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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

LOAD-DATE: April 6, 2000

Document 8 of 21.


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