Copyright 2000 Federal News Service, Inc.
Federal News Service
April 5, 2000, Wednesday
SECTION: PREPARED TESTIMONY
LENGTH: 2408 words
HEADLINE:
PREPARED TESTIMONY OF JOHN G. BARTLETT, M.D. PROFESSOR OF MEDICINE CHIEF OF THE
DIVISION OF INFECTIOUS DISEASES JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE ON
BEHALF OF THE INFECTIOUS DISEASES SOCIETY OF AMERICA
BEFORE THE
HOUSE APPROPRIATIONS COMMITTEE LABOR, HHS & EDUCATION
SUBCOMMITTEE
SUBJECT - FISCAL YEAR 2001 APPROPRIATIONS FOR THE
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES AND THE CENTERS FOR
DISEASE CONTROL AND PREVENTION
BODY:
The
Infectious Diseases Society of America (IDSA) represents over 5,000 physicians
and scientists devoted to patient care, education, research, and community
health planning in infectious diseases. We appreciate this opportunity to
testify before the Subcommittee on Labor, Health and Human Services, and
Education concerning fiscal year 2001 funding for the National Institutes of
Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), and
the Centers for Disease Control and Prevention (CDC). We applaud the dedication
and expertise of the Chairman and Members of this Subcommittee, who have
contributed so much to the health of the nation, and deeply appreciate the
generous and much needed funding increases for NIH and CDC over the past few
years.
Infectious diseases are the leading cause of death worldwide and
the third leading cause of death in the U.S. Today's investment in infectious
disease research, prevention, and treatment will pay significant dividends in
the future to the American people in dramatically reduced health care costs and
improved quality of life for millions. We urge this Subcommittee to continue to
demonstrate leadership and foresight in this area by appropriating much needed
funding increases for these programs in recognition of the lives and dollars
that ultimately will be saved.
Infectious Diseases in the U.S.
The United States has made great progress toward controlling infectious
diseases, thanks largely to our investments in biomedical research and public
health programs. Federal support for the development and distribution of
vaccines has dramatically cut or eliminated the incidence of many serious
diseases. Increasingly high rates of childhood vaccinations will allow American
children to grow up free from worry about smallpox, polio, diphtheria,
pertussis, measles, mumps, and rubella. This list of vaccine-preventable
illnesses will grow as NIAID researchers contribute to the development of new
and improved vaccines, such as those against hepatitis B, varicella, and
Haemophilus influenza type b. Adults, of course, are protected by vaccines too,
particularly the vaccines against influenza and pneumococcal infections, which
prevent thousands of deaths each year. The benefits to society from our
investment in vaccine development and widespread distribution are immense, as
Americans live longer, healthier lives, thus saving millions in health care
costs.
In addition to vaccine development, strong federal support for
research has brought about new treatments for infectious diseases. For example,
NIH research into HIV and AIDS uncovered information about how the virus
replicates itself. This research led to the development of protease inhibitors,
drugs that slow the progress of illness in HIV-positive people when used in
combination with other antiretroviral medications. These medications, combined
with education and prevention programs, have contributed to the two-thirds
decline in annual AIDS- related deaths since 1995.
Although these
advances are encouraging, they are only a small part of the work we need to do.
Infectious diseases kill 170,000 Americans each year, nearly twice the 1980
death rate, with a disproportionate number of minorities affected. Many of these
deaths are from pathogens whose existence was discovered only recently. For
example, since hepatitis C was identified in 1989, we have learned that
approximately 4 million Americans carry it. The number of deaths from this
virus, which causes liver cancer and cirrhosis, may exceed the number
attributable to HIV/AIDS in the next five years. Other diseases, such as
tuberculosis, that we once believed to be gone from the United States are making
a "comeback," as many pathogens develop resistance to our most commonly used
medications. We also expect to face new crises, such as a new flu pandemic or
bioterrorist attack, for which we must develop response plans, vaccines, and
therapies. The threat of bioterrorism requires advanced study of microbial
agents to prepare vaccines and therapies, as well as response plans. Clearly,
this is no time to relax our efforts to fight infectious diseases.
Global Health
Infectious disease research cannot focus only on
illnesses in this country. As our global trade and travel opportunities expand,
so does our exposure to infectious diseases from other parts of the world.
Illnesses from other countries, whether they be new variant Creutzfeldt-Jakob
disease in the United Kingdom and Europe or drug- resistant malaria from
tropical countries, can be carried to the U.S. by imported products, animals, or
travelers. We should no longer be surprised by the arrival of new diseases, such
as West Nile fever or influenza. We must be prepared to recognize emerging
disease risks and to develop timely responses to their appearance in the U.S.
However, it would be shortsighted to focus our efforts solely on the U.S.
Effective infectious disease control must address the diseases that we can only
hope will never reach the United States. The IDSA strongly encourages adequate
funding for NIH Fogarty International Center (FIC), which focuses on mobilizing
scientific resources to meet global needs, especially within developing
countries.
Infectious diseases are devastating to nations in the
developing world. In nations where uneven economic development, unstable
political regimes, and armed conflict have restricted access to medical care and
health education, infectious diseases face little opposition. Sub-Saharan Africa
accounts for nearly half of infectious disease deaths globally, with the highest
HIV/AIDS and malaria death rates and poorest health care capacity in the world.
The alarming rates of HIV/AIDS infection in Sub-Saharan Africa are almost
matched by those of Asia, where multidrug-resistant TB, malaria, and cholera are
uncontrolled, as well. The former Soviet Union faces a TB epidemic and rapidly
increasing rates of HIV infection. In these countries, a lack of medical care is
cutting life expectancies by decades, orphaning children, and destroying
communities. No one should be allowed to suffer like this when we have the
knowledge and technology to help.
We have more than humanitarian reasons
to look overseas. A recent report by the National Intelligence Council (NIC)
examined the potential threat to our national security posed by global
infectious diseases. The report argued that developing countries bear not only
the costs of treating infectious diseases, but also the losses to their economic
development. Infectious diseases decimate their workforces, discouraging foreign
investment and curtailing much needed economic growth. This economic instability
contributes to political unrest by intensifying demands over control of a
nation's limited financial resources, possibly leading to crises in nations with
already weak democracies. Attempts to control such a crisis through peacekeeping
and humanitarian operations would expose U.S. military personnel and aid workers
to greater threats from infectious diseases than from combat.
The Need
for Continuing Support for NIH and CDC
Mr. Chairman, with the
Subcommittee's support of NIH and CDC, we can make new advances against
infectious diseases at home and abroad.
IDSA supports a 15 percent
increase for NIH that would be the third step toward doubling its budget by
fiscal year 2003, with a comparable increase for CDC to support its public
health initiatives. We would like to point out just four of the areas that would
benefit from increased funding for NIH and CDC.
1. Vaccine Development
NIAID has made great contributions toward creating safe and effective
vaccines for many diseases. The Institute's research has laid the groundwork for
the development of new vaccines, including those against hepatitis A and B,
Haemophilus influenzae type b, pertussis, typhoid, varicella, and pneumococcal
disease. At the moment, NIAID is working on a vaccine against
Streptococcuspneumoniae, a pathogen that causes 1.2 million child deaths
worldwide each year. The Institute also performs and supports important research
that helps to improve vaccine safety, allay concerns about current vaccines, and
develop new methods of administering vaccines. With increased support, NIAID
will be able to bring us closer to preventing even more diseases, both in the
U.S. and around the world.
2. Public-Private Partnerships
Our
ability to translate research into treatment is greatly enhanced by partnerships
with the private sector. By working together, NIH and biotechnology and
pharmaceutical companies can speed the introduction of new medications and
vaccines to the world. The President's budget for fiscal year 2001 includes a
proposed tax credit for the development of vaccines against infectious diseases,
such as HIV/AIDS, TB, and malaria, which will benefit both the U.S. and
developing countries. We applaud this proposal, as well as the NIAID Challenge
Grant program that will match dollar-for-dollar private sector investment in
emerging infectious diseases. The NIH cannot fight this battle alone; we ask for
your support in enlisting the private sector as well.
3. Genomics
Increased support for NIH will allow expanded research into the
important field of pathogen genomics. Years of investment in studying the
genetics of humans and pathogens has produced new information about the genetic
make-up of microbes and the technology needed to do further analysis. NIAID
researchers have successfully mapped complete or partial genetic sequences of
malaria, TB, chlamydia, and syphilis. Research on these pathogens, along with
work on many other infectious agents, must continue. We believe that pathogen
genomics holds great promise for drug and vaccine development, particularly for
TB, malaria, and other diseases that ravage developing nations. We also hope to
discover more of the pathogenic organisms that cause chronic diseases.
Approximately 20 percent of all cancers are related to infections. Further
research may uncover pathogenic causes of coronary artery disease, diabetes, and
multiple sclerosis.
4. Prevention and Education
The CDC performs
a great service for America and the world by tracking the spread of infectious
diseases, preparing responses to outbreaks, and educating the public about
prevention. CDC works with states, localities, and the private sector to ensure
that all Americans get the vaccines they need when they need them. CDC programs
purchase and distribute vaccines, monitor immunization levels, and develop
guidelines on the use of vaccines. These programs are making great progress, but
we can and must improve our vaccination rates for both children and adults.
While over 90 percent of 2-year-olds receive the most critical vaccines, only 58
percent of Americans over 65 years of age received influenza vaccine in 1995,
and only 32 percent received the pneumococcal vaccine. The immunization rates
are worse for African-Americans, Hispanic persons, and persons under 65 years of
age with high-risk medical conditions. CDC also helps distribute vaccines
overseas, providing assistance to the World Health Organization in its work to
eliminate polio. Increased CDC funding would facilitate the centers' efforts to
provide all Americans with timely, appropriate vaccines.
In addition to
its vaccine programs, CDC helps to prevent infectious diseases through education
and screening. These efforts cover a wide range of diseases and affect almost
all Americans, with a particular emphasis on the minority populations who are
most affected by infectious diseases. Through testing and education programs at
the national, state, and local levels, CDC works to reduce the spread of
HIV/AIDS, STDs, and TB. The small cost of these programs pales in comparison to
the cost of treating these terrible diseases.
CDC epidemiologists
conduct vital research into the spread of infectious diseases around the world.
Their work provides us with essential data on the risk factors, modes of
transmission, and rates of occurrence associated with infectious diseases. Those
data are needed to predict and prepare for our next challenges, including the
threat of biological terrorism. New and emerging infectious diseases and the
evolution of drug-resistant strains of diseases will require more of our
attention and resources in the years to come. We ask this Subcommittee to
provide CDC, which has been designated by HHS as the agency to lead the overall
effort against biological terrorism, with the resources it needs to protect us.
IDSA also respectfully requests that the Subcommittee act favorably on
the budget request to begin a 10-year program to reconstruct CDC's outdated and
overcrowded laboratories. These laboratories are relied upon to help control
disease outbreaks and thus to prevent illness and injury. Current buildings and
facilities are desperately inadequate and an unforeseen public health danger--a
bioterrorism event, a global flu pandemic--likely would overwhelm CDC's current
capacities. Three laboratory construction projects are proposed-each is
essential to the public health, and to the national security.
Finally,
Mr. Chairman, IDSA supports a $125 million increase for all
titles of the Ryan White Care Act, which provides funding for
vital medical care, life-saving drug treatments, and important enabling services
for people living with HIV/AIDS who are uninsured or underinsured. This increase
will provide 2,900 persons with much- needed drug therapy through the AIDS Drug
Assistance Program. The important advances in developing new drug therapies
mentioned earlier are useless unless we can provide them to the patients who
need them the most.
Mr. Chairman, this nation's successes in fighting
infectious diseases have raised expectations of our ability to conquer more
diseases. We must remember that research needs to focus on not only the diseases
we have today, but also the infections we will face tomorrow. The Infectious
Diseases Society of America very much appreciates the opportunity to testify
regarding the importance of adequate appropriations for the NIAID and the CDC to
continue programs supporting research, prevention, and treatment involving
infectious diseases. We believe that you will continue to conclude, as we do,
that greater investment in these significant programs today will pay great
dividends in the near future.
END
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April 6, 2000