CDC 24/7: Keeping Americans Healthy, Safe and Secure, and Competitive

March 5, 2013

Thomas R. Frieden, MD, MPH

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

Good morning, Mr. Chairman, Congresswoman DeLauro, 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. Today I would like to focus on how CDC’s works 24 hours a day, 7 days a week with boots on the ground protecting Americans from health threats.

CDC′s mission is to keep Americans safe, healthy and secure. CDC leads an interconnected network around the country and the world to: put science into action to save lives and money; stay on the cutting edge of health security; and protect our communities by supporting state and local health departments to investigate and control life-threatening diseases.

Working to Provide Health Security 24/7

CDC helps save lives 24/7 by preventing, detecting, and controlling the growing risks of new 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’s laboratory capacity, and its support to state and local health departments, were critical elements in the response to the recent multistate fungal meningitis outbreak, as CDC was able to quickly identify rare and obscure pathogens and provide added capacity to the states. During the peak of the outbreak, CDC’s fungus laboratory was operating 7 days a week to test the hundreds of samples so we could provide timely critical guidance to medical professionals and the public. This outbreak also underscored the role of CDC to protect our nation’s health and the pressing need to invest in new bioinformatics and genomics technologies that can more rapidly detect, respond to, and control large outbreaks.

CDC’s state-of-the-art laboratories are critical to our nation’s safety and health. We capitalize on that excellence by having diagnostic capabilities available close to the source of an outbreak -- which means more rapid detection and response. For this reason, CDC supports and trains a network of geographically distributed public health labs. These local, state, and global public health labs form a national disease detection tracking network to identify, track and respond to disease outbreaks and other health threats as quickly as possible. For example, CDC’s PulseNet is a national lab network which "fingerprints" the DNA of bacteria that cause foodborne illnesses. CDC and other local public health labs use this evidence to quickly identify and stop outbreaks. Just think about the difference between the U.S. listeria outbreak, which was identified in cantaloupes in Colorado in less than 12 days leading to a rapid national recall, versus the E. coli outbreak in Europe, lingering for months, sickening thousands during the long search for the culprit, and crippling some agricultural markets.

The crucial data CDC and its state and local partners gather allows the public, clinicians, health plans, and policy-makers to make rapid decisions based on objective evidence. CDC’s systems help identify our Nation’s health priorities, providing hard evidence of what works and what doesn’t. As a science-based agency, CDC data are used to guide decisions that protect Americans and prevent illness.

CDC is also home to our nation’s Epidemic Intelligence Service (EIS). These disease detectives undergo a unique 2-year learn-by-doing program in the practice of applied epidemiology. This corps of highly trained health professionals responds at a moment’s notice to emerging threats and disease outbreaks across the country and around the world. Most recently, EIS officers were dispatched to multiple states including Michigan, Indiana, and Tennessee to investigate and control the 2012 multistate fungal meningitis outbreak. That outbreak underscored CDC’s ability to track down and solve urgent threats in concert with local public health authorities.

CDC focuses on low-cost, high-impact, sustainable programs such as building a public health workforce that is prepared, diverse, and flexible. CDC assigns fellows for the Public Health Associate Program (PHAP) to serve on the frontlines of public health in state and local public health departments. More than 50% of the PHAP fellows have stayed in the public health field, and CDC places 600 or more staff in health departments at any given time. More importantly, health departments around this country could not provide basic services to protect Americans without CDC’s expertise and support – in fact, about two thirds of all CDC appropriations are sent to State and local entities to detect, control, and prevent health threats in every State in the United States.

Our response to diseases such as influenza, salmonella, hantavirus, HIV, and fungal meningitis outbreak are highly visible ways CDC protects the public from health threats. But it’s often what the public does not see every day that keeps American’s safe from ever-present health threats. CDC plays a pivotal role in our country’s ability to respond to potentially catastrophic events such as pandemics, natural disasters, and acts of bioterrorism by ensuring that state and local public health systems are prepared for public health emergencies. CDC operates the Public Health Emergency Preparedness (PHEP) program, which provides approximately $700 million annually to 50 states, four localities, and eight U.S. territories to strengthen their abilities to respond to natural or man-made health threats. This was the funding State and local governments used to prepare for and respond to the health effects of Superstorm Sandy. Additionally, CDC is responsible for the nation’s Strategic National Stockpile (SNS), a distributed national repository of medical countermeasures. The SNS contains antibiotics, antiviral drugs, chemical antidotes, antitoxins, vaccines, life-supporting medications, and medical supplies that are made available to state and local health departments within 12 hours of a public health emergency. CDC also maintains a 24/7 command center for emergency response to public health threats here and abroad. Since its inception in 2001, the Emergency Operations Center has responded to more than 50 public health emergencies, including many natural disasters and foodborne outbreaks.

Keeping the Home-front 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 scientists and disease detectives are deployed globally 24/7 because outbreaks that start in remote corners of the world can travel here as quickly as a plane—or a bird—can fly. Detection and response time is critical. The most effective and most cost-effective way to protect Americans from health threats that begin overseas is to stop them before they reach our borders. The foundation for CDC’s global health engagement is technical rigor and expertise, strong partnerships, and enhanced disease tracking and laboratory networks around the world. From 2006 to 2012, CDC’s global disease detection network responded to 1,134 disease outbreaks, and discovered five pathogens that were new to the world. During that time, CDC helped detect, track, and respond to major health threats that started abroad but threatened U.S. citizens—including Ebola, Marburg virus disease, plague, the cholera outbreak in Haiti, and the earthquake and tsunami in Japan and the subsequent nuclear radiation.

Keeping America Competitive Through Improved Health

CDC plays another critically important role in 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. Many of today’s greatest opportunities for improving health fall outside the traditional health care system. CDC is at the epicenter of a public health system which empowers people to live healthier, longer, more productive lives with lower health care costs. From folic acid to prevent birth defects, to preventing senior falls, we support individuals and communities with tools to protect themselves from health threats. This not only improves health but also increases economic competitiveness by creating a more competitive workforce.

For example, the United States sustains economic costs of over $80 billion annually, and U.S. businesses endure over one hundred million workdays lost due to the flu alone. To reduce this crushing burden on our economy, CDC develops effective strategies for employers to promote seasonal flu vaccination. These science-based and low cost strategies have been shown to dramatically increase vaccine participation among employees which can lead to a healthier and more productive workforce.

Beyond the workplace, CDC leads community-based prevention 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 develops tests, and implements practical, scalable solutions that are building healthier communities. For example, to better address heart disease and stroke, the first and fourth leading causes of death, CDC, CMS, and private-sector partners, launched the Million Hearts initiative, which brings together communities, health systems, nonprofit organizations, and private-sector partners from across the country to prevent 1 million heart attacks and strokes by 2017 by scaling up proven community and clinical strategies.

Challenges in a 24/7 World

In the next few years, CDC and our nation will face ongoing and new challenges in protecting our health security in a time of fiscal constraint. We must accurately detect disease threats, whether natural or man-made, and respond effectively and quickly. 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. CDC has already received more than $750 million in cuts to its base appropriation since fiscal year 2009. Cuts to CDC’s budget impact state and local operations, and their ability to detect and respond to life threatening diseases. We take very seriously our role as stewards of public funds. We have streamlined our administrative operations, contracts, and business services, and continue to look for innovative ways to maximize the funding we receive. I hope to engage in a dialogue with you all today—and after the 2014 budget is released—so we can discuss the health security of the nation and how CDC will continue to save lives and protect America from health threats. Thank you for your continued support of CDC’s important work to serve this nation, and I am happy to answer any questions.