By Alexandra Menardy, CPH Foundation Intern and MPH Health Policy Candidate at GW Milken Institute SPH
All public health graduate students learn about the Centers for Disease Control and Prevention’s role in public health. Still, most of us think infectious disease is the agency’s sole focus. I now realize how mistaken that idea is, after joining the CPH Foundation and a bipartisan delegation of U.S. Senate HELP Committee staffers on an educational tour of the agency’s headquarters in Atlanta.
Over the course of two days, I helped the CPH Foundation lead a tour group through a series of meetings and site visits; where we learned how the agency lives up to its motto of “24/7: Saving Lives. Protecting People.” During a panel discussion, representatives from the New York Department of Health and CDC leadership discussed the agency’s partnerships with state and local governments. The CDC distributes over 60% of its budget to help these entities address a wide array of public health challenges. The agency also works to address chronic diseases such as obesity, diabetes, stroke, and heart disease- providing scientific expertise to regional public health laboratories and working directly with local experts on the ground.
Tour participants engaged in a panel discussion on chronic disease with senior CDC leadership and the NY Department of Health.
CDC’s Chamblee and Roybal campuses are home to globally renowned, “gold standard” environmental health research facilities, the emergency response operations center, occupational safety laboratories, and divisions dedicated to improving laboratory science standards. During our tour of the Tobacco Laboratory, a world leader in tobacco research, we discussed the agency’s unique work in the field. The CDC is the only laboratory that measures more than 100 addictive and toxic substances in tobacco products and smoke; including the highly-addictive, free-nicotine constituent. The agency goes to remarkable lengths to keep pace with ever-changing tobacco products, analyzing more than 10,000 specimens each year. CDC science also supports of the FDA’s efforts to monitor the behavioral and health impacts. This laboratory is often referred to as the “world’s reference lab”for toxic substances. Judging by the state-of-the-art technology, CDC’s work is true to its reputation.
Upon entering the CDC’s Environmental Health Laboratory, tour participants wore shoe covers to maintain the sterile facility and safety.
Another highlight of our tour was a discussion with the CDC’s Injury Center on the recent U.S. prescription drug overdose epidemic. I was nominally aware of PDO as an emerging issue, but was stunned to learn that opioid-related overdose death rates have been rising steadily. From 1999 to 2010 alone, there was a 102% increase. The CDC is not a regulatory agency, but they are working to address this issue by implementing their three pillars for prevention: improving the data quality and tracking trends on a national level, collaborating with states to strengthen their ability to address this issue, and supplying healthcare providers with the proper resources to improve patient safety. The agency’s efforts have already drastically improved healthcare standards through new prescribing guidelines in several states. The CDC expects to implement more drug monitoring programs, facilitate better access to substance abuse treatment, and ensure greater health care provider accountability.
Tour participants were joined by CPH Foundation partner organizations, sponsors, and senior CDC staff for dinner. Katherine Simeon (Sen. Orrin Hatch’s staff) speaks with CDC’s Dr. Anne Schuchat (foreground). Natalie Burkhalter (Sen. Rand Paul’s Staff) on left.
A culminating point in the visit occurred when CDC Director, Dr. Tom Frieden, provided a glimpse into a typical week at the CDC, focusing on the agency’s remarkable work in infectious disease prevention and surveillance. Dr. Frieden discussed efforts to address MERS, ebola, TB, chikungunya virus and the Million Hearts Initiative. Another key issue covered was the threat of antibiotic resistance. Awareness of antibiotic resistance is on the rise and the severity of this issue is alarming. AR in the United States kills at least 23,000 people every year, and ultimately puts modern medicine at risk. The CDC’s Detect and Protect FY15 Proposal seeks to address this issue. The proposal requests $30 million/year for 5 years to speed-up outbreak detection through support of regional labs and improve infection prevention and antibiotic prescribing. By doing so, the CDC’s AR Initiative could achieve 25-50% reductions in many harmful infections.
CPH Foundation Executive Director, Karl Moeller, thanks tour sponsors during a meeting with CDC Director, Dr. Tom Frieden.
A final highlight of the tour was the insightful panel discussion with CDC Epidemic Intelligence Service (EIS) officers and others. Our group was given a glimpse of a “day in the life of a disease detective”. It’s evident the agency’s infectious disease research and field work truly makes a difference worldwide. One interesting account was from EIS Officer Rachel Smith who led a research team during 2012 U.S. fungal meningitis outbreak. The CDC’s collaboration with and training of state health departments’ staff helped minimize what could have been a national outbreak.
As a public health graduate student, experiencing first-hand the CDC’s tireless efforts to ensure our nation’s health and safety has provided me with inspiring insights into the hard work of the often under-appreciated staff at this amazing agency. Helping in the CPH Foundation’s efforts to educate policy makers about the agency’s expansive work was an excellent opportunity. The CDC is not only a leader in widely-known prevention efforts, but also is a pioneer in public health innovation.
To see more of our latest CDC tour, view photos here.
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