DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2003

HEARINGS

BEFORE A

SUBCOMMITTEE OF THE

COMMITTEE ON APPROPRIATIONS

HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION

SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES

RALPH REGULA, Ohio, Chairman

C. W. BILL YOUNG, Florida

ERNEST J. ISTOOK, JR., Oklahoma

DAN MILLER, Florida

ROGER F. WICKER, Mississippi

ANNE M. NORTHUP, Kentucky

RANDY "DUKE" CUNNINGHAM, California

KAY GRANGER, Texas

JOHN E. PETERSON, Pennsylvania

DON SHERWOOD, Pennsylvania

DAVID R. OBEY, Wisconsin
STENY H. HOYER, Maryland
NANCY PELOSI, California
NITA M. LOWEY, New York
ROSA L. DELAURO, Connecticut
JESSE L. JACKSON, JR., Illinois
PATRICK J. KENNEDY, Rhode Island

NOTE: Under Committee Rules, Mr. Young, as Chairman of the Full Committee, and Mr. Obey, as Ranking
Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees.

CRAIG HIGGINS, SUSAN QUANTIUS, SUSAN ROSS FIRTH, MEG SNYDER,
and FRANCINE MACK-SALVADOR, Subcommittee Staff

PART 3

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLIC HEALTH SERVICE

(Excluding the National Institutes of Health)

Centers for Disease Control

Page

1

745

1379

Agency for Health Care Research and Quality

Printed for the use of the Committee on Appropriations

COMMITTEE ON APPROPRIATIONS

C. W. BILL YOUNG, Florida, Chairman

JAMES W. DYER, Clerk and Staff Director

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND REAGENCIES APPROPRIATIONS FOR

LATED 2003

THURSDAY, MARCH 21, 2002.

CENTERS FOR DISEASE CONTROL AND PREVENTION

WITNESSES

DAVID W. FLEMING, M.D., DEPUTY DIRECTOR FOR SCIENCE AND PUBLIC HEALTH, CENTERS FOR DISEASE CONTROL AND PREVENTION WILLIAM GIMSON, ASSOCIATE DIRECTOR FOR BUDGET AND FINANCE KERRY WEEMS, ACTING DEPUTY ASSISTANT SECRETARY, BUDGET, DHHS

Mr. REGULA. Okay, we will get started. I appreciate Mr. Obey and Mr. Wicker being here, in view of the fact that we are recessed for a couple of weeks. So the fact that they're here shows their dedication and interest in something that is a very important topic. I just thought coming down the hall, if we had a hearing on Enron, there would be a line a mile long out there. [Laughter.]

And there was no line. Yet what you do is more important to the people of this Nation than Enron, by a long shot.

CDC is somewhat of a well kept secret. We to some degree discovered it as a result of September 11. We discovered it in my district when we had a meningitis scare and everybody was kind of panicking until CDC got on the scene and then everything just calmed down. Likewise at the Ford plant in Cleveland when they had a scare from Legionnaire's disease. You are the 911, using that another way, for America in a lot of ways. We're happy you're here, Dr. Fleming, to represent the agency and tell us about the things that are important to the people of this Nation.

Mr. Obey, would you like to make any comments?

Mr. OBEY. No, Mr. Chairman.

Mr. REGULA. Okay. Dr. Fleming, your full statement will be made a part of the record. We'd like to have you summarize it for

us.

INTRODUCTION

Dr. FLEMING. Thank you, and good morning, Mr. Chairman. I'm David Fleming, Deputy Director for Science and Public Health and the Centers for Disease Control and Prevention. This is my first appropriations hearing.

Despite that fact, I am nevertheless delighted and honored to be here today on behalf of CDC, our Nation's prevention agency that

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protects the health of the American people. Mr. Chairman, I would like to submit our written statement and I would like to summarize that for you now.

Mr. REGULA. Without objection, so ordered.

BIOTERRORISM ATTACKS

Dr. FLEMING. Summarizing isn't easy, because as you may have. heard, we've had a busy year. On September 11th, life changed for the Nation and for CDC. The horrible events of that day and the anthrax attacks that followed brought into focus the urgent public health challenges that we were facing like no other event, and also the need for investing in our Nation's public health infrastructure. The events of September 11th precipitated the greatest challenge in CDC's history, and resulted in an unprecedented response. Ten minutes after that second plane crashed into the World Trade Center, CDC's emergency operations center was up and running. Mr. REGULA. Ten minutes?

Dr. FLEMING. Ten minutes. And although we couldn't know it at the time, Mr. Chairman, it would be running continuously, 24 hours a day, for the next 91 days. Within hours, even though all airplanes were grounded, CDC emergency response personnel were in the air with material from the national pharmaceutical stockpile, on the way to Washington and New York City.

By early that afternoon, CDC's health alert network had already started transmitting emergency messages to key public health officials throughout the country. And that was only the beginning. Over the next four months, CDC was a key part of the Federal team that guided our Nation's response to the bioterrorism events. We delivered almost 4 million doses of antibiotics in 65 separate deployments to 10 different States to prevent anthrax. The average time from us receiving those requests until delivery in the field was five hours.

We coordinated laboratory testing of over 70,000 suspected anthrax samples, from every State in the country, and tested at CDC 6,000 of those samples, of the most critical samples using state of the art methods. We provided through teleconferences training to over a million and a half providers throughout this country, and through our MMWR and health alert network, provided key recommendations to millions of additional providers. We provided public information every day to the media. In October alone, CDC's web site was accessed 175 million times.

Most importantly, though, CDC deployed almost 600 professional staff into the field, and mobilized an additional 1,500 staff at our facilities throughout the country. These individuals served by gathering critical public health information, by investigating cases and suspect cases, by developing new treatment and prevention guidelines, by counseling those directly affected and providing technical assistance to our State and local partners. They did this with the utmost professionalism and confidence, often away from their husbands or wives or children, and potentially at risk themselves. We're very proud of them.

These actions by your country's public health system saved many lives. The investment this Committee had the foresight to make before September 11th paid off. We had made substantial progress to

developing the capacities of public health agencies at all levels, Federal, State and local.

But the events of last fall also showed that we need to be even better prepared. We need to correct the weaknesses that we identified and build the capacities not yet developed.

Fortunately, though, our basic strategy is sound. The best way to protect against any health threat is to develop and enhance our already existing public health system and tools, not only at the Federal level but at the State and local level as well. Because while only a few States were involved with anthrax illness, every State in this country was involved in this crisis. We saw so dramatically how State and local health department partners are the core of our public health system and how they must be ready to responding to all public health threats.

Thanks again to your support, we have just awarded over $900 million in funding to strengthen State and local health departments. These resources are going to be used to plan for this new generation of public health threats and to assure that our responses are supported by a fully staffed, fully trained work force, strengthened public health laboratory facilities, enhanced surveillance and epidemiologic response capacities, secure, up to date information systems, and an improved health communication capability.

We are trying as hard as we can to be smart with these investments. We are working closely with all parts of the Department. We are building in measures of accountability. We are preparing for those unknown threats by enhancing those proven systems that deal with our natural, day to day threats, like the meningitis outbreak in Ohio. And we are bolstering State and local health department infrastructure, because it is that infrastructure that supports every public health action.

There is one more task that is facing us. This fall, public health was strained to the breaking point, dealing with the challenges that were brought on by the terrorist attacks. CDC and other public health agencies were also working around the clock to attend to the other public health challenges that are facing this Nation today. We must continue to attend to them in the future.

So as we prepare for treating injuries from a terrorist attack, we must also work to push every day injury and violence from its rank as the leading cause of premature death in this country. As we plan how best to respond to botulism or plague or tularemia attack, we must also work to prevent the everyday infections of HIV and tuberculosis and hepatitis C and e-coli, and to assure the safety of postal workers, and we enhance our ability to respond to a chemical terrorist attack. We must also work to reduce the burden of existing occupational illness and to better understand the relation between chemicals already in our environment and illness already in our people.

As we develop adequate supplies of smallpox vaccine, we must also assure the adequacy of our supply of standard childhood vaccines, and work to increase the lifesaving vaccines in adults, like pneumococcal vaccine and influenza. And as we work to prevent anthrax hospitalizations, we must also work to prevent hospitaliza