in support of all states and certain cities that could become bioterrorism targets.This program includes the Centers for Public Health Preparedness based in schools of public health, integration of the CDC's high-tech Epidemic Information Exchange network into state and local surveillance plans, the National Laboratory System, the Laboratory Response Network, and dozens of other specific and science-based efforts to prepare all health agencies for possible bioterrorist attack.
The ASM urges the Congress to recognize that efforts to protect the nation against bioterrorism must function within a federal agency that also is strong in all other aspects critical to public health. The high consequence implications of bioterrorism place it in a special category that requires immediate and comprehensive response. At the same time, naturally occurring infectious diseases caused by emerging pathogens seriously threaten the health and security of the United States and other countries on an existing and continuing basis. Building the health infrastructure to respond to bioterrorism should also increase our ability to respond to naturally occurring and reemerging infections
Tracking Potentially Dangerous Biological Agents
Congress mandated CDC to implement and enforce regulations for monitoring the acquisition and transfer of biological agents within the United States under authority of the Antiterrorism and Effective Death Penalty Act of l996. Section 511 of the Act, Regulatory Control of Biological Agents, is intended to protect the safety of the public while not imposing undue restrictions on scientific research needed to develop new therapeutics for deadly pathogens.
The ASM has recommended that the CDC be provided adequate resources for implementation of the select agent rule. Congress is presently considering legislation that will expand the mandate to track the acquisition, transfer and possession of select agents and to now register laboratories which possess select agents. The new regulations include safeguard and security requirements, the collection of information for law enforcement and a process for alerting authorities about unauthorized attempts to acquire select agents. The ASM recommends that Congress determine the resources that will be needed for implementation of an expanded select agent program and provide the necessary new funding to ensure proper administration of the program.
Improving Buildings and Facilities
The ASM recommends that Congress appropriate $250 million for CDC buildings and facilities in FY 2003, an amount equal to the FY 2002 funding.Current research and management facilities used by the CDC are very inadequate.Some agency personnel experiment with pathogenic microorganisms in laboratories constructed as temporary facilities almost 60 years ago.Other structures are neither entirely efficient nor completely secure.Modern demands on CDC infrastructure grow more urgent and complex, and the agency must be supported in its long-range plans for updating old laboratories and constructing new buildings.It is critical that CDC research and management activities be consolidated into up-to-date and physically secure facilities, and that certain projects proceed quickly -- such as completion of the new Infectious Disease Laboratory, the Scientific Communication Center, the Environmental Toxicology Laboratory and a replacement for the aging vector-borne infectious disease laboratory in Fort Collins, Colorado, where researchers study plague bacteria, West Nile virus, and other deadly pathogens.