Centers for Disease Control and Prevention - FY 2002 Testimony

The American Society for Microbiology (ASM) gratefully acknowledges Congress' increased support for the Centers for Disease Control and Prevention (CDC), particularly for the CDC's National Center for Infectious Diseases (NCID), which supports programs to address emerging and drug resistant infectious diseases, public health infrastructure, bioterrorism preparedness and food safety. The CDC is the primary agency responsible for guarding the public's health, including protecting the nation against potentially life threatening infectious diseases. The ASM appreciates Congressional recognition for CDC's role in responding to the threats of emerging infectious diseases and encourages Congress to maintain and renew that support.

The ASM endorses the recommendation of the CDC Coalition to increase the overall CDC budget to $5 billion in FY 2002 to provide additional new resources for CDC programs focused on national and global health and security. The CDC is called upon constantly to identify, control, and prevent outbreaks of disease here and abroad. For the past fifty years, members of the CDC's Epidemic Intelligence Service have helped solve microbial mysteries, such as the recent outbreaks of Legionnaire's disease at a Cleveland automotive plant and the unexpected arrival in New York of West Nile encephalitis. Despite this nation's successes against certain diseases, our public health system continues to be at risk from both new and re-emerging infectious diseases, from threats of bioterrorism and antibiotic resistant pathogens, and from an aging public health infrastructure. These areas are of particular concern to the ASM, which represents more than 42,000 members from a broad spectrum of microbiology-related professions, including microbiologists who work in biomedical, clinical, public health, and industrial laboratories.

Prevention strategies promoted by the CDC promise significant rewards in the form of improved public health. Likewise, strong financial support for the CDC will give Americans both a healthier society and cost-saving benefits. The multi-billion-dollar cost of microbial diseases in this country alarms all of us. Foodborne diseases alone cost the national health care system more than $3 billion per year, added to annual lost productivity estimated at $8 billion. On a global scale, the CDC's participation in eradication campaigns like that against polio also promises high returns: the U.S. would save more than $230 million annually in vaccine costs, and worldwide the estimated savings would exceed $1.5 billion. Investment in a stronger CDC undoubtedly will yield measurable positive results in the form of disease identification and control, helping to fulfill the CDC's vision of a healthier 21st Century. Investment in CDC will also enhance national and global security, both economic and political. For these reasons, the ASM asks Congress to respond aggressively to threats from infectious diseases with generous support of the Centers for Disease Control and Prevention.

Infectious Diseases -- Threats to National and Global Health and Security

Microbial pathogens and the diseases they cause persist as a leading cause of death worldwide and in the United States. In today's global society, it is possible for a new disease to spread internationally within days, perhaps hours. It is alarming to realize that infectious diseases would cause even more deaths in this country if it were not for a persistent federal assault against these pathogens.

The CDC's vision for the 21st Century is "healthy people in a healthy world -- through prevention." Toward this goal, the CDC launched a nationwide effort to protect the public from infectious diseases that includes surveillance and response, applied research, infrastructure and training, and prevention and control. In 1998 the CDC developed a comprehensive plan, "Preventing Infectious Diseases: A Strategy for the 21st Century," listing a sobering array of new and re-emerging infectious diseases and the obstacles that make stopping these diseases so difficult. Last year, Congress passed the Public Health Threats and Emergencies Act to strengthen the public health infrastructure in the areas of antimicrobial resistance, bioterrorism and major infectious disease outbreaks.

New and re-emerging infectious diseases pose unique challenges to the CDC in its role as the nation's prevention agency. More than 35 new infectious diseases have been identified since 1973, among them those caused by HIV, E. coli O157:H7, and airborne Ebola virus. The ever-changing threats posed by infectious diseases demonstrate the importance of a public health infrastructure capable of rapid and accurate disease identification and prevention anywhere in the United States or abroad. On-call CDC personnel consistently assist local and state health departments across the United States in identifying outbreaks due to such emergent microorganisms as the West Nile virus.

First described in New York State in 1999, West Nile encephalitis spread to a wider area during the summer of 2000, carried by mosquitoes and underscoring the need to rebuild our capability to deal with vector-borne diseases. The CDC's response illustrates its four-pronged approach - surveillance and response; applied research; infrastructure and training; and prevention and control - to protect the public against infectious diseases. The agency developed a national electronic surveillance system (ArboNet) to track the virus in humans, birds, mosquitoes and horses. It also helped develop rapid laboratory tests to detect the presence of the virus, as well as a DNA vaccine that thus far looks promising in animal studies. Funding to 49 state and local health departments and related training sessions and educational materials enhanced the public health system's chance of stopping the virus. To prevent spread of the virus, the CDC formulated a large-scale emergency plan for mosquito control in affected areas.

A similar multifaceted CDC program is in place against hepatitis C viral infection (HCV), a relatively recent problem in the United States. HCV is the most common chronic bloodborne viral infection in the United States, where it has infected more than 4 million people, nearly 75 percent of whom remain chronically infected. Persistent infection often leads to serious medical conditions, possibly cirrhosis or liver cancer; in fact, an estimated 40 to 60 percent of chronic liver disease is due to this virus. The CDC supports a national survey of blood collection centers and hospital transfusion services to determine the progress of notifying transfusion recipients who received blood from donors who later tested positive for HCV, works with state and local health departments to coordinate activities including viral hepatitis education and counseling, testing, referral, surveillance and vaccination efforts, and coordinates the Hepatitis C Public Information Campaign. CDC will continue to fund new studies to monitor the transmission of HCV among various populations, enhance support for state and local health department programs, and develop and provide training to healthcare professionals.

New infectious diseases are not the only menace to public health. Historic killers such as malaria and influenza continue to challenge national and global health systems. Of all the emerging and re-emerging infections, influenza has the greatest potential to cause catastrophic morbidity, mortality, and social disruption both locally and globally. Three pandemics in the past century were grim reminders of how dangerous influenza can be. The CDC actively supports influenza surveillance in other countries, to monitor for variant viruses that may cause new pandemics. Agency mathematical models suggest that an influenza pandemic could result in a five-fold increase in U.S. deaths, compared with non-pandemic years. In a typical year, the disease causes an average of 20,000 deaths in the United States, along with more than 110,000 hospitalizations. Each year brings new influenza viruses and fears of even more serious U.S. epidemics, during which up to 40,000 deaths and 200,000 hospitalizations can occur. The CDC counters such persistent problems with long-term, year-round surveillance both in the United States and in countries known to be sources of new viruses. As with other diseases, the agency also works to improve individual states' ability to respond to epidemics and to strengthen the international network of laboratories and personnel able to identify outbreaks. Recognized as a global leader in responding to any disease outbreak, the CDC must be provided with sufficient resources to improve its readiness for any future pandemic.

Antibiotic resistance in pathogens and the threat of bioterrorism have further complicated the current global infectious disease crisis, forcing health officials to rethink our approach to both old and new infectious disease. Overuse of antibiotics contributes to a rising incidence of microbial mutants resistant to the traditional therapeutic-of-choice. In some areas of the United States, more than 30 percent of pneumococci resist penicillin, a drug once effective against virtually all pneumococcal pneumonia and meningitis. More than 90 percent of strains of Staphylococcus aureus in U.S. hospitals are resistant to penicillin; these strains now are spreading into the general community. Other common infections, such as gonorrhea and salmonella, also are becoming more difficult to treat. The cost of resistant diseases is significant: the U.S. health care system spends an estimated $1.3 billion, annually, on the treatment of nosocomial infections caused by resistant organisms. It normally costs $2,000 to treat a patient for tuberculosis in this country, but if the tubercle strain is resistant, that cost may be inflated 100 times.

On January 18, the Department of Health and Human Services released its plan to combat antimicrobial resistance, to be led by the CDC, the Food and Drug Administration (FDA) and the National Institutes of Health. The plan, which provides a blueprint for coordinated federal action, has four components - surveillance, prevention and control, research, and product development. CDC personnel and collaborators will work with state health departments and others to coordinate and improve surveillance methodologies. The CDC already has begun preparation of clinical guidelines for health professionals on the best use of antimicrobials and on infection control practices, to prevent the spread of drug resistance. With the FDA and the U.S. Department of Agriculture, the CDC is monitoring resistant nosocomial infections in 300 hospitals in 15 states. This program complements the CDC's National Nosocomial Infection Surveillance System (NNISS) already in place, a prototype system for preventing adverse health care events. An estimated 44,000 to 98,000 Americans die each year from preventable medical errors, which include nosocomial infection. In the past decade, hospitals participating in the NNISS have had a 30 percent decline in targeted infections.

Substantial funding and flexibility is needed to enable CDC to fully implement the goals set forth in its strategic and comprehensive plan against emerging and re-emerging infectious diseases. The ASM recommends an additional $120 million in FY 2002 to achieve such goals as improving the detection and prevention of emerging pathogens, communicating among all levels of government health agencies, and integrating laboratory science with on-site epidemiology.

Bioterrorism Preparedness and Response

Unfortunately, emerging infectious diseases and drug-resistant pathogens could also be used in terrorist attacks. The CDC considers bioterrorism as part of its mission against emerging infectious diseases here and abroad. It is worrisome that there is no guarantee that the nation's current public health infrastructure could adequately respond to a bioterrorist event. CDC has joined other federal agencies in implementing new programs and expanding others to include counterterrorism capabilities.

To diminish our vulnerability to such attacks, the CDC will continue to focus its attention on laboratory capabilities at CDC and at State and local health department levels; on the development and implementation of rapid diagnostic tests for biological agents; on surveillance activities with hospitals, health clinics, private and commercial laboratories, as well as with veterinary and agriculture partners; on electronic communication capacity at the local level with the Health Alert Network (HAN) and the National Electronic Data Surveillance System (NEDSS), designed to collect, analyze and interpret health-related data in a timely and efficient manner; and on public health preparedness and readiness activities such as the education and training of both public and private health care personnel, firefighters, police officers and emergency medical technicians.

In FY 2002, ASM recommends that Congress provide an additional $100 million for CDC to continue and expand these activities to respond to the threat of bioterrorism.

Buildings and Facilities

In protecting American health and safety, the CDC puts science into action, shares vital information, and creates partnerships with public and private groups concerned with public health. But unless the CDC's buildings and physical infrastructure receive more funding from Congress, its ability to respond to disease anywhere, anytime, could be seriously undermined. The expansion of CDC's responsibilities around the world and in the United States has stretched thin the agency's infrastructure. CDC buildings in Atlanta cannot house the current staff and about half of that workforce labors in nearly two dozen leased offices around Atlanta. Much of CDC's laboratory equipment is outdated. According to the agency, at present 70 percent of its infectious disease scientists and all of its parasitology and environmental health specialists work in highly inadequate and potentially hazardous laboratories. Last year the CDC began a phased 10-year improvement of its Atlanta facilities. As a result, phase I of the infectious disease laboratory was completed and opened, and phase II will be completed this fall. In addition, the emerging infectious disease laboratory is currently being designed and construction has begun on parasitology and environmental health laboratories. The ASM appreciates Congress' attention to CDC's physical infrastructure needs and urges an additional $175 million in FY 2002, for the construction of the emerging infectious disease laboratory, the design for the environmental toxicology laboratory and routine maintenance projects nationwide.

Thank you for the opportunity to submit ASM's recommendations for the hearing record of the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, for the CDC's FY 2002 appropriation.