The American Society for Microbiology (ASM) welcomes the opportunity to provide a written statement for the record in support of the Fiscal Year 2000 (FY 2000) appropriation for the Centers for Disease Control and Prevention (CDC). The ASM appreciates the Subcommittee's past support for the CDC, especially for infectious disease funding. The CDC is recognized for its efforts to combat the continuing threats of new, emerging, and drug-resistant infectious diseases. In this difficult appropriations year, the ASM encourages the Subcommittee to consider the successes of the CDC and to weigh the costs of prevention and response to infectious diseases versus the cost of human health.
The ASM is the largest single life science society in the world with more than 42,000 members representing a broad spectrum of subspecialties, including microbiologists who work in clinical, public health, biomedical and industrial laboratories. The mission of ASM is to enhance the science of microbiology to better understand basic life processes and to promote the application of this knowledge for improved health and for economic and environmental well-being.
The Administration has requested a 6.7 percent increase in funding for CDC for FY 2000, a $252 million increase over FY 1999 funding levels. Included in the Administration's increase is $94 million to strengthen science for public health action; $14.9 million to collaborate with health care partners for prevention; $126.5 million to promote healthy living at every stage of life; and $17 million to work with partners to improve global health. While the ASM is supportive of these programs, the Society would like to focus its testimony on CDC's efforts to prevent and contain the spread of infectious diseases.
The ASM is a member of the CDC Coalition which is comprised of more than 100 organizations committed to improving public health through cost effective prevention and control strategies. The CDC Coalition has estimated the full funding for CDC programs in FY 2000 to be $3.9 billion. The ASM urges the Congress to fully fund the programs at CDC. Every American citizen will benefit from this increased level of support.
Infectious diseases pose significant threats to human health in today's global society. Not only are new diseases emerging, but diseases that have been controlled through the use of antibiotics are becoming resistant to some of the strongest drugs currently on the market. The threat of intentionally released chemical and biological agents has also become a serious concern. In addition, infectious diseases have been found to contribute to chronic diseases, including ulcers, heart disease, cancer and diabetes.
In late 1998, the CDC updated "Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States," its strategic plan for preventing emerging infectious diseases and combating existing diseases. It is estimated that the full cost of implementing this strategic plan is $200 million. The ASM appreciates Congress' provision of an increase of $20 million in FY 1999 but urges Congress to provide CDC with an additional $180 million in FY 2000 to fully fund this plan. With full funding, CDC anticipates achieving the following goals:
- Detecting, investigating, and monitoring emerging pathogens, the diseases they cause, and the factors influencing their emergence, and responding to problems as they are identified.
- Integrating laboratory science and epidemiology to optimize public health practice.
- Strengthening public health infrastructures to support surveillance and research and implementing prevention and control programs.
- Ensuring prompt implementation of prevention strategies and enhancing communication of public health information about emerging diseases.
Microbial adaptations are the primary cause for development of antibiotic resistance, and increased use of antibiotics has contributed to increased resistance. Infectious diseases' resistance to some of the world's most potent drugs poses a serious threat to global human health, and the ASM urges Congress' support to confront this malady. To address this global health threat, the CDC will require additional resources to:
- Establish a enhanced national surveillance system for antibiotic resistance;
- Monitor antibiotic resistance genetic markers in environmental settings;
- Develop improved clinical guidelines, particularly for hospitals, nursing homes, and day-care facilities; and
- Establish a program to educate the general public on the appropriate use of antibiotics.
The ASM requests that Congress provide $35 million for FY 2000 to allow CDC to take these steps to address the threat that antimicrobial resistance poses to human health.
Hepatitis C is considered the leading cause of chronic liver disease and the leading indication for liver transplantations. An estimated four million Americans have been 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 medical, economic and social impacts of hepatitis C infections are finally 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. In spite of the annual economic and social costs, only $5 million of the Administration's requested funding increase has been designated for combating this disease. This increase is targeted toward the development and implementation of an educational campaign targeted toward high-risk populations within selected states and major cities. The ASM requests that Congress provide CDC with $50 million to combat this serious infectious disease.
Experts agree that pandemics of influenza are likely, if not inevitable, in the near future. In the United States alone, preliminary estimates indicate that an influenza pandemic would cause between 88,000 and 227,000 deaths, and the economic impact would range between $71 billion and $166 billion. The sudden and unpredictable emergence of pandemic influenza and its social and economic ramifications demand a national plan to prevent such an occurrence. CDC's responsibilities include:
- Confirming the cause and scope of the threat.
- Establishing a communication network for prompt dissemination of information to public health officials, health care providers, and the general public.
- Developing and testing candidate vaccines in partnership with the National Institutes of Health.
- Implementing vaccine purchase and distribution.
- Monitoring adverse events after vaccination.
- Disseminating information and coordinating education campaigns through the national media.
- Communicating and coordinating activities with other countries.
- Evaluating the effectiveness of the national effort.
The ASM urges Congress to provide $25 million in FY 2000 to CDC to assist in the preparation, and if necessary, the carrying out, of the national plan to avert the impacts of a pandemic influenza outbreak.
Unfortunately, the threat of a biological attack against American citizens must be taken seriously, and U.S. preparedness is essential. In the event of an attack, the public health infrastructure will bear the greatest burden, and CDC's role in identifying and monitoring an infectious or chemical agent to mitigate the impacts of such an event will be imperative. Unfortunately, it has been documented that the public health infrastructure across the United States currently does not have the capacity to handle a potential act of bioterrorism. Congress' allocation of funds to CDC not only assists in the preparedness of such an attack, but it also allows the public health system to improve substantially upon their current capacity to identify and monitor naturally occurring outbreaks.
The ASM has joined a coalition of public health organizations in recommending that Congress provide $263.55 million to CDC in FY 2000 to assist in preparing the public health infrastructure to protect U.S. citizens against the threat of bioterrorism. Funds for this effort are needed for upgrading and expanding surveillance programs; building the epidemiological and laboratory capacity; and preparing a medical stockpile. The ASM recommends that specific resources of $3.5 million be allocated to implement the congressionally mandated program to monitor the transfer of select agents under Section 511 of the Antiterrorism and Effective Death Penalty Act of 1996. Additional funding would enable CDC to provide programs to ensure research institutions are in full compliance with the Act, which is intended to restrict access to potential biological warfare agents without hindering legitimate research.
Ensuring a Safe Food and Water Supply
As a participant of the Presidential Food Safety Initiative, CDC has been working with the Food and Drug Administration and the United States Department of Agriculture to combat the incidence of foodborne diseases. With funding from prior fiscal years, these agencies have expanded the Foodborne Diseases Active Surveillance Network (FoodNet) to more precisely monitor and quantify incidences of foodborne illnesses. Results are already being noticed: there has been a sizeable drop in the incidences of Salmonella and Campylobacter. This year, the Administration has requested a $10 million increase for CDC's continued role in this initiative. The increase is specifically targeted to expanding PulseNet sites. PulseNet is a national network of public health laboratories that perform DNA fingerprinting of disease-causing bacteria. Currently, 29 sites have the capacity to identify E-coli O157:H7, and 33 laboratories have the capacity to identify Salmonella strains. With the requested additional resources, 40 laboratories will have the capacity to identify these biological agents. The ASM urges the Congress to continue its support for the Food Safety Initiative by funding the CDC with an additional $10 million for a total of $29.5 million for FY 2000.
In addition to taking steps to provide a safe food supply, the ASM also urges Congress to ensure the safety of the nation's water supply. Waterborne microorganisms pose increasingly greater threats to public health due to changing patterns in water use, increased water pollution, the nation's aging water treatment system, and out-moded risk assessment protocols. The CDC estimates that more than 900,000 cases of illness and possibly 900 deaths occur from waterborne microbial infections each year in the United States. Action needs to be taken to address microbial water quality issues through coordinated policymaking and research efforts by appropriate agencies and institutions.
In order to carry out their responsibilities efficiently and effectively, CDC personnel must be able to operate in a comfortable, secure environment equipped with state-of-the-art technologies. With the majority of its facilities more than 35 years old, the CDC is in a dire situation regarding its continued ability to safely detect, monitor and study infectious agents. 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 to complete phase one and a portion of phase two of the new infectious disease laboratory. However, there is a funding shortfall of $22 million to complete construction of phase two and a $17 million shortfall to equip the laboratory. In FY 2000, the ASM specifically requests that Congress allocate the $39 million necessary to complete the construction of the Roybal Infectious Disease Research Laboratory. We urge Congress to make CDC laboratory renovation and construction a high priority in the next several years. The growing threats of new and emerging infectious diseases mandate attention to this matter.
The threat of new, emerging and drug-resistant diseases and the intentional release of harmful agents make it imperative that the federal government have action plans and prevention measures in place to mitigate the impact on human health. CDC's role in ensuring public health is critical, and the agency has proven to be a world leader in this area. However, without adequate resources, the agency cannot continue to operate safely and effectively to identify, monitor and combat one of the leading causes of death.
Thank you for the opportunity to submit a written statement for the record. ASM would be pleased to submit additional information and to assist the Subcommittee as it addresses issues related to CDC funding and emerging infectious diseases.