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For Release on Delivery

Expected at 10:00 am

Friday, March 9, 2007

Good morning Mr. Chairman, Congressman Walsh, and other distinguished
members of the Subcommittee. It is a pleasure to appear before you again
as Director of the Centers for Disease Control and Prevention (CDC), the
nation's leading public health protection agency located within the
Department of Health and Human Services. Thank you for the opportunity
to present the President's budget request for CDC for fiscal year (FY)
2008. I would like to highlight just a few examples of what we have
achieved with the Subcommittee's support over the past year and
introduce the priority public health initiatives we plan to pursue in FY
2008 in accordance with the President's request.

The FY 2008 budget request for CDC addresses a balanced portfolio of
health protection activities, emphasizing both urgent threats we must be
prepared to face tomorrow and the urgent realities we are confronting
today. This dual emphasis reflects CDC's complex mission in the 21^st^
century -- to protect the public's health against major calamities such
as pandemic influenza, natural disasters, and terrorism, while remaining
focused on the threats to health and well-being that Americans face each
day, including chronic diseases, injuries and disabilities. CDC's Health
Protection Goals address both categories of activity in equal measure,
and are designed to accelerate health impact, reduce health disparities,
and protect people at home and abroad from current and imminent health
threats. Organized in four thematic areas, these goals serve to focus
our programmatic efforts and financial investments:

-   Healthy People in Every Stage of Life

-   Healthy People in Healthy Places

-   People Prepared for Emerging Health Threats

-   Healthy People in a Healthy World

Over the course of the past 18 months, CDC has engaged in an intensive
effort to bring together experts from inside and outside the agency to
agree on a set of objectives to help us achieve these overarching goals.
We have solicited external input through a series of public meetings
around the country, and we will continue to be responsive to internal
concerns among parts of CDC's workforce about the new, goal-oriented
approach to our mission. As the goals are refined and implemented, CDC
will be better equipped to measure and demonstrate the impact of our
health protection activities and the benefit that accrues to the public
as a result of the agency's efforts. These measures are intended to
target our resources and enhance accountability to our most valued
customers -- Congress, our partners, and the public.

I am pleased to report that the public perception of CDC continues to be
positive, as measured by a nationwide Harris Poll conducted in January
2007 in which CDC was again ranked the top agency in government. CDC
received the most positive votes of the thirteen agencies included in
the poll, with ninety percent of adults saying they understand what the
agency does and 84 percent giving us high marks for our work. We are
gratified by this public endorsement, yet we remain committed to
improving and refining our capacity to address urgent public health
challenges. The strategic realignment CDC embarked upon in 2005 and the
goals planning process in which we are currently engaged illustrate our
commitment to be an integrated, adaptive, and highly effective
organization, and we are well on our way to achieving that vision.

For FY 2008, CDC's budget request includes a total funding level of
\$8.8 billion, reflecting a \$143 million adjustment to the estimate for
the Vaccines for Children mandatory budget, and a discretionary funding
reduction of \$20 million below the FY 2007 estimate. The request
includes the following increases: \$158.3 million for a range of
pandemic influenza preparedness activities, \$93.0 million for the
HIV/AIDS Testing Initiative, \$89.9 million for the Strategic National
Stockpile, \$17.3 million for the Adolescent Health Promotion
Initiative, \$5.2 million to improve special pathogens laboratory
capacity, and several smaller additional increases. Within the total
funding level, CDC balances increased investments in these high priority
areas with targeted reductions in other areas. Specific reductions
include the following: -\$125.4 million for upgrading state and local
capacity activities, -\$113.6 million for Buildings and Facilities,
-\$99.0 million for the Preventive Health and Health Services Block
Grant, -\$17.2 million for Steps to a HealthierUS, -\$16.9 million for
West Nile virus, -\$13.9 million for the anthrax research study, as well
as several smaller additional reductions.

We are committed to serving as responsible stewards of the public
dollars with which we are entrusted each year and will continue to
strive to maintain our position as the most trusted agency in
government. Prioritizing the agency's activities within the four
overarching health protection goals described above assures that we are
focused on optimizing health impact in every laboratory on our campus,
in every program we fund, in all our health protection research, and in
every outbreak we contain. With sustained focus and continued
investment, we will continue to be prepared for the next public health
emergency, and we will begin to roll back the impact of a sedentary
lifestyle and stop the spread of HIV/AIDS. The President's budget
request makes a number of investments in the coming fiscal year to help
us prepare for urgent threats on the horizon and bolster our efforts to
address the urgent realities our communities face today.

[Preparing for Urgent Threats]{.underline}

Preparedness for a wide array of health threats and emergencies remains
a central priority for CDC and our public health partners. In the last
five years CDC has responded to a variety of public health emergencies,
ranging from the anthrax attacks of 2001 to SARS in 2003, Hurricane
Katrina in 2005, and preparing for pandemic influenza in 2007. Since
2001, Congress has greatly expanded the resources available for public
health preparedness efforts and we are seeing a return on that
investment at the state and local level, as well as at CDC. To offer one
example, CDC has increased the number of Laboratory Response Network
labs to 152 (up from 91 in 2001), with a presence in all 50 states and
abroad, and with 100 percent able to confirm anthrax, tularemia and
plague. In addition, CDC has trained more than 9,000 clinical
laboratorians to date to play a role in the detection, diagnosis, and
reporting of public health emergencies.

We continue to make progress in the preparedness arena, but the combined
capacity of federal, state and local public health partners is not yet
where it should be. The FY 2008 budget contains a number of investments
that will augment our capacity to address urgent health threats, in
close alignment with our preparedness and global health protection
goals. These include upgrades to the Strategic National Stockpile (SNS),
laboratory capacity enhancements, and pandemic influenza readiness
activities. As noted earlier, the request also contains targeted
reductions in areas such as the anthrax vaccine research program, West
Nile virus activities, and funding for general state and local
preparedness activities. CDC remains committed to allocating
preparedness dollars in a way that maximizes our ability to enhance
federal, state and local response capabilities.

[]{.mark}

*People Prepared for Emerging Health Threats*

In an effort to achieve the goal of People Prepared for Emerging Health
Threats, we continue to upgrade our response capacity for natural
disasters, intentional attacks, and infectious disease outbreaks at home
and abroad. CDC's management of the Strategic National Stockpile (SNS)
-- a national repository of lifesaving pharmaceuticals, medical supplies
and equipment that can be deployed within 12 hours to any point in the
U.S. -- exemplifies the agency's engagement in frontline preparedness
activities. The request of \$581 million for SNS will expand our
capacity to respond to mass trauma events, including natural disasters
and intentional attacks, by including selected pharmaceuticals and
special needs items in the SNS that are essential for a broad range of
public health emergencies.

CDC also serves as an international leader for identifying and
containing infectious disease threats. The agency's trademark
contribution in this arena resides in the integration of our extensive
laboratory capacity with subject matter and epidemiologic expertise to
identify and respond to virulent outbreaks. Increased funding for CDC's
special pathogens laboratory capacity in the amount of \$5.2 million
will build our basic science program for high hazard pathogens (such as
Ebola and Marburg virus), our cadre of elite scientists who work in this
area, and our capacity for rapid and effective outbreak response. The
budget request will greatly augment our capacity to predict and mediate
the public health impact of natural disasters and other urgent health
threats.

*Healthy People in a Healthy World*

Although much progress has been made toward preventing and controlling
infectious disease, it remains clear that a disease, such as pandemic
influenza, emerging in one country can rapidly become a worldwide
threat. The ability to identify and contain such an outbreak is critical
to assuring a healthy and prosperous international community. Thus
pandemic influenza readiness is central to our goal of achieving Healthy
People in a Healthy World.

CDC has accomplished a great deal in this regard with the supplemental
resources Congress has allocated to pandemic preparedness since FY 2006,
including preparing and disseminating guidance, information, and initial
funding to 62 states, localities, territories, and tribal nations.  The
guidance contains templates for operational drills of influenza
immunization clinics and tabletop exercises for community-based school
closing decision processes, as well a model contract for engaging
pertinent private sector entities in the emergency distribution of
antiviral drugs. At an international level, CDC and partners released a
one-week standard curriculum last summer in Bangkok, Thailand to provide
essential skills to Rapid Response Teams composed of medical doctors,
epidemiologists, communications specialists and other health responders.
The public health community has become better prepared for a pandemic in
the past year, thanks to the support of this Subcommittee and the
Congress, but there is more to be done.

We need four things to achieve an optimal state of readiness: people,
products, plans, and practice. Within the total increase for pandemic
influenza activities of \$158.3 million, we have requested a number of
increases to expand capacity in these four broad areas. First, the
budget request includes an increase of \$10.0 million to expand the
number of quarantine stations at major ports of entry around the country
to assure that we have trained people on the frontline to identify and
contain a pandemic. Quarantine station expansion has enhanced the
systematic collection, analysis and dissemination of data related to
public health events at U.S. ports of entry, improving CDC\'s capacity
to respond. Secondly, in terms of products, we need to continue our
efforts to increase demand for annual influenza vaccine (+\$19.8
million), a critical factor in stimulating production. CDC is working to
establish a reference library of circulating influenza viruses and to
identify suitable vaccine candidates (+\$19.8 million). We also need to
increase the stock of diagnostic reagents for influenza (+\$14.9
million) to improve our capability to detect a pandemic.

With regard to planning, the President's request includes an increase of
\$9.9 million to develop real-time assessment models and other decision
tools to analyze influenza patterns and to plan accordingly. It also
contains an increase of \$14.6 million to enhance CDC's vaccine
registry, which monitors distribution of influenza vaccine and other
countermeasures to allow for continuing identification of plans to fill
gaps in coverage. Finally, with respect to practice, an increase of
\$69.0 million is requested for a group of activities: human-animal
interface studies for domestic grantees, international and domestic
surveillance, and rapid outbreak response actions in the U.S. and in
high priority countries abroad to assure that local practitioners are as
prepared as possible to confront pandemic outbreaks. The President's
request for these resources will allow CDC to continue vital activities
begun with your support for supplemental funding in FY 2006.

CDC continues to work with state and local public health agencies and
with international partners to prepare for an influenza pandemic. We
recognize the long-term value of this investment and are committed to
leveraging these resources to maximize preparedness for all manner of
public health emergencies.

[Combating Urgent Realities]{.underline}

While CDC is making great strides to prepare for myriad health threats
that loom on the horizon, we remain focused on battling the urgent
health realities of diseases, injuries and disabilities that affect the
lives of Americans each and every day. The threat of pandemic influenza
is real and our nation is making a major investment in preparing for it.
But urgent realities such as diabetes, heart disease and asthma are more
than a threat; they are with us right now. Moreover, the actual burden
of these current health realities parallels the projected impact for
many of the urgent threats we face. The annual burden of cardiovascular
disease in this country (79 million ill), for example, is the same order
of magnitude as the projected impact of an isolated influenza pandemic
(90 million ill). While suffering from a potential influenza pandemic is
a one time toll, we tolerate the impact of cardiovascular disease at
these levels every single year.

Complacency is not an option when one in three Americans is obese, one
in four of those living with HIV is unaware of his infection, and one in
33 infants is born with a birth defect. The FY 2008 budget request
reflects the fundamental challenge of balancing urgent threats and
urgent realities, and illustrates CDC's commitment to strong and
effective programs in both arenas.

*Healthy People in Every Stage of Life*

CDC is focused on maximizing health impact and reducing health
disparities through programs that address key prevention and health
promotion factors across every life stage. Our childhood immunization
programs and adult cancer screening services are two examples of life
stage-focused efforts. CDC awards grants through Section 317 of the
Public Health Service Act and the Vaccines for Children (VFC) program to
assist state and local health departments in purchasing safe and
effective childhood vaccines and in conducting immunization programs. A
recent economic evaluation[^1] of seven routine childhood immunizations
found that the vaccines resulted in annual savings of \$9.9 billion in
direct medical costs and over \$33.4 billion in indirect societal costs.
These immunizations prevent more than 14 million cases of disease and
over 33,000 deaths over the lifetime of children born in any given year.
CDC continues to aim for maximum impact in the management of these
essential immunization programs.

The National Breast and Cervical Cancer Early Detection Program is an
important component of the agency's preventive services for adults,
providing access to critical cancer screening for underserved women in
the U.S. since 1991. To date, almost three million women have been
screened who otherwise would not have had access to these services. The
program has provided more than 6.5 million screening examinations and
diagnosed almost 27,000 breast cancers, over 88,000 mild to severe
cervical precancerous lesions, and more than 1,700 invasive cervical
cancers. CDC is proud of this record of assisting state and local health
departments to deliver vaccines to underserved children and to conduct
preventive screenings for underserved women, and will uphold this
leadership role in promoting health across life stages.

The prevalence of HIV/AIDS is an urgent reality that has been with us
for over two decades, and CDC continues to search for ways to stop the
spread of the virus at home and abroad. CDC plays a vital role in
implementing the President\'s Emergency Plan for AIDS Relief, an
international effort that in 2006 supported HIV/AIDS treatment for
822,000 men, women and children in 15 countries. On the domestic front,
the FY08 budget request includes funding for an initiative to increase
testing and treatment for HIV. Yesterday (March 8) CDC hosted a partner
meeting in Atlanta to call attention to the urgency of addressing high
rates of HIV/AIDS among African-Americans. Participants included
African-American leaders representing a wide range of sectors such as
business, philanthropy, education, entertainment and civic
organizations. The meeting is intended to launch a widespread community
mobilization effort aimed at encouraging a heightened response to
HIV/AIDS among African-Americans in communities around the country.

In the FY 2008 budget request, an increase of \$63.0 million is included
to expand the number of people who are aware of their HIV status in the
U.S., with a focus on populations, jurisdictions and venues with the
highest prevalence of disease. This funding will support testing
programs primarily in 10 jurisdictions with the greatest rates of new
infections, in addition to incarcerated persons and intravenous drug
users. We estimate that over two million people, mostly
African-Americans, will be tested and over 31,000 new infections will be
diagnosed through this initiative. Because individuals who are aware of
their infection are less likely to transmit the virus, this effort is
expected to avert 1,500 infections in the first year alone, thereby
saving \$1.5 billion in lifetime medical care and lost productivity
costs.

An additional \$30.0 million included in the request will provide
support for HIV testing and treatment in states with policies for
voluntary opt-out testing for pregnant women and high risk populations,
as well as universal testing of newborns, as authorized in the Ryan
White HIV/AIDS Treatment Modernization Act. These combined resources
will allow those who are infected to learn of their infection earlier,
stay in better health longer, and take steps to protect others,
resulting in decreased overall cost to the health care system and
improved health across life stages.

*Healthy People in Healthy Places*

In addition to encouraging healthy behaviors and actions in all life
stages, CDC seeks to assure that places where people live, work, learn,
and play will protect and promote their health and safety, especially
those at greater risk of health disparities. In particular, home, school
and workplace are three places that have a tremendous impact on health.
CDC is pushing forward with a variety of efforts to improve health
outcomes in each of these places, including an initiative to expand
adolescent health promotion in schools as part of the President's budget
request.

In the home, for example, CDC takes a lead role in preventing
residential fire deaths. A review of homes participating in CDC-funded
smoke alarm installation and fire safety education programs found that
more than 1,100 lives have been saved to date as a result of these
programs. In the workplace, CDC and partners received the prestigious
R&D 100 Award in 2006 for creation of the first device that can
immediately determine whether coal dust concentrations in active areas
of underground mines have been sufficiently mixed with rock dust to
prevent risk of explosion. This represents a significant step forward
for mine safety, as current technologies used to assess coal dust
concentrations require lab analysis that may take as long as two weeks
to complete.

Promotion of healthy schools is another area of emphasis for CDC, and a
key component of the President's FY 2008 budget request. In recognition
of CDC's leading role in health promotion, the President has requested
\$17.3 million for an Adolescent Health Initiative to promote physical
activity, healthy eating, and injury prevention through funding and
technical assistance to 3,600 schools across the country. The ultimate
goal is to help encourage a culture of wellness among our young people,
which would go a long way toward addressing the long-term urgent health
realities we face as a country.

Schools can play a critically important role in fostering wellness by
teaching children and adolescents essential knowledge and skills for
healthy eating, physical activity, and personal safety, and providing
plenty of opportunities to practice those skills. Today almost eight out
of ten high school students do not eat the recommended five servings of
fruits and vegetables a day, and only 33 percent participate in daily
physical education classes. Given the importance of establishing healthy
habits early in life, it can be no surprise that nearly one in three
children and adolescents are overweight or at risk of becoming
overweight. In addition, one-third of high school students reported
being in a physical fight in the 12 months preceding a 2004 CDC survey,
and nearly one in five students reported carrying a weapon in the 30
preceding days. These data represent an unacceptable state of adolescent
health in this country.

By directly reaching more than three million young people and their
families, CDC's Adolescent Health Initiative aims to improve these
conditions. If these young people can be taught strong and effective
health promotion messages while they are still in school, and if schools
are models of healthy and safe environments, we may be able to begin to
reverse the trend toward sedentary behavior and unhealthy habits in
adulthood. This is health promotion at its most promising and CDC is
proud to be leading this initiative on behalf of HHS.

Thank you for the opportunity to appear here today to discuss the
support CDC has received in the President's FY 2008 budget request. In
an era of limited fiscal resources and many competing priorities, the FY
2008 budget strikes a balance between preparing for urgent threats and
confronting urgent realities, and we are committed to leveraging these
resources to achieve maximum health impact and reduce health
disparities. In the coming fiscal year, CDC will sustain our leadership
role in promoting health among young people and adults, across all life
stages, and in schools and communities around the country. We will
continue our investment in preparedness for urgent health threats and
will work with partners at home and abroad to assure a healthy
international community. In closing, I would like to express particular
thanks to you, Mr. Chairman, and to the members of this Subcommittee,
for your continued support. I look forward to working with Congress over
the course of this next fiscal year to fulfill our public health
mission, and I would be happy to answer any questions you might have.

[^1]: Z Fangjun, Santoli J, Messonier M, Hussain Y, et al.; Economic
    Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule
    in United States, 2001; *Archives of Pediatrics and Adolescent
    Medicine;* 2005;159:1136-1144