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

March 25, 2015

Witness: Thomas Frieden, MD, MPH

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

Good morning, Chairman Cole, Ranking Member 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 health protection agency and an operating division of the Department of Health and Human Services. We thank this committee for supporting CDC through the 2015 appropriations process and essential emergency funding for Ebola response and building the Global Health Security Agenda.

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 save our nation health care dollars through prevention. I will also focus on two high-priority initiatives for Fiscal Year (FY) 2016: Antibiotic Resistance and Prescription Drug Overdose Prevention.

Working to Provide Health Security 24/7

CDC helps save lives by preventing, detecting, and controlling the growing risks of infectious disease outbreaks, emerging infectious and other diseases, drug-resistant bacteria, and natural and man-made hazards and disasters. We provide emergency response support, technical expertise, and rapid development of prevention solutions, including means to rapidly diagnose health threats, and deliver vaccines and other medical countermeasures.

CDC focuses on high-impact, sustainable programs, including building a public health workforce that is prepared, diverse, and flexible. For instance, CDC assigns fellows for the Public Health Associate Program (PHAP) to serve on the front lines of public health in state and local public health departments. More than 80% of the PHAP fellows have stayed in the public health field. Health departments throughout the United States depend on CDC’s expertise and support to provide basic services that protect Americans. In fact, about 80 percent of all CDC funding is awarded through grants and contracts to help accomplish our mission to promote health and quality of life by preventing and controlling disease, injury, and disability. CDC also integrates nearly 800 staff in health departments throughout the nation to support the critical work of state and local responders and to ensure accountability for our federal investments.

CDC’s boots-on-the-ground presence in the United States and throughout the world is essential to sustain public health preparedness and response. From the first week the West African Ebola epidemic was reported, CDC had an expert team on the ground working to contain the rapidly- expanding outbreak with core public health measures like laboratory testing, emergency operations centers, and culturally appropriate public health messaging. As part of this unprecedented Ebola outbreak, CDC developed the Rapid Isolation and Treatment of Ebola (RITE) strategy, which is helping end the epidemic in Liberia and making significant progress in Sierra Leone. CDC RITE team members continue to work around the clock in difficult conditions and harsh terrain. They sometimes travel by jeep, canoe, or on foot for hours to rapidly isolate Ebola patients, transport blood samples for testing, explain safe burial practices, and trace patient contacts for the 21-day incubation period.

Diseases do not respect borders, as we have witnessed during the West Africa Ebola epidemic, Middle East Respiratory Syndrome Coronavirus outbreaks, measles, and ongoing challenges from highly-pathogenic strains of influenza. We all are connected by the air we breathe, the water we drink, and the food we eat. We appreciate Congress’ strong support for the Global Health Security Agenda, which enables us to provide sustainable assistance to other countries so they can detect, stop, and prevent the spread of infectious diseases. Sustainable Global Health Security is crucial to stopping outbreaks before they reach our shores. As this year’s measles outbreak reminds us, diseases now rare in the United States can be just an airplane ride away, and we need to sustain a strong public health infrastructure here to keep them from regaining a foothold.

Fighting the Leading Causes of Death in America

CDC plays another critically important role protecting Americans from the leading causes of death and disability. CDC leads prevention and health promotion efforts to improve health and reduce chronic diseases such as heart disease, cancer, stroke, and diabetes, which account for 75 percent of annual United States health care costs. Together with state and local partners, CDC develops, evaluates, and supports implementation of evidence-based interventions to prevent expensive and preventable illness such as heart attacks, strokes, and cancer. For example, CDC collaborates with the Centers for Medicare & Medicaid Services (CMS) and private-sector partners to co-lead the Million Hearts® initiative, which aims to prevent one million heart attacks and strokes by 2017 through proven strategies such as improving blood pressure control and promoting smoking cessation.

Fighting Antibiotic Resistance

Antibiotic resistance (AR)—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, AR causes more than 23,000 deaths, more than two million illnesses, and up to $20 billion in health care costs in the United States each year¹. We face a fundamental threat to modern medicine: if antibiotics are rendered ineffective by resistant bacteria, we will lose the ability to treat sepsis (blood infection) or cancer, provide organ transplants, or save victims of burns and trauma. Routine surgical procedures, such as hip and knee replacements, would be far riskier, and common complications of life-saving treatments such as chemotherapy could prove fatal. A simple cut of the finger could lead to a life-threatening infection. If antibiotics lose effectiveness, we may have no means to treat otherwise treatable illnesses and our entire health care system would take a huge step backwards.

Now is the time to address this urgent threat to our health. The FY 2016 CDC Budget includes $283 million, an increase of $264 million to implement the National Strategy to Combat Antibiotic Resistance Bacteria and support CDC’s Antibiotic Resistance Solutions Initiative to detect and protect against antibiotic resistance. We can combat these threats by investing in every state through accelerated outbreak detection, prevention, and innovation; and improved antibiotic use. CDC will establish AR “Protect” programs in all 50 states and ten large cities to better track outbreaks, improve prescribing, and prevent future infections. We will double the number of Emerging Infection Program sites from ten to 20, significantly expanding our ability to track all urgent and serious AR threats through vital partnerships with state and local health departments and academic institutions. Additionally, CDC will establish a “Detect” network of up to seven regional labs to characterize emerging resistance and rapidly identify outbreaks of dangerous AR threats.

By investing in these critical activities and allocating the majority of these funds to states, communities, health care providers, universities, and other groups on the frontlines, we can turn the tide on the mounting threat of AR. The initiative would aggressively attack our biggest threats. For example, CRE (carbapenem-resistant Enterobacteriaceae) is a “nightmare bacteria” as it is resistant to nearly all known antibiotics. With the initiative’s funding supporting national prevention activities, we believe we can cut CRE infections by as much as 60 percent in five years. In 2011, nearly half a million Americans were infected by C. difficile (Clostridium difficile),a deadly diarrheal infection, and 15,000 died as a result of those infections. By implementing this initiative, we believe we can reverse this trend by cutting C. difficile infections in half over five years and save $3.8 billion C. difficile related medical costs alone over five years.²

Every antibiotic resistant-infection has the potential to devastate people’s lives and their families. I am reminded of the stories of Peggy Lillis and Nile Moss. Peggy, a 56-year-old mother of two and a beloved kindergarten teacher, lost her battle with C. difficile, after receiving antibiotics and accessing health care facilities for routine procedures. Nile was a 15-year-old boy who loved music and art, but his life was cut short after contracting MRSA (Methicillin-resistant Staphylococcus aureus) pneumonia following routine annual tests at the hospital. I want to extend my sympathies to the families of Peggy and Nile, as well as the millions of patients who acquire antibiotic resistant-infections each year. I also want to salute the families of others who have been sickened by, or died from, AR for working to protect others from similar tragedies. With resources to implement the National Strategy, CDC will work to prevent these infections from killing more Americans.

Curbing the Prescription Drug Overdose Epidemic

We have witnessed a deadly epidemic quietly unfold in rural areas and on the main streets of America: deaths from drug overdose have been rising steadily over the past two decades, and have become the leading cause of injury death in the United States. Every day in the United States, 120 people die as a result of drug overdose, and another 6,748 are treated in emergency departments for the misuse or abuse of drugs. As the nation’s health protection agency, CDC has applied public health principles to identify the connection between inappropriate opioid prescribing and resulting overdose deaths. The prescription drug overdose epidemic is driven largely by fundamental changes in the way health care providers prescribe opioid pain relievers: 259 million prescriptions were drafted for painkillers in 2012, enough for every American adult to have their own bottle of narcotics .³ As the amount of opioids sold has increased, so has the number of deaths. Just as troubling, there is growing evidence that the sharp increase in prescription opioid abuse plays a role in the large increase in heroin overdose deaths, which have more than doubled since 2010.

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 2016 budget requests an increase of $54 million, which will support expansion of the Prescription Drug Overdose Prevention for States Program to all 50 states and Washington, D.C. This national response will provide state health departments with funding and scientific expertise to enhance and maximize the effectiveness of prescription drug monitoring programs, improve adoption of opioid prescribing guidelines, and target communities experiencing the highest burden of drug overdose. This CDC investment complements other FY 16 proposed investments and work across the Department to reduce the misuse and abuse of opioids.
Additionally, CDC’s work to reverse the prescription drug overdose epidemic will continue to have important implications for understanding and addressing the troubling increase in heroin overdose deaths. The requested increase for FY 2016 will strengthen heroin overdose prevention by improving heroin-related surveillance and further investigating the relationship between prescription drug abuse and heroin use. The Budget also includes an increase of $5 million for Health Statistics to expand electronic death reporting to provide faster, better quality data on deaths of public health importance, including Prescription Drug Overdose deaths.

Over the past year, CDC and our nation have addressed difficult challenges to protect our health security. CDC will continue our vigilance to detect and quickly respond to numerous, unpredictable disease threats. We will protect Americans from the leading causes of death and disability that threaten our economic productivity and global standing. Thank you for your continued support of CDC’s important work serving our nation; I am happy to answer your questions.