The American Society for Microbiology (ASM) is pleased to submit the following statement on the Fiscal Year (FY) 2013 appropriation for the Centers for Disease Control and Prevention (CDC). The ASM is the largest single life science organization in the world with approximately 38,000 members. The ASM strongly supports the leadership role of CDC, in partnership with state and local health departments and global organizations, in safeguarding the public health and protecting against infectious disease threats through surveillance, laboratory diagnosis, and control and prevention strategies.
The ASM is greatly concerned that the proposed FY 2013 budget for CDC of $5.1 billion represents a decrease of $664 million, or 11.6 percent. The CDC budget may be reduced in FY 2013 by an additional 8 percent as the result of an across-the-board, sequestration provision in the Budget Control Act. The FY 2013 decreases accelerate declines in CDC’s funding that have occurred in the past several years. Such cuts will inevitably have a severe impact on CDC’s ability to protect the nation from disease threats and public health emergencies. CDC oversees programs that are critical to addressing vaccine preventable diseases, foodborne diseases, pandemic influenza, vector-borne and zoonotic diseases, high consequence pathogens, antimicrobial resistance, healthcare acquired infections, and outbreak response activities. Because of declining funding for CDC in recent years, its core infectious disease budget has eroded and these reductions threaten core epidemiology, laboratory and surveillance capacity, as well as modern technologies and methods to ensure that CDC laboratories, researchers and outbreak response teams are able to continue critical infectious disease activities. In the past, declines in resources for prevention and control of infectious diseases have resulted in disease reemergence, leading to significantly higher costs for the health care system and for disease containment efforts. The ominous increase in measles cases seen in the United States in 2011 is an example of the potential for disease reemergence when public health programs are not optimized.
Although concerned about CDC’s overall budget, the ASM does support those areas that have received funding increases. These include the proposed increase for the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) of $27 million and for the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections and Tuberculosis Prevention of $35 million. The NCEZD includes CDC’s antimicrobial resistance activities for surveillance, data collection and stewardship which require additional resources to address the danger of pathogens resistant to antibiotics. The ASM is pleased to see the increase of $17 million for food safety activities to restore and improve state and local surveillance and outbreak response capacity and move toward implementation of CDC’s provisions of the Food Safety Modernization Act including Centers of Excellence. The ASM also supports the increase of $12.6 million for the National Healthcare Safety Network (NHSN). This investment is needed as the number of hospitals, long term care facilities, and hemodialysis centers that are now using NHSN has risen dramatically in the last two years in response to state and federal efforts to control healthcare associated infections. The additional funds for NHSN will allow CDC to maintain and update the system to meet the increased demands and optimally target prevention and control measures.
The ASM is concerned about the proposed cut of $15.5 million in funding to state and local preparedness and response capacity which threatens the nation’s preparedness for infectious disease outbreaks and other hazards. The Strategic National Stockpile is reduced by $64 million in the Administration’s proposed budget. CDC is one of the few federal agencies providing continuous surveillance, detection and response for chemical, biological, radiological and nuclear threats, as well as natural disasters, outbreaks and epidemics. CDC fulfills this critical role by supporting state and local health departments, safeguarding deadly pathogens, managing the Strategic National Stockpile, creating national tracking and surveillance systems and overseeing the national laboratory network. The FY 2013 budget represents a decrease of $54 million below FY 2012 for these critical activities, including elimination of funding for the Academic Centers for Public Health Preparedness. We urge Congress to reject these reductions and to restore funding for these important programs.
CDC Funding Supports Strategies to Protect Public Health
CDC activities are critical to preventing disease and disability across the United States and abroad. Through partnerships with local, state, federal, and international institutions, CDC has created disease prevention campaigns that combine scientific research, public education and training of health professionals, case surveillance systems, and prevention protocols. Only programs of wide scope and complexity like those administered by CDC can be effective against major health issues, such as drug resistant pathogens and microbial threats to the nation’s food supply.
Antimicrobial Resistance. Both US and global health officials list microorganisms resistant to available drugs as one of their top priorities. According to the World Health Organization (WHO), there are about 440,000 new cases of multidrug resistant tuberculosis (MDR TB) each year and at least 150,000 MDR TB deaths. Drug resistant cases of malaria and cholera are rising in number, and healthcare facilities worldwide are beset by unacceptable rates of AR infections like methicillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections (CDI). Recently CDC surveillance has collected case reports from across the United States of bacteria, including E. coli, that produce Klebsiella pneumoniae carbapenemase (KPC), an enzyme that makes bacteria resistant to most known treatments.
In large part due to CDC partnerships and prevention initiatives, there has been a 60 percent reduction of MRSA in Veterans Administration facilities and a 2010 report demonstrated a significant MRSA decline in US healthcare settings in general. CDC data also show that rates of MRSA bloodstream infections in hospitalized patients fell nearly 50 percent from 1997 to 2007. Last November, CDC initiated a new antibiotic tracking system within its National Healthcare Safety Network (NHSN) for monitoring in hospital antibiotic use electronically. Promotion of appropriate antimicrobial stewardship is a critical component of a comprehensive program to reverse the impact of antibiotic resistance.
Healthcare Associated Infections (HAIs). Pathogens like MRSA that are increasingly resistant to therapeutics are particularly alarming among vulnerable patients being treated for other medical conditions. Last year CDC expanded its NHSN surveillance system from 3,400 to 5,000 hospitals, hemodialysis and long term acute care facilities, and other facilities faced with patient infections acquired in house. NHSN data are strong evidence that CDC education and surveillance programs achieve gains against these infections. For example, infections reported to NHSN that declined in 2010 included a 33 percent reduction in central line associated bloodstream infections and 35 percent among critical care patients. Such declines result in billions of dollars of cost savings to the healthcare system, although the economic and human costs of HAIs remain far too high. CDC estimates that 1 out of 20 hospitalized patients will develop an infection while receiving treatment for other conditions. Continued investments in addressing other costly healthcare associated infections such as surgical site infections and ventilator associated pneumonia should have similar impacts to those seen with bloodstream infections.
Immunization. CDC campaigns have made impressive progress against childhood vaccine preventable diseases in the US and, jointly with WHO and other stakeholders, worldwide. A recent CDC report listing the most significant global public health achievements in the past decade included various vaccination programs that prevent 2.5 million deaths every year among young children, that is, measles, polio, and diphtheria tetanus pertussis vaccinations. Global mortality from measles has declined from an estimated 733,000 deaths in 2000 to 164,000 in 2008. Since 1988, polio incidence has fallen by 99 percent, from more than 350,000 cases to 1,410 in 2010, with four remaining endemic countries. In December, CDC activated its Emergency Operations Center to strengthen its partnership with the Global Polio Eradication Initiative. However, more than 1 million infants and young children still die from vaccine preventable pneumococcal disease and rotavirus diarrhea every year, and multiple other diseases take lives that could be saved through immunization. However, as noted above, the increase in measles cases seen in the US in 2011 and similar increases in pertussis in 2010-2011 demonstrates the importance of continued investment in vaccination programs to keep these diseases at bay.
The CDC continues to make progress in raising immunization coverage levels for some of the newly available vaccines. In the United States, vaccinating infants against rotavirus has shown impressive gains against a major cause of severe diarrhea in infants and young children. Before introduction of the rotavirus vaccines in 2006, the pathogen was responsible for about 200,000 emergency room visits and 55,000–70,000 hospitalizations per year. Intensive immunization campaigns resulted in high percentages of protected children, responsible for a 75 percent decline in rotavirus related hospitalizations in 2007–2008 compared with pre vaccine levels. Federal estimates indicate that for every dollar invested in immunizing Americans, we save $10.20 in direct medical costs.
Food Safety. Based on surveillance data, CDC believes that foodborne contaminants are responsible for about 128,000 US hospitalizations annually. The 31 known microbial pathogens linked to foodborne illness account for an estimated 9.4 million of the roughly 47.8 million illnesses yearly, the remaining blamed on “unspecified agents.” Five pathogens targeted by CDC account for more than 90 percent of the identified agent cases: norovirus, Salmonella, Clostridium perfringens, Campylobacter, and Staphylococcus aureus. The agency’s food safety activities utilize multiple tools that include case reporting systems, public and food processor education, and product recalls. CDC will support five Food Safety Centers of Excellence at state health departments across the country. A 2011 CDC report summarizing 15 years of case surveillance showed that illnesses from E. coli O157 have been cut nearly in half and the overall rates of six foodborne infections have been reduced by 23 percent, but warned that Salmonella caused infections have risen 10 percent. However, problems like the 2011 outbreak of listeriosis associated with cantaloupes, the deadliest foodborne outbreak in the United States in decades, demonstrates the importance of prompt recognition and response to foodborne disease, including laboratory capacity to make the diagnosis and fingerprint the strains.
Public Safety and Preparedness. The ASM is concerned that the Administration’s FY 2013 budget decreases funding for some important CDC biodefense and emergency preparedness activities. Programs like the Strategic National Stockpile build our national capabilities against both intentionally released and naturally occurring infectious agent threats. The agency oversees a national laboratory network, develops science based expertise in numerous health threats, and serves as primary first responder during sporadic disease outbreaks, epidemics, and a broad spectrum of other crises. With state and local budgets strained economically, it is all the more important that CDC is able to fully support health departments across the country. The ASM also urges Congress recognize that funding is needed to ensure CDC’s own laboratories and personnel continue to serve as national and global leaders against infectious disease and other health threats.
CDC Funding Supports Research and Education to Prevent Infectious Disease
The CDC Office of Infectious Diseases (OID), which oversees the National Center for Immunization and Respiratory Diseases, the National Center for Emerging and Zoonotic Infectious Diseases, and the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention addresses antimicrobial resistance, chronic viral hepatitis, food and water safety, healthcare associated infections, HIV/AIDS, respiratory infections, vaccine preventable diseases, and zoonotic and vectorborne diseases. The ASM strongly supports funding for OID efforts to identify, treat, and prevent a long list of infectious diseases that kill millions each year. CDC’s infectious disease programs play a critical role in protecting all Americans from the dangers of microbial threats, and we cannot allow these important functions to continue to erode.
The ASM urges Congress to provide needed new resources in FY 2013 for the CDC budget to strengthen science based programs that have so effectively investigated, controlled, and, most importantly, prevented disease and disability. This funding is critical to maintaining the CDC laboratories, expert personnel, education and prevention campaigns, and CDC supported collaborations that work together daily to protect people in this nation and worldwide.