Centers for Disease Control and Prevention - FY 1999 Testimony

The American Society for Microbiology (ASM) thanks you for the opportunity to provide a written statement for the record in support of the Fiscal Year 1999 (FY99) appropriation for the Centers for Disease Control and Prevention (CDC). The ASM is the largest single life science society in the world with a membership of over 42,000 individuals who work in clinical, public health, biomedical and industrial laboratories, as well as in academia and government. The ASM recognizes the difficult budget constraints the Committee on Appropriations faces in determining the fiscal priorities for the nation, and would like to thank you for your past support for the CDC, especially for infectious disease funding. The CDC has been recognized for its efforts to combat the continuing threats of new, emerging and drug resistant infectious diseases. The ASM recommends that Congress continue its support and increase the Administration's request for new and emerging infectious diseases from $79 million to $125 million. The ASM supports the Administration's request for $25 million for the Prevention Research Program and $5 million for foodborne diseases. In addition, the ASM recommends Congress provide adequate resources for the construction, maintenance, and equipment for the new infectious disease laboratory at CDC.

The Administration's request for CDC's infectious disease program includes an increase of $20 million for new and emerging infectious diseases and $5 million for its role in foodborne disease prevention. The ASM supports the Administration's request for an additional $25 million to combat new and reemerging infectious diseases. However, the ASM does not believe it is sufficient to implement the CDC's plan "Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States". Full implementation of the CDC plan is estimated to require $125 million. The ASM recommends Congress allocate $125 million in FY99 due to the continued resurgence and emergence of infectious diseases in this country. 

As a member of the CDC coalition, the ASM recommends that Congress adopt the FY99 budget proposal developed by the CDC Coalition. The CDC Coalition is comprised of over 100 members committed to improving public health through cost effective prevention and control strategies. For FY99, the CDC Coalition recommends Congress appropriate $2.8 billion for the CDC.

Infectious Diseases

The ASM would like to commend you and the members of the Subcommittee for your leadership in addressing issues related to new, emerging and drug resistant infectious diseases and their impact on the nation's health. The ASM would like to emphasize the critical role the Centers for Disease Control and Prevention play in the fight against infectious diseases in the United States and in the world. The United States continues to be faced with new, emerging and drug resistant infections. Many chronic diseases and conditions have now been proven to have infectious origins (ulcers, cervical cancer, and chronic liver disease). The world's leading cause of death are infectious diseases, which account for over seventeen million deaths annually, the majority (9 million) are among children. In the United States, the death rate from infectious diseases, excluding AIDS, rose 22 percent between 1980 and 1992, claiming approximately 166,000 lives annually. At a cost of $120 billion each year, infectious diseases account for one out of every six health care dollars and 25 percent of all physician office visits. 

Few public health concerns today carry as great a sense of urgency and importance as infectious diseases. Each day headlines in the national news describe new diseases that are rapidly arising worldwide and "old"diseases that are reemerging as infectious agents evolve or spread and as changes occur in ecology, socioeconomic conditions and population patterns. Humans, through rapid world travel and unprecedented international trade, have become a major vector of infectious diseases, transporting disease from one country to another, often in less than 24 hours. Infectious diseases can be spread from human and animal sources but also from "bioterrorism," the intentional release of pathogens to harm human health or the animal and plants on which humans depend. The threats posed by infectious diseases to the security and well being of the world community are now apparent, and the United States is no exception. 

It has become clear in recent years that many chronic diseases and cancers have infectious origins, including: ulcers (Helicobacter pylori), cervical cancer (human papilloma virus (HPV), and liver cancer, (the hepatitis C and hepatitis B viruses). Hepatitis C is now considered the leading cause of chronic liver disease and the leading indication for liver transplant. There are now an estimated 4 million Americans infected with hepatitis C. About 85 percent of those infected will develop chronic liver disease, and about 10 to 20 percent eventually develop cirrhosis. Approximately 30,000 new infections occur each year and about 10,000 individuals die each year as a result of hepatitis C infection. The consequences of hepatitis C infection often occur years after infection. The medical, economic and social impacts of 4 million individuals infected with hepatitis C are only slowly being realized. The CDC estimates the current cost of hepatitis C to society is $600 million dollars per year. The numbers of Americans who will eventually get chronic liver disease and require treatment, including liver transplants, may overwhelm the health care system in the next century. 

The ASM recommends Congress allocate $125 million to the CDC to fully implement the agency's strategies as outlined in "Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States". The CDC emerging infectious disease plan is focused on four goals: strengthening the surveillance of and response to emerging infectious diseases; implementing an applied research extramural program to address important research questions related to emerging diseases (including research to develop new or improved diagnostic tests); developing and implementing prevention and health communication activities and strengthening the infrastructure of CDC and state/local health departments, including laboratories, to address new and reemerging diseases. 

If the CDC plan for emerging diseases is fully funded, the CDC will be able to expand its Emerging Infections Programs (EIP) from seven states to ten in FY99. The EIP states are conducting early warning surveillance activities and investigations to monitor more accurately and respond to infectious disease outbreaks, illnesses and death. These surveillance sites are the backbone of the national surveillance system for new and reemerging pathogens. At these sites, applied epidemiological and laboratory research are conducted to help identify known microbial agents responsible for infectious diseases and also discover new pathogens which have emerged to create a new niche for microbial proliferation in humans. 

These new resources for new and reemerging infectious diseases will also allow CDC to expand its Epidemiology and Laboratory Capacity (ELC) program which provides states with financial and technical support towards modernizing the public health laboratory's facilities and abilities to combat new and reemerging pathogens. To prevent the public health infrastructure and laboratories from further deterioration, these additional resources will provide specific states with upgraded information systems, enhanced laboratory technology, and trained staff to strengthen the capacity for public health surveillance and disease outbreak response. A portion of these resources will also be devoted to implementing health communication strategies for the general public to prevent the spread of new and reemerging infectious diseases.

Antimicrobial Resistance

The ASM is concerned with the growing world-wide problem of antimicrobial resistance. Serious infections are increasingly caused by infections resistant to antibiotics. Antibiotics that we once took for granted are now failing to control common diseases such as bacterial pneumonia. Recent reports indicate that in some parts of the country as many as 40 percent of the strains of pneumococci (can cause meningitis) are resistant to penicillin and other antibiotics, making treatment difficult, and sometimes impossible. In addition, 90 percent of the strains of Staphylococcus aureus, one of the most common disease producing organisms in humans, are resistant to penicillin and many other related antibiotics. Many communities are experiencing high rates of Staphylococcus aureus resistant to methicillin leaving only vancomycin available for therapy. This year, strains have emerged with intermediate levels of susceptibility to vancomycin. The leads to the specter of a future with no effective therapy for this aggressive pathogen. The incidence of vancomycin resistant strains of Enterococcus, one of the more common causes of infections in hospitalized patients, has increased 20 fold since 1989. New, resistant strains of bacteria will continue to threaten the effectiveness of antibiotics. Antimicrobials are the second most commonly prescribed category of drugs in the United States. Children under the age of 15 are being prescribed antibiotics 3 times more than adults. The ASM supports the Administration's request which includes initial funding to develop and implement a national monitoring system for antimicrobial use, resistance, and related risk factors. However, the ASM is concerned that antimicrobial resistance is not yet measured on a national scale due to a lack of resources. Costs to treat infectious diseases are escalating, and run into the billions, due to ineffective therapeutic treatments, and longer hospital stays which are required to fight resistant organisms. The ASM recommends Congress fully fund the CDC plan at a level of $125 million to enable the CDC to apply more resources in the critical area of antimicrobial resistance.

Foodborne Diseases

The ASM would also like to emphasize the global problem of food safety. There are more than 250 foodborne diseases which have been diagnosed and recognized. Many different bacteria (such as Campylobacter, Salmonella and Escherichia coli O157:H7) and viruses cause microbiological contamination and disease. Estimates for incidences of foodborne disease vary widely from 6 million to more than 33 million cases per year due to incomplete data and sporadic surveillance. Impacts of foodborne illnesses range from mild to severe cramps and diarrhea which can cause a range of mild to severe illness, paralysis and sometimes death.

As part of the Presidential Food Safety Initiative, CDC, the Food and Drug Administration, and the United States Department of Agriculture are working collaboratively to combat infectious foodborne hazards. These agencies have established FoodNet, a network for responding to new and emerging foodborne disease of national importance, monitoring the burden of foodborne diseases, and defining the source of specific foodborne diseases so that proper action and prevention measures can be taken. FoodNet is established at seven sites in Minnesota, Oregon, Georgia, California, Connecticut, New York and Maryland. Approximately 25 million people or 10 percent of the U.S. population are covered by this foodborne disease surveillance system. The ASM supports the additional resources ($5 million) that have been requested to expand the FoodNet program to eight sites which will lead to a more effective early warning system which will detect outbreaks earlier and should lead to the prevention of illness and death from foodborne pathogens.

Laboratory Facilities

The CDC is in a critical situation regarding the existing laboratory space and its continued ability to safely handle and study infectious organisms. CDC's laboratory facilities are inadequate for handling the broad array of pathogens that exist and that continue to emerge. Inadequate, outdated and overcrowded facilities at the CDC threaten to jeopardize the continued implementation of the CDC plan to combat infectious diseases. The ASM appreciates the Committee's support in the past to complete phase one of the new infectious disease building. However, the ASM is concerned that funds for phase two are not available and have not been identified. There is a funding shortfall of $33 million to complete construction of Phase II and a $17 million shortfall to finish equipping the building appropriately. The ASM recommends that Congress consider laboratory construction and renovation a high priority in the years ahead considering the growing threats to the nation's health and security due to new and emerging infectious diseases and provide the necessary funds for this critical facility at CDC.

Prevention Research

The ASM supports the Administration's request for $25 million for a new prevention research program as part of the Research Fund for America. Prevention research will help transform findings from bench level research into cost effective prevention programs that reach directly into communities. If allocated, these resources will support extramural research in academic health centers and other community organizations. For example, this type of research could help answer critical public health questions such as: How do we keep organisms such as cryptosporidia and E. coli from invading our water and food supplies? How to persuade health care providers to prescribe antibiotics more appropriately? Can we prevent the chronic disease complications of infectious diseases, such as cervical cancer? More emphasis on prevention research will be necessary to develop the science base for public health measures targeted at the individual, family and at the community level.

Conclusion:

Strengthening the global surveillance capabilities of the CDC to keep local outbreaks from growing is of critical importance. The ASM recommends Congress fully fund the CDC's plan, "Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States" at the $125 million level. The recent outbreak of "bird flu" in Hong Kong has focused new attention on the threat of influenza which presents the most imminent viral threat to public health. Strengthening and maintaining a first-rate surveillance system is the first line of defense against these "old" and new diseases. Influenza reemerges worldwide each year in a new form and causes between 10,000 and 40,000 deaths yearly in the United States alone. Because of the Hong Kong experience, CDC diverted critical resources from the domestic emerging infectious disease plan to work on this international crisis. With full funding for its emerging disease plan, CDC would have the opportunity to firmly establish all ten surveillance sites which, for the first time would represent a national infectious disease surveillance system. Infectious microbes have the remarkable ability to evolve, adapt and develop resistance to drugs. As we approach the crossroads of the new century, it is essential that the nation invest wisely in research and prevention of infectious diseases. 

Thank you for the opportunity to submit written testimony for the record and would be pleased to submit additional information and to assist the Subcommittee as it addresses issues related to CDC funding and emerging infectious diseases.

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