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The President’s Fiscal Year 2015 Budget

May 7, 2014

Witness: Thomas Frieden, MD, MPH

Testimony - Testimony before the Subcommittee on Labor, Health and Human Services, Education and Related Agencies Committee on Appropriations, United States Senate

Good morning, Chairman Harkin, Ranking Member Moran, and other distinguished Members of the Subcommittee. It is a pleasure to appear before you as Director of the Centers for Disease Control and Prevention (CDC), the nation′s leading health protection agency and an operating division of the Department of Health and Human Services, to discuss CDC’s fiscal year 2015 budget request. Today I would like to focus on how CDC works 24 hours a day, 7 days a week to protect Americans from health threats, and how we propose to make even more progress in Fiscal Year 2015. We thank this committee for supporting CDC through your 2014 appropriations.

CDC works 24/7 to keep America safe from health, safety, and security threats, both foreign and domestic. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and people to do the same. For Fiscal Year 2015, CDC has requested additional funding to accelerate the fight against three growing threats—the risk of infectious disease threats from around the world, growing resistance to antibiotics, and the increasing epidemic of prescription drug overdose.

Working to Provide Health Security 24/7

CDC helps save lives 24/7 by preventing, detecting, and controlling the growing risks of infectious disease outbreaks, emerging infectious diseases, drug-resistant bacteria, and natural and man-made hazards and disasters. We provide emergency response support, technical expertise, and critical rapid development of prevention technologies, including vaccines and other medical countermeasures.

CDC provides boots on the ground presence in the US and throughout the world, supported by our state-of-the-art laboratories, which are critical to our nation’s safety and health. With this Committee’s support, CDC is now building our advanced molecular detection capacity, unlocking microbial genomes to track and stop outbreaks more effectively, and finding new ways to prevent these outbreaks in the first place.

CDC’s response to diseases such as influenza, salmonella, hantavirus, HIV, and Ebola are highly visible ways CDC protects the public from health threats, but it is often what the public does not see every day that keeps Americans safe from ever-present health threats. CDC plays a pivotal role in our country’s ability to respond to and mitigate potentially catastrophic events—such as pandemics, natural disasters, and acts of bioterrorism--by ensuring that local, state and global public health systems are prepared for public health emergencies and by working to keep health threats from entering our country.

CDC plays another critically important role protecting Americans from the leading causes of death and disability. CDC applies life-saving solutions that work to drive down the incidence of costly diseases and improve the lives of Americans.

CDC leads prevention and health promotion efforts to improve health and reduce chronic diseases such as heart disease, cancer, and diabetes, which account for 75% of the $2.7 trillion in health care costs spent in the United States each year. Together with state and local partners, CDC deploys proven interventions to build healthier communities. For example, CDC worked with CMS and private-sector partners to launch the Million Hearts® initiative, which will prevent one million heart attacks and strokes by 2017 through proven strategies such as improving blood pressure control and promoting smoking cessation.  Our efforts to control chronic diseases are expanding in 2014, thanks to the support of this committee.

Keeping America and the World Safe through Global Health Security

Diseases and disasters know no borders; we are all connected by the air we breathe, the water we drink, and the food we eat. CDC deploys scientists and disease detectives globally 24/7, because outbreaks that start in remote corners of the world can travel here as quickly as a plane can fly. Detection and response time is critical. Diseases infecting people around the world in the past 10 years—such as MERS Coronavirus, SARS and H1N1 and H7N9 influenza—cost lives and caused enormous economic disruption. These and other diseases have far-reaching health, economic, political, and trade implications.  Less than a week ago we confirmed our first MERS case in the US, and CDC has a team on the ground helping to prevent the spread of that deadly virus.

Our FY 2015 budget requests $45 million to support expanded global health security activities. Over the next five years, CDC and U.S. government partners, including the Departments of State and Defense, will work with up to 30 countries to protect at least 4 billion people through global health security efforts. As an important step toward this larger goal, CDC’s funding request will allow us to partner with up to 10 countries in FY 2015 to advance global health security, building on successful demonstration projects in Uganda and Vietnam, as well as others currently underway. CDC will help countries find threats faster, stop them closer to the source, and prevent them wherever possible.

Fighting Antibiotic Resistance

Antibiotic resistance—when bacteria do not respond to the drugs designed to kill them—threatens to return us to the time when simple infections were often fatal. Today, antibiotic resistance causes more than 23,000 deaths, more than 2 million illnesses, and up to $20 billion in health care costs in the United States each year. Tomorrow could be even worse: a simple cut of the finger could lead to a life-threatening infection; routine surgical procedures, such as hip and knee replacements, would be far riskier; and common complications of life-saving treatments such as chemotherapy and organ transplants could prove fatal.

Now is the time to address this threat. CDC’s 2015 budget request includes $30 million to detect and protect against antibiotic resistance. With strategic investment over the next five years, CDC can turn the tide on the most dangerous of these infections, including reducing infections with CRE—the nightmare bacteria—by 50% and reducing C. difficile infectionsby 50%. Reduction in C. difficile alone will save 20,000 lives, prevent 150,000 hospitalizations, and cut more than $2 billion in healthcare costs. Achieving these goals requires investments in laboratory capacity to detect resistance across the nation, implementing best practices for infection control in health care settings, and improving antibiotic prescribing practices.

Reversing the Prescription Drug Overdose Epidemic

We are witnessing a new epidemic rapidly unfold in America: deaths from prescription painkiller overdoses. Prescription painkiller overdose deaths increased four-fold between 1999 and 2010, killing more people than all illicit drugs combined—including cocaine and heroin. The prescription drug overdose epidemic is driven in large part by fundamental changes in the way healthcare providers prescribe opioid pain relievers. We can prevent abuse of prescription drugs while at the same time making sure patients receive safe, effective, and appropriate pain treatment. CDC’s FY 2015 budget requests $16 million to work with states and the health care system to begin to reverse this epidemic.

As the nation's health protection agency, CDC has led the way in identifying the connection between inappropriate opioid prescribing and resulting overdose deaths.  CDC’s proposed investment would target states with the highest burdens of prescription drug overdose to implement proven strategies to reverse the trend, including assisting insurers and clinicians in improving coordination of care for high-risk patients; supporting development and effective use of universal, real-time, and actively-managed prescription drug monitoring programs—state-run prescription tracking databases; and evaluating state programs and policies to build the evidence base for overdose prevention.

Public Health Challenges in a 24/7 World

In the next few years, CDC and our nation must face both new and ongoing challenges to protect our health security in a time of fiscal constraint. We must accurately detect and quickly respond to numerous and unpredictable disease threats, whether natural or man-made. We must also ensure that CDC is able to protect Americans from the leading causes of death and disability that weaken our economic productivity and global standing. Thank you for your continued support of CDC’s important work to serve this nation, and I am happy to answer your questions.

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