With people at risk from a broad range of health threats, our public health system will not be able to respond adequately without appropriate resources for public health programs. The ASM, therefore, recommends an increase of 8 percent in the FY 2006 budget for the CDC. CDC’s importance to safeguarding public health, both nationally and globally, is now unprecedented, but the level of funding for CDC is not keeping pace with its growing responsibilities to address new health threats. Infectious disease public health needs have been and will continue to increase and CDC’s funding must remain strong to address them.
CDC Infectious Disease Programs
The CDC recently reorganized programs to better adapt to changing health threats. The Infectious Diseases Coordinating Center oversees three major programs, the National Immunization Program, the National Center for Infectious Diseases, and the National Center for HIV/AIDS, Sexually Transmitted Diseases and Tuberculosis Prevention. The President’s budget includes $1.7 billion related to domestic prevention and control of infectious diseases through these programs.
The National Center for Infectious Diseases is responsible for measuring progress in global influenza surveillance and detection to prepare for a pandemic influenza outbreak. Funding for pandemic influenza preparedness is appropriated through the Department of Health and Human Service’s (DHHS) Public Health and Social Services Emergency Fund (PHSSEF). The budget proposes $120 million for the expansion of year-round vaccine production capacity, a priority in the DHHS’s draft Pandemic Influenza Response and Preparedness Plan. A significant investment will be required to enhance vaccine capacity to address the threat of pandemic influenza by developing a newer generation of influenza vaccine that can be quickly produced and deployed to strengthen the public heath infrastructure on state and local levels, and to ensure that needed vaccines, antivirals and antibiotics are readily available.
Under the CDC reorganization, programs focused on HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis are managed through the National Center for HIV, STD, and TB Prevention (NCHSTP). The budget proposes $956 million, $658 million of which is focused on prevention of these infectious diseases. Despite CDC efforts over the past two decades, the number of new HIV infection cases each year continues to remain high and the number of Americans living with HIV/AIDS is increasing. In FY 2003, CDC launched a different U.S. initiative, based on new rapid testing techniques for immediate patient results, designed to better prevent infections through earlier notification and to help identify the estimated 180,000 to 280,000 people not aware of their HIV-positive status.
The agency’s recent reorganization also coordinated programs under the Office of Global Health (OGH) to track and prevent the international spread of diseases like measles, polio, and HIV/AIDS. The overarching goals are to recognize outbreaks faster, wherever in the world they occur, and to better control and prevent further outbreaks. Global disease detection mandates steady expansion of surveillance systems worldwide, as trade and travel allow rapid spread of previously unknown or unanticipated pathogens.
Clinical and public health laboratory capacity must be strengthened together with epidemiologic and communications capabilities. The World Health Organization goal of eradicating polio by 2005 has suffered some setbacks recently, with wild poliovirus spreading in some African countries during 2003 and 2004. But last year, cases of the disease declined by nearly 50 percent in India, Pakistan, and Afghanistan. Since the WHO global initiative began in 1988, CDC and others have invested more than $3 billion in the polio campaign. An estimated 250,000 lives have been saved and 5 million cases of childhood paralysis prevented. The CDC also partners with other federal agencies in the Global AIDS Program and in the President’s Emergency Plan for AIDS Relief. In FY 2004, nearly 2 million HIV laboratory tests and 275,000 tuberculosis infection laboratory tests were conducted under auspices of the Global AIDS Program. In addition, antiretroviral drug therapy was provided for nearly 19,000 AIDS patients in nine countries. By the end of 2003, the active spread of measles had been stopped in the Western Hemisphere. That year the CDC and its partners vaccinated more than 115 million children worldwide. Unfortunately measles persists as one of the world’s leading child killers with an estimated 30 million cases and 700,000 deaths each year.
Overuse of antimicrobials seriously increases the prevalence of pathogens resistant to commonly prescribed drugs. Antimicrobial resistance is considered one of the pressing issues faced by the CDC and other public health institutions. The 2003 Annual Report of the Antimicrobial Resistance Interagency Task Force reported that the number of cases of invasive pneumococcal disease in children in seven geographic areas declined by 75% in 2002 due to widespread use of pneumococcal vaccine, thereby reducing the use of antimicrobials which may become resistant. In FY 2004, the CDC inaugurated a national media campaign about antibiotic resistance, to educate both patients and health care providers about the serious ramifications of overprescribing antibiotics. Also in FY 2004, extramural grants were awarded for applied research in the estimate of economic costs for antimicrobial resistant human pathogens of public health importance. The purpose of the grant program is to obtain information that might impact and improve the current methods of preventing the emergence and spread of antimicrobial resistance. ASM supports sufficient budgetary increases in such prevention programs. The return on investment creates enormous health and economic benefits to the American public.
The CDC’s immunization program would receive $2.1 billion under the proposed FY 2006 budget, to support the two primary goals of the program: at least 90 percent of all two-year-olds to receive the recommended vaccines, and assurances of an adequate annual influenza vaccine supply. Investments in immunization programs are proven cost-savers. For example, every dollar spent on measles-mumps-rubella vaccine saves an estimated $23 in health-care costs. FY 2006 funds would flow through the Vaccines for Children program and the Section 317 program, the former to provide vaccinations to children otherwise underserved in the health care system, the latter to subsidize state immunization efforts. As part of the overall CDC immunization focus, $197 million is requested for influenza-related activities, representing a nine-fold increase over FY 2001 appropriations. Funds would further expand the pediatric vaccine stockpile initiated last year, purchase additional doses of influenza vaccines for the general public, and encourage greater vaccine production for next winter’s flu season. The FY 2006 emphasis on immunization activities is a prudent use of federal funds needed to protect the public.
DNA technology provides some of the notable cutting-edge science upon which CDC testing and surveillance programs are built and operated. The PulseNet system, which tracks foodborne illness outbreaks, is one particularly extensive use of such technology. These illnesses affect more than 76 million Americans each year; periodic outbreaks often are widely publicized in the national media. One example is the 2004 outbreak of salmonellosis among more than 500 people across five states, which CDC epidemiologists tied to contaminated restaurant tomatoes. Another is a multi-state incident of hepatitis A infecting more than 1,000 people after they ingested imported green onions. Similar surveillance systems now exist in Europe, Pacific Rim countries, and Latin America. The CDC’s Tuberculosis Genotyping Program, initiated in FY 2004, also fingerprints the genetic profiles of pathogens, enabling case investigators to assess very quickly how and where the bacterium is spreading. It already has described outbreaks in several states, permitting rapid deployment of preventive measures.
Defenses against possible bioterrorist attacks are a collaborative initiative among federal, state, and local agencies and authorities. The CDC is largely responsible for sufficient supplies of countermeasures such as vaccines and portable treatment units. The Administration proposes an increase of $56 million for bioterrorism preparedness activities at the CDC, for a total of $1.6 billion in FY 2006. Six hundred million is proposed for further enhancing the Strategic National Stockpile (SNS). Specifically, the Medical Contingency Station project will be enhanced and increased funding will also help to pay for BioShield acquisitions and the purchase of additional anthrax antibiotics for the SNS. The CDC maintains the capacity to transport SNS materials and personnel to any location within the United States within 12 hours. During FY 2004, the CDC nearly tripled the amount of medical countermeasures against anthrax, now capable of treating 30 million people.
Since 2001, the CDC has recognized the importance of anti-bioterrorism capabilities at the state and local levels, where attacks are most likely to occur. About $4.5 billion has been invested in CDC programs to assure state and local preparedness. The agency’s Laboratory Response Network (LRN) now includes 134 reference labs in all states, up from 91 in 2001, nearly all capable of detecting agents of anthrax, tularemia and smallpox. Five veterinary diagnostic laboratories are now part of the system, recognizing the importance of animal-to-human transmission of disease pathogens. More than 8,800 laboratory personnel have been trained for bioterrorism emergencies under CDC auspices. During FY 2004, CDC invested about $846 million to improve the ability of 62 state, local, and territorial health departments to respond to terrorism, infectious disease outbreaks, and other public health crises. The CDC funded the Cities Readiness Initiative, to boost delivery of medicines and other supplies during large-scale emergencies. The current proposed budget for FY 2006 however, decreases support for state and local capacity. A report released this March by New York University concludes that bioterrorism-related training and equipping of local response personnel like paramedics have been seriously neglected, an example of yet unmet needs.
Buildings and Facilities
Since 2001, the CDC has initiated or completed construction of more than 2.7 million square feet of laboratory and administrative space, replacing badly deteriorating buildings that were unsafe and inadequate. This year will mark the completion in Atlanta of a new Infectious Disease Laboratory, the Scientific Communications Center, the headquarters building with an Emergency Operations Center to coordinate quick responses, and the Environmental Toxicology Laboratory. The FY 2006 request includes $22.5 million to complete a replacement Vector Borne Infectious Diseases lab in Fort Collins, Colorado and an additional $7.5 million to fund miscellaneous repairs and improvements. CDC’s master plan for its buildings and facilities includes additional building renovations that are currently on hold, with hope to be funded in the near future. ASM applauds expenditures in recent years to replace the former CDC facilities in such poor condition and supports the completion of the master plan when funds can be allocated.
The ASM appreciates the opportunity to provide written testimony and would be pleased to assist the Subcommittee as it considers its appropriation for the CDC for FY 2006.