The FY 2007 budget request would reduce funding for the CDC for the second year in a row. Excluding one-time emergency funding items, CDC core programs would be cut over 4 percent below the FY 2006 level of funding, which was 4 percent below the FY 2005 budget. In view of the CDC’s critical role in protecting the health and safety of the public, the cumulative two year reduction of funding of over 8 percent is cause for serious concern. The ASM recommends that Congress provide $8.5 billion plus sufficient funding for pandemic influenza preparedness for the CDC in FY 2007. This level of funding will sustain core programs crucial to improving public health in the United States and overseas.
The CDC works with partners in the United States and across the globe to monitor health status and trends, detect and investigate health problems, conduct research to enhance prevention, develop and advocate sound health policies, and foster safe and healthy environments. CDC capabilities must expand, not contract, as increasing worldwide connectivity brings global health concerns to the United States. Among the CDC’s health protection goals are “people prepared for emerging health threats” and “healthy people in a healthy world.” Both will require continued, extensive efforts here and abroad and clearly need sustained funding to assure success.
CDC leadership in public health requires readiness to respond to unexpected health crises, above and beyond the Agency’s ability to guard day-to-day wellness of people. In FY 2005, the CDC’s Epidemic Intelligence Service (EIS) officers responded to 66 health outbreaks, eight of them in other countries, and personnel from the CDC assigned to state or local health departments conducted 367 field investigations. After Hurricane Katrina struck the Gulf Coast, the CDC quickly provided information critical to preserving health and created the Katrina Information Network, later called the Emergency Response Information Network. Within two weeks, the CDC posted nearly 200 pertinent documents on its website (on infection control, first responder and volunteer safety, environmental issues and more). A commercial test kit for mold contamination, developed in 2003 by scientists of the CDC and a private biotech company, became a valuable assessment tool post-Katrina. Calls to the agency for rapid response generally involve infectious diseases, which persist as a principal concern of the CDC.
Within the proposed FY 2007 budget, pandemic influenza is a top-priority for funding for the CDC. The requested $188 million for pandemic preparedness would expand the CDC’s participation in the federal interagency National Strategy for Pandemic Influenza, the federal agency plan to prevent, detect, and treat outbreaks of influenza. Since mid-2005, a virulent avian influenza virus (strain H5N1) has been moving more rapidly from nation to nation, killing millions of wild and domestic birds and causing concern that viral mutations might cause human-to-human transmission. Scientists recently found that the human virus strains responsible for three major pandemics in the 20th century contained genetic material derived from avian viruses. Thus far, human deaths from H5N1 have been relatively few, but those known to be infected suffer a high mortality rate. Globally, traditional seasonal influenza already kills 250,000 to 500,000 each year; pandemic influenza could kill many millions. Although the H5N1 virus has not reached the United States, many health officials consider future outbreaks in this country to be inevitable. If viral mutations provoke a human pandemic, 15-35 percent of the US population could be affected, exacting a large number of influenza deaths and economic losses of $71.3-166.5 billion, according to the CDC’s estimates.
The proposed FY 2007 funding for pandemic preparedness will continue FY 2006 improvements in domestic disease surveillance, upgrades of quarantine stations at major ports of entry, and support of global surveillance and detection activities in endemic, epidemic, and other high-risk countries. The proposed budget would fund new resources to increase stocks of diagnostic reagents; establish laboratory facilities with appropriate biocontainment capabilities; develop models and risk-assessment tools to predict disease spread; increase seasonal flu vaccine production; establish a viral-genome reference library; and create an electronic registry to more effectively track, distribute and administer vaccines to the public. The CDC would conduct studies that examine human infections of animal influenza A viruses; an additional $2.8 million would streamline outbreak response in countries identified as needing special assistance; and nearly $20 million would help states administer more seasonal influenza vaccines and thus stimulate greater vaccine production by manufacturers.
In the past year, federal support for the CDC’s influenza preparedness activities yielded promising testing and vaccine development innovations. Researchers developed a laboratory test to diagnose currently circulating A/H5 (Asian lineage) strains of influenza in patients, which was approved this February by the Food and Drug Administration. Using advanced molecular technology, the test gives preliminary results within four hours, compared to two to three days with previous testing. To more rapidly detect US influenza outbreaks, the test is being distributed to laboratories within the national Laboratory Response Network (LRN), facilities in all 50 states with special training in molecular testing, biosafety, and containment procedures. The CDC also shared the new testing technology with the World Health Organization (WHO); the CDC is one of four WHO Collaborating Centers worldwide providing technical and logistical expertise on pandemic influenza. Using new genetic sequence information, scientists from the CDC also collaborated last year with federal and academic researchers to reconstruct the virus responsible for an estimated 20 to 50 million people during the 1918-19 pandemic. The virus particles are being stored at the CDC, for use in expedited vaccine and antiviral drug development.
To protect public health, the CDC has a major responsibility for preventing and controlling infectious diseases, still a leading cause of death and disability in this country and worldwide. The ASM is particularly aware of the important role of the CDC in protecting against infectious diseases. The FY 2007 budget request includes $245 million for infectious disease programs, from laboratory research and epidemic investigations to surveillance networks, public education programs and specialized training. Increased funding for infectious diseases is needed not only to maintain and expand funding for existing infectious disease problems, but also to respond to new infectious disease threats and emergencies. The CDC must be able and ready to respond to shifting challenges, as it has done in the past for emerging disease outbreaks. The public clearly expects and relies on the CDC for rapid response to disease threats and for accurate, science-based advice on health issues. After the agency consolidated all of its more than 40 health information hotlines and clearinghouses into one toll-free service last March, the consumer center handled nearly 500,000 calls during its first nine months and continues to expand.
Preventing and controlling serious infectious diseases in the United States depends on the CDC’s scientific expertise and education outreach tailored for specific diseases. An example is the CDC program to prevent HIV/AIDS, sexually transmitted diseases, and tuberculosis, an ongoing multi-faceted effort that is allotted $1.0 billion in the Administration’s FY 2007 request ($86 million more than FY 2006). Tuberculosis continues to be a serious threat in the US and worldwide, with a 13.3 percent increase in multi-drug resistant (MDR) TB in the United States from 2003 to 2004, the largest single year increase in MDR TB since 1993. An estimated 40,000 individuals newly acquire HIV in the United States each year and far more effort to prevent new infections is needed. The prevalence of anti-retroviral resistance to therapy at the time of HIV diagnosis is also increasing rapidly and will result in dramatically increased morbidity and health care costs if more effective efforts at prevention are not implemented. In contrast, new pediatric HIV infections are decreasing in number and routine prenatal HIV testing planned by the CDC for FY 2007 should decrease pediatric cases even further. The CDC’s National Plan to Eliminate Syphilis, started in 1999, requires further support with syphilis rates among US men unfortunately increasing in the United States.
Preventive health in the United States met a major milestone last year, when government efforts finally eliminated rubella virus, the highly contagious agent of childhood measles. The ASM agrees with the CDC’s FY 2007 budgetary emphasis on vaccination, certainly one of the most efficient and effective methods to fight infectious diseases. The FY 2007 $2.6 billion immunization program continues two established components to protect the nation’s children, the Vaccines for Children program that provides vaccines free to children in financial need (40 percent of all childhood vaccines purchased in the United States), and the Section 317 program, supporting state-managed immunization programs. Researchers from the CDC recently used computer modeling to evaluate economic benefits from this country’s standard childhood immunization schedule, comprising seven vaccines for illnesses like diphtheria, mumps, and polio. They concluded that collectively the immunizations not only save thousands of lives each year, but also $10 billion in direct medical costs plus more than $40 billion in indirect costs.
The CDC’s protection of American health and safety reaches beyond national borders, facing infections that can migrate from one afflicted population to the next through global travel and commerce. International collaboration against pandemic influenza is a large-scale example, but one among many such responses. Last year, experts from the CDC worked with officials from the WHO and the Angola government to control an outbreak of Marburg hemorrhagic fever in that African nation, posting traveler alerts on its website and providing on-site laboratory and field investigative services.
The proposed FY 2007 budget requests $381 million for the CDC’s global health activities, to improve detection and control of diseases such as HIV/AIDS, malaria, polio, and measles. In FY 2005, the CDC program Preventing Mother-and-Child HIV Transmission collaborated with other nations to screen 2 million pregnant women in 15 countries, giving short-course antiretroviral prophylaxis to 125,000 who tested HIV-positive. The FY 2007 budget includes $122 million in direct AIDS-related funding for ongoing prevention, treatment, and surveillance in 25 countries. From 1988 to 2004, global polio incidence declined by more than 99 percent, saving about 250,000 lives and avoiding 5 million cases of childhood paralysis. Global deaths due to measles fell by 48 percent between 1999 and 2004.
The National Laboratory Training Network (NLTN) is a unique training system sponsored by the CDC and the Association of Public Health Laboratories. The NLTN is solely dedicated to ensuring quality laboratory practice for testing of public health significance through relevant and timely continuing education offered in a variety of educational venues at a reasonable cost, often at no charge. The NLTN Continuing Education programs offer laboratories critical insights into public health needs while also ensuring high quality, cost-effective, and clinically relevant direct patient testing needs are met. The ASM strongly supports the continuation of the NLTN programs though the CDC.
The possibility of bioterrorism persists as a principal focus for the CDC, and the FY 2007 budget requests $1.7 billion to support ongoing programs, the Strategic National Stockpile (SNS), surveillance and quarantine efforts, laboratory research on high-risk pathogens like anthrax, and assistance to state and local governments. Since its creation in 1999, the SNS has expanded its inventory of vaccines, drugs, and other countermeasures, preparing for health crises like influenza pandemics, natural catastrophes like Hurricane Katrina, and biological, chemical, radiological, or nuclear terrorist attacks. Supplies can be delivered anywhere in the United States within 12 hours of an event. The SNS FY 2007 request of $593 million increases the FY 2006 appropriation by $70 million, nearly $50 million of which will finance portable hospital units under the Mass Casualty Initiative, for rapid deployment to expand local hospital capacity. The CDC’s FY 2007 bioterrorism strategy also includes funding to utilize a recent invention, a new mass spectrometry method from the CDC’s Environmental Health Laboratory for detecting botulinum toxin in people and the nation’s milk supply within 15 seconds. The additional funds will improve the method to more rapidly detect anthrax lethal factor, ricin and other toxins that can be used as bioweapons, as well as fully exploit the method’s “fingerprinting” of suspect toxins to determine their source.
The ASM asks Congress to recognize and support the CDC’s crucial activities by providing increased support for the CDC’s core programs and pandemic influenza preparedness.