April 4, 2013
This letter was sent to the House and Senate members of the Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies under the letterhead of our organization. We also delivered copies to all members of Congress.
The Honorable Tom Harkin, Chairman [Senate]
The Honorable Jerry Moran, Ranking Member [Senate]
The Honorable Jack Kingston, Chairman [House of Representatives]
The Honorable Rosa L. DeLauro, Ranking Member [House of Representatives]
Dear Chairman and Ranking Member:
As business leaders deeply involved with employee health and health care, and as former government officials who worked to set or implement national health policies, we are growing increasingly concerned by the federal government’s potential lack of investment into the prevention and control of disease. America’s corporate interests, the health of the public and our nation’s economy all benefit from a robust public health system.
Already this year, Congress has faced several opportunities to either fund or further diminish our nation’s public health infrastructure – and more debate lies ahead.
Automatic spending cuts enacted last year went into effect this winter, reducing federal prevention programs by 5 to 9 percent. On March 21, a continuing resolution passed Congress funding the last six months of FY13 that effectively level-funds prevention programs at this reduced level.
Our tight fiscal situation and the pending debt ceiling debate; the upcoming FY14 presidential budget request along with Congress’ related FY14 funding bills; and many other legislative proposals will all require that Congress again choose between strengthening, or further degrading, prevention initiatives.
The Centers for Disease Control and Prevention is recognized globally for disease outbreak prevention efforts, disaster preparedness and response work, research and immunization efforts, and on-the-ground operations that protect the public from injuries and illness. Most of its work is carried out with little or no fanfare.
Equally impressive are the CDC’s many targeted responses in our communities. Few realize that more than 70 percent of the CDC’s budget is redirected back to local prevention experts in our communities. This funding helps to bolster the local public health infrastructure needed to identify fungal meningitis in nationally distributed pharmaceuticals, discover foodborne disease outbreaks and respond to influenza pandemics – to highlight well-publicized incidents. In reality, the CDC does far more to protect and defend the population than the media could ever cover on a day-to-day basis.
Given all the CDC and its local partners do to keep our population from entering the ever-more costly health care system, the threat of additional CDC cuts is troubling.
There is little awareness, even in Congress, of the fact that pre-sequestration federal cutbacks have pushed the CDC’s 2012 core discretionary funding levels back to 2001 equivalents, and that state budget cuts have led to the elimination of tens of thousands of local prevention experts.
As businesses and governments both struggle to corral the unsustainable growth in health care expenses, we must address the fact that more than 70 percent of these costs are attributed to preventable health conditions. Unfortunately, neither the Congressional Budget Office nor the Administration’s Office of Management and Budget estimate the budgetary savings of prevention programs. Still, investments that control preventable health conditions will lower disability, disease and preventable death rates in the future.
This is not a time to further degrade the CDC’s budget and our state and local prevention efforts. As you grapple with the many legislative issues facing the 113th Congress, we encourage you to protect and strengthen our nation’s disease control and prevention infrastructure.
Roger P. Baxter, MD, Co-director, Vaccine Study Center, Kaiser Permanente
Sue Binder, MD, former Director, National Center for Injury Prevention and Control, at the Centers for Disease Control and Prevention
Ronald R Blanck, DO, Lieutenant General, US Army, Retired, former US Army Surgeon General
John J. Callahan, PhD, former Assistant Secretary of Management and Budget, U.S. Department of Health and Human Services
The Honorable Michael N. Castle, former two-term Governor, nine-term US Congressman, Lieutenant Governor, Deputy Attorney General and State Senator (Delaware)
David Fleming, MD, Director and Health Officer, Public Health - Seattle & King County, former Deputy Director of the Centers for Disease Control and Prevention
Steven K. Galson, MD, former Acting Surgeon General
Julie L. Gerberding, MD, MPH, former Director of the Centers for Disease Control and Prevention
George E. Hardy, Jr., MD, former Assistant Surgeon General, former Assistant Director of the Centers for Disease Control and Prevention, former Health Officer for the Jefferson County Department of Health in Birmingham (AL)
Jessica Herzstein, MD, MPH, Global Medical Director, Air Products
John H. Klippel, MD, former clinical director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, president and CEO of the Arthritis Foundation
Jeffrey P. Koplan, MD, MPH, former Director of the Centers for Disease Control and Prevention
Peter Lee, MD, MPH, Global Occupational Health and Wellness Leader, GE
The Honorable Mary Bono Mack, former member of Congress
Matthew Minson, MD, Medical Director, Superior Energy Services
Michael L. Moore, MD, FACP, Vice President, Chief Medical Director, Nationwide
Kenneth P. Moritsugu, MD, MPH, former Acting Surgeon General of the United States, and the former Deputy Surgeon General
Michael T. Osterholm, PhD, MPH, former Special Advisor to then–Department of Health and Human Services Secretary Tommy G. Thompson on issues related to bioterrorism and public health preparedness
Sudip S. Parikh, PhD, Battelle Memorial Institute and the former Science Advisor and Professional Staff to the United States Senate Appropriations Committee
Brent Pawlecki, MD, Chief Health Officer, Goodyear Tire and Rubber Company
The Honorable John Edward Porter, JD, former member of Congress and Chairman of the United States House of Representatives Labor, Health and Humans Services and Education Appropriations Subcommittee
Jim Rooney, Vice President of Medical Affairs, Gilead Sciences
William L. Roper, MD, MPH, former Director of the Centers for Disease Control and Prevention
Mark L. Rosenberg, MD, MPP, former Assistant Surgeon General and former Director of the National Center for Injury Prevention and Control
David Satcher, MD, PhD, former Surgeon General, Assistant Secretary of Department of Health and Human Services and Director of the Centers for Disease Control and Prevention
John R. Seffrin, PhD, member, Advisory Group on Prevention, Health Promotion, and Integrative and Public Health and chief executive officer of the American Cancer Society
The Honorable Louis Stokes, former member of Congress and member of the United States House of Representatives Labor, Health and Humans Services and Education Appropriations Subcommittee
W. Craig Vanderwagen, MD, former Assistant Secretary for Preparedness and Response, US Department of Health and Human Services
Elias A. Zerhouni, MD, former Director, National Institutes of Health
CC: National Governors Association
Members of Congress
November 29, 2011
Reading yesterday’s Associated Press story, “More kids skip school shots in 8 states” made me think back to a presentation given a month ago at APHA’s annual meeting. Alexander Brzezny, MD, MPH, a health officer with the Grant County Health District in Ephrata, WA, discussed a 2008 measles outbreak among less than twenty unvaccinated school-aged children. In an unusual but should-happen-more-often move, Grant County tracked the resulting disease control and response effort’s cost to the taxpayer.
As the outbreak summary states, 18 of the 19 cases occurred, “in adolescents and children between 9 months and 18 years of age, none of whom had previously received any doses of measles-containing vaccine. 16 of those 18 were school-aged children and were either home- schooled [and so did not need to be vaccinated to attend school] or were exempted from school vaccination requirements.”
Dr. Brzezny’s presentation detailed the exact cost his small county health department shouldered (and, by default, the taxpayers of that county supported) to monitor, contain and eradicate the disease. The effort to manage the 19 cases used 4.9 percent of the county health department’s annual budget, costing the department alone more than $5,200 per case. Meanwhile, the state health agency spent $46,480. All government response efforts from all sources were conservatively estimated to cost $213,858. Remember, these numbers do not include the medical costs paid by each family, the costs to local businesses, and so on.
So here is what I’m wondering…
Would parents who wish to opt their children out of vaccinations still agree to do so if they then signed an indemnity clause that promised to pay back taxpayers for any expense the government might need to undertake if their child later becomes infected by a vaccine preventable contagious disease?
The family quoted in the AP story, who believes that the reduced number of vaccine preventable diseases prevalent in society today is, “due to effective sewer systems, nutrition and hand-washing,” would be welcome to avoid outhouses, eat well and wash their hands – but if that failed to protect their child from measles, shingles, chickenpox, meningitis, rubella… taxpayers could rest easy knowing that the family would cover the bill of any government response needed to protect others if their child later began spreading a vaccine preventable disease.
Would another level of personal responsibility call for parents to cover their own medical costs without the help of an insurance provider? I wonder if they would sign a similar document with their insurance company that said, “If you skip vaccinations and later get the illness, you’re on your own.”
And, what about the medical costs – or funeral costs - of those who were exposed to an unvaccinated child spreading a preventable disease? The elderly, cancer patients weakened by chemotherapy or newborn babies yet to be vaccinated are just some of the people who would be at risk. Should the opt-out family also agree to cover these costs as well?
Of course, this isn’t a serious proposal. The point is this: in addition to the suffering of those afflicted with the preventable diseases, there are tangible financial costs to society when parents avoid recommended vaccinations. Part of this debate should focus on the costs paid by everyone in the form of higher taxes, higher insurance premiums and through the increased risk of having your loved one contract a disease that is wholly preventable.
Karl Moeller | Executive Director | The CPH Foundation