Statement by
Julie Louise Gerberding, MD, MPH, Director Centers for Disease Control and Prevention Administrator, Agency for Toxic Substances and Disease Registry
President's Budget Request for Fiscal Year 2004
before the
House Subcommittee on Labor-HHS-Education Appropriations

March 26, 2003


Mr. Chairman, Congressman Obey, other distinguished members of the Subcommittee, I am Julie L. Gerberding, Director of the Centers for Disease Control and Prevention, and Administrator of the Agency for Toxic Substances and Disease Registry. Thank you for the opportunity to appear before you today on behalf of the Centers for Disease Control and Prevention (CDC). Our mission is to protect the health and safety of the American people through activities that range from terrorism preparedness and response, to promoting physical activity and nutrition, to preventing birth defects and the spread of infectious diseases. These responsibilities require an aggressive approach to leadership and management that allows CDC to balance emerging issues with our vision for safer, healthier people in every community. Soon after I was appointed CDC director in July 2002, I asked our senior management staff to focus on excellence in science, service, systems, and strategy, for the benefit of our partners and constituents. The overarching goals of this collective focus are to ensure that we as an agency do the following:

  • Practice evidence-based science grounded in sound peer-reviewed research.
  • Promote efficient service to meet the needs of our partners and customers.
  • Fine-tune and manage our systems so that we use our personnel, technology, infrastructure, and information efficiently to achieve results.
  • Ensure that our strategies truly prepare us for future challenges.

The President's fiscal year (FY) 2004 Budget request for CDC reflects these imperatives in a strong endorsement of the agency's commitment to promoting and protecting the health and safety of all Americans. The President's request will enable CDC to address our central strategies of prevention and preparedness, while capitalizing on science and technology to achieve public health goals. We will continue to upgrade our buildings and facilities and we will further strengthen the nation's public health infrastructure, areas in which we have made substantial progress over the last year, thanks in large part to the support of this Subcommittee. I would like to highlight some of my broad priorities for CDC, which the President has expressed in his budget request for FY 2004.

Promoting Health and Quality of Life through Prevention Strategies

As the lead federal agency for protecting the health and safety of Americans, CDC strives to prevent disease, injury, and disability through a wide range of public health activities. President Bush, Secretary Thompson and I have identified high priority prevention areas that will be addressed by innovative initiatives proposed for FY 2004. The centerpiece of this effort is Steps to a HealthierUS, a program designed to reduce the burden of obesity, diabetes, asthma, and other chronic conditions, by promoting healthy choices in nutrition, physical activity, youth behavior, and preventive health care. CDC will kick off this effort in FY 2003, building on the work of the National Center for Chronic Disease Prevention and Health Promotion in partnership with other HHS agencies.

Chronic diseases, which are largely preventable through attention to healthy lifestyles and preventive services, cause 70% of all deaths each year and account for 75% of the health care costs in the United States. If current policies hold true, by the year 2011, our nation will spend more than $2.8 trillion on health care. The U.S. spends more on health care than any other country in the world, yet 125 million Americans live with chronic conditions and millions of new cases are diagnosed each year. Our country now faces an unparalleled epidemic of chronic disease. The burden of obesity, diabetes, and asthma is well documented. Over 45 million adult Americans meet the body mass index threshold for obesity, and close to 8 million young people are considered overweight. Diabetes affects more than 17 million Americans and contributes to approximately 200,000 deaths per year in this country. An additional 17 million Americans have developed pre-diabetes. An estimated 26 million Americans suffer from asthma.

Despite these disheartening statistics, the underlying causes of these conditions are often risk factors that can be modified successfully years before they contribute to illness and death. Consider diabetes, for example. Studies have shown that improved diabetes care and patient self-management can delay blindness, amputations, kidney disease, and other complications. Over the past six years, the Diabetes Prevention and Control Program in New York State has put this knowledge into practice with outstanding results. New York State, with CDC support, has reduced the rate of lower extremity amputations among people with diabetes by 36 percent; reduced hospitalization rates of diabetics by 30 percent; and reduced the incidence of end stage renal disease in people with diabetes by 14 percent. This is the critical gap CDC fills: we take biomedical discoveries from the bench to the trench.

Steps to a HealthierUS is a bold new initiative from the Department of Health and Human Services that advances the President's HealthierUS goal of helping Americans live longer, better, healthier lives. At the heart of the Steps to a HealthierUS program lie both personal responsibility for the choices Americans make and social responsibility to ensure that policymakers support programs that foster healthy behaviors and prevent disease. We can no longer sustain the skyrocketing health care costs created by over-reliance on treatment, nor can we sustain the suffering that preventable diseases and conditions cause. Steps to a HealthierUS represents a bold shift in our approach to the health of our citizens, moving us from a disease care system to a true health care system.

In an effort to increase access to childhood immunizations, the President has proposed a series of improvements in the Vaccines for Children (VFC) program. First, the Budget request proposes allowing public health clinics to provide VFC vaccine at no cost to underinsured children. Under current law, underinsured children (that is, those children whose insurance does not cover immunization) are eligible for vaccination through the Vaccines for Children program only at participating Federally Qualified Health Centers or Rural Health Centers. In FY 2004, this proposed change would enable nearly 5,500 state and local health department clinics to provide VFC vaccines to underinsured children. The proposed change would allow an estimated several hundred thousand additional children to receive the Pneumococcal Conjugate Vaccine (PCV) four dose series, which prevents pneumonia and meningitis, through the VFC program. In addition to expanding access points, the President's Budget proposes to restore tetanus and diphtheria booster to the vaccine program by removing the outdated price caps that are currently so low vendors will not bid on VFC contracts. Finally, to ensure against future vaccine shortages, the Department of Health and Human Services will begin in FY 2003 to invest in the creation of a six-month national stockpile of all childhood vaccines. The proposed improvements to the Vaccines for Children program will protect more children in this country against vaccine-preventable disease, and is consistent with CDC's overarching emphasis on prevention.

On the international front, the President has requested funds for prevention of mother-to-child HIV transmission, with the goal of reducing this type of HIV transmission by 40% among one million treated women in 14 countries in Africa and the Caribbean. This effort represents the initial step in the President's new Emergency Plan for AIDS Relief. Interventions now exist to reduce mother-to-child transmission substantially in developing countries. Recent international clinical trial results have demonstrated that the risk of transmission could be reduced by 30 to 50 percent by administering antiretroviral prophylaxis in the last weeks of pregnancy or at labor and delivery, and by changing breastfeeding practices in HIV-infected women. With CDC's support, countries have begun putting this information into practice. In 2000, for example, Thailand instituted a national program that now reaches all 822 public hospitals (covering more than 70% of all births) and annually provides HIV testing to more than 500,000 pregnant women, prophylactic antiretroviral drugs for more than 5,000 HIV-infected women, and infant formula for more than 5,000 HIV-exposed infants. This effort is expected to reduce Thailand's mother-to-child HIV transmission rate from 30% to less than 10%, preventing more than 1,000 infections in children each year. The President's commitment, as expressed in the Budget request, will enable us to move forward in the prevention of mother-to-child transmission of HIV.

Both at home and abroad, the President's FY 2004 Budget will enable CDC to continue efforts to prevent disease and disability and to promote healthy behaviors.

Protecting Health through Prepared Public Health Systems

CDC is committed to strengthening the capacity of our public health system to respond to health threats. To achieve this imperative, we must continue to improve CDC buildings and facilities and continue to enhance the ability of the broader public health infrastructure to respond to public health emergencies, including biological, chemical, radiological, or conventional terrorism.

As CDC Director, I place the highest priority on rebuilding our physical infrastructure. Using innovative procurement and design methods, we have been able to greatly reduce the timeline for construction and we continue to make progress on our Buildings and Facilities Master Plan. Sustained investment, reflected in the President's request for FY 2004, will provide our first-class scientists with state-of-the-art public health facilities, assuring CDC's ability to serve the American people and to respond to public health emergencies rapidly and effectively.

The broader public health infrastructure at the state and local level also is in need of repair. The $2 billion investment Congress has devoted over the past two fiscal years to state and local preparedness has substantially strengthened the foundation for emergency response at the frontlines of public health, but much work remains to be done. The President's FY 2004 request for upgrading state and local capacity will continue to assist states and local governments in building terrorism preparedness capacity, particularly in the areas of surveillance and epidemiology, laboratory capacity, communications, and education and training. The following examples illustrate the progress that has been made in the area of emergency preparedness and response. Currently, nine out of ten States can initiate a field investigation within 6 hours of urgent disease report on a round-the-clock basis; three out of four States have systems in place to send and receive urgent health alerts among critical response organizations; and nearly 22,000 civilian health care and public health workers in 52 jurisdictions had been vaccinated against smallpox as of March 14. The FY 2004 request will continue to develop capacity at all levels of government to address public health emergencies.

Advancing Health through 21st Century Science and Technology

In FY 2004, CDC will advance public health through science and technology with a focus on building the Public Health Information Network. The Public Health Information Network will help monitor and maintain the public's health by detecting problems, analyzing data, disseminating information, communicating alerts, and directing appropriate responses. Building on CDC's existing investments in public health information technology, including the National Electronic Disease Surveillance System, Epi-X, and the Health Alert Network, the Public Health Information Network will establish consistent, secure, and timely exchange of surveillance, communications, and response data between public and private health partners on a routine basis and in emergency circumstances. This standardization of public health data exchange is a critical element in assuring rapid identification of, and a seamless public health response to an emergency situation, whether naturally-occurring or terrorist-induced.

Improving Management and Service

The FY 2004 Budget request for CDC supports the President's Management Agenda and includes cost savings from consolidating administrative functions, competitive sourcing, implementation of effective workforce planning and human capital management strategies, and adoption of other economies and efficiencies in administrative operations. CDC is focused on workforce planning, budget and performance integration, and E-Government. As a result of these efforts, we will realize a savings of $34 million due to improved information technology practices and nearly $21 million due to increased management efficiency.

Financial management is a focus of particular importance among CDC's efforts to improve management and service across the agency. CDC's management team has developed a Financial Management Excellence Initiative to improve fiscal management practices across the agency. With the Secretary's leadership, we are moving toward a Unified Financial Management System within the Department that will integrate existing systems and allow for a more timely and coordinated view of critical financial management information. CDC has received an unqualified audit opinion for the fifth consecutive year, indicating that we provide accurate and effective financial stewardship for the public funds with which the agency is entrusted.

The progress we are making toward more effective management practices translates to capable and efficient service to the Administration, the Congress, our public health partners, and ultimately to the American people.


I would like to reiterate my thanks for the opportunity to be here to discuss the support CDC has received in the President's FY 2004 Budget request to Congress, and I would like to express particular thanks to you, Mr. Chairman, and to the members of this Subcommittee, for your continued support of our activities to enhance the public's health and safety. CDC is committed to promoting and protecting the health of the American people. I look forward to working with Congress to fulfill CDC's essential public health mission, and I would be happy to answer any questions you might have.