Wednesday, March 15, 2006
Mr. Chairman, Congressman Obey, and other distinguished members of the subcommittee; thank you for the opportunity to appear before you again on behalf of the Centers for Disease Control and Prevention (CDC). CDC is the premier public health protection agency of the Department of Health and Human Services (HHS), serving people in the United States of America and around the world. Since the first building foundation was poured in 1946, CDC has remained at the forefront of public health efforts to prevent and control infectious and chronic diseases, injuries, workplace hazards, birth defects, disabilities, and environmental health threats. With the new public health challenges of the 21st century, CDC leads the nation in protection, preparedness, and response to terrorist activity from the public health perspective.
Thank you for your continued support of CDC's vision for healthy people throughout all stages of their lives and facets of living. In order to achieve this vision, CDC is moving forward in attaining our health protection goals through implementing key strategies and imperatives that encompass domestic and global health, customer focus, public health research, leadership, and accountability.
CDC is committed to mobilizing programs and science to ultimately achieve the greatest health impact among the highest priority populations. CDC does not do this alone. We rely extensively on our partners, other federal agencies, state and local public health agencies, community and faith-based organizations, professional associations, academic institutions, and other non-traditional partners, to leverage resources and impact public health in new, innovative ways.
Our nation and the world are intently focused on urgent threats, such as pandemic influenza; but we also must pay attention to the urgent realities of life such as obesity, cardiovascular disease and workplace wellness and safety. This balanced investment strategy is important for today to ensure a healthy future. Compared to a century ago, children are born healthier, and we are living longer; however chronic diseases, injuries, birth defects, disabilities, and environmental problems continue to cause significant morbidity and mortality in the United States. Continued support for prevention efforts that target these problems is needed and will allow us to improve the health of our nation for decades to come.
CDC is proud of our public health accomplishments, and I've chosen several to highlight within each of CDC's overarching goals.
Through the support of the Administration and Congress, CDC has realized accomplishments and successes that have resulted from our health protection strategy. The 2004-2005 influenza vaccine shortage led CDC to refocus its influenza message campaign on getting the limited supply of vaccine to high-risk groups resulting in the redirection of the domestic influenza vaccine supply to those at greater risk. Using the invaluable results of last year's emergency monitoring of priority groups from the Behavioral Risk Factor Surveillance System (BRFSS), CDC's laboratory and epidemiologic expertise, and partnerships with the nation's network of public health practitioners at federal, state and local levels, CDC launched a massive effort to mitigate local shortages in the influenza vaccine supply for the 2005-06 influenza season. This campaign included developing interim guidelines for inactivated influenza vaccine and ensured that the vaccine was as widely used as possible. It also emphasized the importance of late season vaccination, which has proven to have reduced the severity of the influenza season. The National Immunization Program and other CDC programs worked to keep the public informed of actions they could take during the season to lessen the impact of the flu season. This included a vital partnership between the CDC National Center for Health Marketing and the National Ad Council.
In 2005, a major public health milestone was reached when CDC announced the elimination of the Rubella virus in the United States. If a woman is infected by the Rubella virus during pregnancy, it can be passed to her baby, causing birth defects, which may include blindness, deafness, heart defects, and mental retardation. The Rubella virus is still common worldwide, with approximately 100,000 cases of congenital rubella syndrome reported annually. Although we have achieved success, there is still a need for continued work and future support. This remarkable achievement is a tribute to a safe and effective vaccine and a successful immunization program. We appreciate your help in ensuring that all children have access to this and other life saving vaccinations. The U.S. will have to continue working to ensure that rubella remains eliminated within our country.
Approximately 17% of U.S. children have a developmental delay or a behavioral disability, such as autism spectrum disorder, mental retardation, or attention deficit/hyperactivity disorder. As part of its response, CDC launched the Learn the Signs - Act Early campaign in FY 2004-2005 to teach parents how to monitor the social and developmental milestones of their children. The campaign provides guidelines for healthcare professionals that cue them when and how to take action if a developmental or behavioral disability is suspected. Campaign activities include distributing resource kits for parents, healthcare workers and day care providers, and maintaining a call center to provide information to the public. As of the end of 2005, the program had reached over 5 million healthcare professionals and 30 million families through its educational outreach, including radio and television public service announcements and its interactive website.
In the area of chronic disease, CDC has raised awareness of diabetes and its impact on women through its video, "Women and Diabetes: Across the Life Stages." This award-winning video captures the stories of seven women from all walks of life who have struggled with, and learned to manage, their diabetes. In just two months (February and March 2005), approximately 1.5 million women between the ages of 25 and 54 years viewed the program that was based on evidence-based health-protection measures.
The National Institute for Occupational Health and Safety (NIOSH) is the flagship organization for workplace safety and health issues. NIOSH continues to lead efforts to ensure workplace safety through its respirator certification program. In 2005, NIOSH certified its first air-purifying escape respirators with chemical, biological, radiological, and nuclear protection, a monumental achievement. These products are expected to protect the general working population from exposure during a terrorist event.
NIOSH has also been instrumental in leading research efforts in the area of mine safety. With the recent tragedies in West Virginia and across the border in Mexico, it is imperative that we continue our programmatic and scientific efforts in this area. NIOSH conducts a strategic research program dedicated to preventing injuries, illnesses, and fatalities in mining and heightening the awareness of the danger and risk associated with the mine profession, including mine fires, methane and carbon monoxide poisoning, and ventilation control. NIOSH also focuses its resources on rescue, emergency response and emergency mine communication systems.
Outside of the workplace, CDC has dedicated much work and technology to the clean up and recovery efforts in the Gulf Coast following Hurricane Katrina. CDC developed species-specific antibodies that react only to Stachybotrys chartarum, a fungus linked to serious health problems. CDC made these antibodies commercially available, and in conjunction with the Maine-based EnviroLogix, developed an on-site mold detection kit that yields immediate results. This test has become critical in monitoring mold levels in Gulf coast homes.
The school environment provides an opportunity for CDC to make a significant impact on the future of our nation. Forty-six states, reaching approximately one fifth of all school age children, are using CDC's School Health Index planning tool to improve student health. Their efforts involve teachers, parents, students, and the community in improving school health policies and programs. Examples of improvements made as a result of using the School Health Index include: increased time in physical education, addition of healthy choices to vending machines, and development of wellness programs for school staff. In support of the U.S. Department of Agriculture's mandate that requires schools to create wellness policies such as nutritional standards and mandatory physical activity, CDC is working with USDA to provide technical assistance and training in the development and implementation of the local school wellness policies.
CDC's quarantine program protects the nation against the introduction of communicable diseases. Because of growing concern about the importation of disease and the potential for bioterrorism, the program was expanded in 2005 from eight to 18 quarantine stations. While these stations traditionally have been used to evaluate ill passengers, inspect animal shipments, and seize contraband cargo, they now also play a large part in enhancing our preparedness for naturally occurring and bioterrorism related threats and emergency response. Emerging infectious diseases that transcend international borders, such as avian influenza and SARS have reminded us of the importance of an aggressive quarantine program. We look forward to adding new stations in the future.
A vital component of CDC's capacity to be prepared for emerging health threats is CDC's Laboratory Response Network (LRN). This lab system is designed for the early detection of naturally occurring as well as biological and chemical terrorism agents. In addition to bio-surveillance, the network is called upon to respond to public health emergencies. In 2005, LRN added 14 new partner labs, increasing the network's total number to 152 labs. The LRN has at least one lab in each of the 50 states and several abroad. One of the major accomplishments of the LRN this past year, was the development of rapid detection tests, including a procedure that tests for multiple biological agents simultaneously.
As the nation plans for preventing and responding to the possible spread of avian influenza, CDC's groundbreaking research has unlocked the mystery of the 1918 influenza pandemic, and, in doing so, has advanced preparedness for possible future pandemics. In collaboration with the Mount Sinai School of Medicine, the Armed Forces Institute of Pathology, and the Southeast Poultry Research Laboratory, CDC researchers actually reconstructed the 1918 influenza virus strain. Scientists can now identify gene sequences that may predict when and if an influenza strain is likely to spread among humans. The 1918 influenza strain has been declared a select agent, and its use is strictly limited under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002.
A hallmark of our international efforts is the Global Disease Detection Initiative (GDD). The GDD Initiative works with international partners such as the World Health Organization, UNICEF, Rotary International, and Ministries of Health to protect Americans from infectious threats. This is achieved through efforts to ensure rapid and accurate detection, diagnosis, and verification of emerging infectious diseases and bioterrorist threats in order to prevent transmission internationally. Early last year, CDC confirmed the diagnosis of the Marburg virus infection in nine patients who had died in Angola as a result of an Ebola-like hemorrhagic condition. CDC was instrumental in the international response to assist Angola with the epidemiologic investigation, infection control, and lab diagnosis of this disease.
CDC continues to be instrumental in efforts to eradicate vaccine preventable diseases all over the world. In partnership with the American Red Cross/ the International Federation of Red Cross and Red Crescent Societies, the World Health Organization, the United Nations Children's Fund, and the United Nations Foundation, CDC supports the Measles Partnership, a vaccination program to reduce measles-related mortality in Africa. This partnership has prevented over 268,000 deaths since its inception.
Under the direction of the U.S. Global AIDS Coordinator's Office, Department of Health and Human Services, CDC Global AIDS Program (GAP) is a proud partner in the unified federal government effort to implement the President's Emergency Plan for AIDS Relief. GAP, in partnership with the World Health Organization, has developed a generic training package for the Prevention of Mother to Child HIV Transmission (PMTCT) initiative. This training package is a tool for health workers to educate their clients on HIV and how to prevent transmitting the disease from mother to child. It includes testing and counseling strategies as well as information regarding breastfeeding and medical treatment. The curriculum is disseminated through the Ministries of Health of participating countries in collaboration with the World Health Organization. These training modules have assisted in the reduction in the number of babies who are born HIV positive.
Fiscal Year 2007 Budget Request
CDC's FY 2007 budget request of $8.2 billion reflects a blend of preparedness and prevention activities that are necessary to protect the health and well-being of our nation's people. The request responds to the Administration's commitment to maintaining the utmost public health protection in the areas of urgent and emergent health issues.
Fiscal year 2007 is marked by the President's message of continued fiscal responsibility in a deficit-reduction environment. In accordance with defined fiscal parameters, it is important that discretionary and non-discretionary spending is held to the levels proposed in the President's budget. CDC's budget request includes several program reductions and eliminations in agreement with this policy.
A significant priority for CDC is to continue working domestically and internationally on preventing, detecting, and responding to a potential influenza pandemic. We appreciate your support of the funding we have received from the FY 2006 Department of Defense emergency supplemental appropriations to address pandemic influenza. This funding provides the foundation for many critical activities. As a part of the National Strategy for Pandemic Influenza Preparedness and Response, in FY 2007, CDC will invest the $188 million in developing and deploying national capabilities to track and manage the distribution of influenza vaccine and other countermeasures, including government purchase, stockpile or commercial purchase of vaccine from the point of manufacture to delivery. This information will also be integrated with adverse event monitoring and surveillance tracking activities.
Additional funding will be used to increase the supply and use of annual influenza vaccine, particularly for high-risk populations, by stimulating manufacturers to produce additional vaccine in the event of a pandemic during the influenza season. This funding will also be used to assist state and local health departments in integrating existing information systems, which would allow them to interface with systems that track adult immunization to determine how many people have received vaccination and how much vaccine is still available. A significant portion of the increased support will allow CDC to develop an ongoing repository of pandemic influenza strains for manufacturing purposes, which will increase the capabilities for genetic and antigenic analysis of influenza viruses. Funding will also allow for the acquisition, storage, shipping, and support of newly acquired diagnostic reagents for influenza and provide incentives for manufacturers to make reagents available when needed.
With the additional $68 million in support for CDC's Strategic National Stockpile (SNS), CDC will work toward meeting the challenge of delivering life-saving supplies and medications within 12 hours of an emergency. The funding will allow us to expand our capacity by purchasing and storing countermeasures, vaccines, and treatments, and procuring antivirals and additional medical supplies.
The $3 million increase for Botulinum Toxin Research will enable CDC to improve the mass spectrometry methods that can detect botulinum toxin and its seven subtypes, and detect anthrax lethal factor, ricin, and other toxins that may be used as weapons of bioterrorism. This additional funding will allow CDC to improve the speed of analysis to up to 1,000 samples per day and simplify the method for effective use by external laboratories. Cost-effective, accelerated, methods will also be developed to screen milk samples, and for "toxin fingerprinting" -- a way of detecting minor variations that can help find the source of the toxin, provide identifying forensic information, and assist in determining the cause and pathways of disease. New technologies will improve early detection, help ensure prompt and appropriate treatment, and prevent further exposure.
Great strides have been made toward improving the lives of adults through the many programs at CDC, and we are thrilled about the President's commitment to addressing HIV/AIDS in the United States. There are an estimated 250,000 persons in the U.S. unaware they are infected with HIV. The priority of CDC's Advancing HIV Prevention Initiative is to identify persons with undiagnosed HIV infection and link them to medical care and prevention services. With the $93 million increase in the FY 2007 President's budget for domestic HIV/AIDS, there will be new initiatives to improve HIV testing in medical settings, by making voluntary testing more of a routine part of medical care, and creating new testing guidelines, models, and best practices. This initiative will facilitate the testing of more than three million Americans, with special emphasis on regions that have a high incidence of HIV, individuals who are incarcerated, and injection drug users.
The FY 2007 request also includes a $189 million increase for the Vaccines for Children (VFC) program. This request includes a proposed change in the law to allow underinsured children to receive the VFC purchased vaccine at approximately 5,500 state and local public health clinics thereby expanding access beyond rural health centers and federally qualified health centers. Expanded access ensures that these children receive the recommended vaccines they may otherwise be missing.
In closing, thank you for the opportunity to come before you to discuss the activities of CDC and the support that CDC has received in the President's FY 2007 budget request. CDC is committed to programmatic and scientific work that contributes to the health and safety of the public at large. My sincerest appreciation to you, Mr. Chairman, Congressman Obey, and the other distinguished members of this subcommittee. I look forward to working with you all this fiscal year.
Last Revised: March 17, 2006