vaccine manufacturers and vaccines, production and procurement of vaccines, distribution and use of vaccines, evaluating the need for, the effectiveness and adverse effects of vaccines and coordinating Government and non-Government activity as far as providing the secretariat functions for the National Vaccine Advisory Committee (NVAC). Furthermore, provisions of Title XXI, Subtitle 2, are to be implemented by NVP: the development and dissemination of vaccine information materials to provide consumer information about the risks associated with immunization; the collections and analysis of information about vaccine-related adverse events; and oversee studies called for by the National Childhood Injury Act of 1986, Title III of P.L. 99-66 that examine the relationship between childhood vaccine and specified illness and conditions. The positions allocated to the NVP are used both in the National Vaccine Program Office (NVPO) and the PHS agencies responsible for vaccine work. Only 9 FTEs are used directly in NVPO. The remainder are allocated to the PHS agencies to enable them to undertake NVP activity. The NVAC strongly recommend that additional staff be provided to NVPO to enhance the NVPO capacity to fully coordinate the legislative mandated activities. The scheduled increase in vaccine activity requires a commensurate increase in program management and coordination activity in NVPO. Mr. Natcher: What other high priorities do you have in the vaccine program that you were not able to include in the budget request? Dr. Mason: In future years, other activities that will likely receive priority attention include implementation of second-dose measles recommendations; studies to develop rapid diagnostic tests for measles; clinical trials with more potent candidate conjugated vaccines and extramural laboratory research to evaluate new/improved candidate vaccines; additional research to develop pre-licensure and improve post-licensure safety testing of vaccines as well as post-marketing surveillance of vaccine safety; improving polio vaccine called for by the Institute of Medicine and acceleration and enhancement of current research efforts; intramural and extramural research to develop serological correlates of protection of vaccines; and projects to address vaccine development and diagnostic issues of tuberculosis. ADOLESCENT FAMILY LIFE Mr. Natcher: In your view, what is the purpose of the Adolescent Family Life program? Dr. Mason: The purpose of the Adolescent Family Life (AFL) program is to explore effective means, within the context of the family, to promote abstinence from adolescent premarital sexual activity; to promote adoption as an alternative for adolescent parents; to establish innovative, comprehensive and integrated approaches to providing comprehensive care (health, education and social services) to pregnant adolescents and adolescent parents, with primary emphasis on unmarried adolescents age 17 and under, and; to support research dealing with various aspects of adolescent pregnancy such as determinants and consequences of premarital sexual activity, the adoption decision-making process, parenting by the unmarried adolescent mother and its impact on offspring and effectiveness of discrete strategies employed in care and prevention service programs. Mr. Natcher: Do you see this as a permanent program, or will it end at some point? Dr. Mason: The AFL is a demonstration program, and we are currently proposing reauthorization for an additional three years. TUBERCULOSIS Mr. Natcher: Doctor, how serious is the problem of tuberculosis in this country? Dr. Mason: Tuberculosis (TB) has been a potentially preventable and curable disease for 3 decades. But despite efforts to control this disease, TB remains an important public health problem for the United States and the world. Left untreated, TB is a deadly disease. About 50 percent of patients will die within 2 years after symptoms appear. Throughout history, TB has ravaged all racial/ethnic and income groups; but the poor, racial/ethnic minorities, and the foreignborn are disproportionately affected. From 1953 through 1984, the United States experienced a significant decrease in the number of new TB cases reported; from 84,304 cases in 1953 to 22,255 cases in 1984. Since 1984, however, the long-term decline has stopped. The CDC estimates that from 1985 through 1989, nearly 21,000 excess cases have accumulated. In addition, an estimated 10 million Americans are infected with the TB bacillus and are at risk of developing the disease in the future. TB is increasing among young Blacks and Hispanics, while TB among non-Hispanic whites continues to decline. From 1985 through 1988, cases among Blacks and Hispanics in the 25- to 44-year age group increased from 4,051 to 5,103. In 1988, about two-thirds of all cases occurred in minority populations. At least 4,865 cases of TB cases in minorities were potentially preventable. This trend is probably attributable in part to TB occurring in persons infected with HIV, the virus that causes AIDS. AIDS-associated TB has occurred in all age groups, in both men and women, and in all HIV-transmission categories, although the largest number of cases have occurred in intravenous drug users and homosexual/bisexual men. There is an extremely high prevalence of TB among AIDS patients: approximately 4 percent of persons with AIDS have had TB. In contrast, the incidence of TB in the general population in 1988 was 9.1 cases per 100,000 population, or .009%. As of December 1989, HIV testing is being performed on TB cases and suspects in 73 sites in 33 States. Preliminary results indicate a range of seropositivity between 0 and 57 percent. Among children less than 15 years of age, 83 percent of cases (936) occurred in minorities. The continuing occurrence of TB in children is a sentinel health event--a warning signal that the quality of medical care needs to be improved. A related issue is TB in the foreign-born. In 1988, 22 percent of all persons with TB reported to the CDC were born in another country. Sixty-six percent of foreign-born cases were potentially preventable had they been identified as infected and given preventive therapy. The elderly, i.e., persons 65 years of age and older, are also disproportionately affected by TB. During 1988, 27 percent of reported cases (6,058) occurred in the elderly, although this age group makes up only 12 percent of the population. Nursing home residents have higher case rates than the elderly not living in nursing homes, suggesting that TB is being transmitted within these facilities. Transmission of TB has also been documented in other facilities, such as prisons and shelters for the homeless. A 29-state CDC survey revealed that prison and jail inmates have TB case rates nearly four times the rate among non-incarcerated adults ages 1564. In addition, data from selected areas show that a relatively high proportion (1.6 to 6.8 percent) of America's homeless have TB, and up to 50 percent have latent TB infection. This is many times higher than the national TB case rate (9.1 cases per 100,000 population, or .009%). It is estimated that approximately 15% of the U.S. population ages 25-54 have latent TB infection. Mr. Natcher: Does the Department have some kind of a plan for controlling tuberculosis? Dr. Mason: Tuberculosis (TB) can be eliminated from the United States. It is occurring predominantly in focal geographic areas and demographically well-defined populations which can be targeted for intensified control and elimination efforts. strategies have been devised and only need be implemented. The In April 1989, an HHS Advisory Committee for Elimination of Tuberculosis (ACET) published a plan for eliminating TB from the United States by the year 2010. Department of Health and Human Services (HHS) Secretary, Louis W. Sullivan, M.D., has endorsed this plan. The American Medical Association, the American Lung Association, the American Public Health Association, and the American College of Preventive Medicine and several other health care organizations have also endorsed the plan and are committed to participating in its implementation. The plan consists of three parts: 1. The more effective use of existing prevention and control methods in high-risk target populations. 2. 3. The development and evaluation of new technologies for The rapid assessment and transfer of newly developed Mr. Natcher: To what extent would additional federal funding make a difference in this area? Dr. Mason: If additional federal funding were available, further implementation of the Department's Strategic Plan for the Elimination of Tuberculosis in the United States could be undertaken to: (1) more effectively utilize existing prevention and control methods in high-risk populations; (2) develop and evaluate new treatment, diagnostic, and prevention technologies; and (3) rapidly transfer newly developed technologies into clinical and public health practice. Through implementation of the Department's Strategic Plan cases of TB in high-risk population groups such as minorities, children, those with HIV infection, the elderly, the homeless, and the foreign-born would be prevented. However, PHS is not requesting additional funds for this purpose within the priorities of the 29-530 0-90--3 1991 budget, and no further offsets have been identified to accommodate such increases. PHS MANAGEMENT BUDGET ACTIVITY Mr. Natcher: In your management activity you're requesting an increase of $1,699,000, or 9 percent over 1990. Why is this rather sizeable increase necessary? Dr. Mason: Over the past several years, the resources available to the Assistant Secretary for Health for the management of the Public Health Service have eroded substantially. This erosion has been the result of sequestrations, across the board reductions, continuous absorption of pay raises, and legislatively required increases such as the Military Officers Retention Bonus pay. PHS Management has not received a pay supplemental since 1980. During this time of continuing reductions in resource levels, responsibilities for new missions and initiatives continue to emerge. For these reasons, in FY 1991 we are requesting restoration to the FY 1990 pre-sequestration level plus the FY 1991 mandatory increases, including the January 1991 executive pay increase. Because this account finances the oversight of the Public Health Service, it includes a significant number of Senior Executive Service employees and flag officers. The FY 1990 level of funding will not permit the replacement of any of the aging equipment. Our professional employees need reliable automated data processing equipment to partially compensate for reduced staff and increased workload. The funds requested for FY 1991 will allow for the purchase of some up-to-date ADP equipment. During the last few years this account has been managed hand to mouth. Constant reductions and restrictions have been applied to live within the budget constraints. I need some flexibility to be able to direct resources to emerging priorities. This request will give me that leeway and assure effective oversight and direction of PHS programs. Mr. Natcher: If the Committee decided to hold salaries and expenses activities at the 1990 dollar level in 1991, what effect would it have on operations? Dr. Mason: If the FY 1991 level of funding is maintained at the FY 1990 level, the effect would be quite severe. The absorption of the additional mandatory increases would mean that funds would be insufficient to pay current staff. We would very likely have to furlough some of our current staff. Mr. Natcher: What is the cost of the recent Federal pay increase in this account in 1990. Dr. Mason: The cost in FY 1990 for the pay raise and related costs is $466,000. Mr. Natcher: How are you absorbing this? Dr. Mason: Several management actions have been taken. Vacancies, except for a few senior level positions, have not been filled. Travel has been significantly curtailed; most training has been eliminated; purchases of equipment to support our automation plan and improve efficiency has been postponed. All planned expenditures have been examined in an effort to reduce costs and save funds. DISEASE PREVENTION AND HEALTH PROMOTION Mr. Natcher: What were the main accomplishments during the past year of the Office of Disease Prevention and Health Promotion. Dr. Mason: Three major accomplishments were: Completion of a four-year effort supporting the U.S. O Follow-up activities to the Surgeon General's Report on Nutrition and Health, including completion of a modeling project to analyze the contribution of dietary fat to premature mortality in the American population, initiation of a project to highlight exemplary school lunch programs that reflect the dietary implications of the Report, and initiation of a DHHS (FDA)-USDA joint project, with assistance from the Food and Nutrition Board (Institute of Medicine, National Academy of Sciences), to improve regulation of food labeling. Management on behalf of the ASH and the Public Health Service of the third and fourth phases of the process to develop health promotion/disease prevention objectives for the year 2000. The third phase involved publication of a draft of proposed objectives for public review and comment. The fourth phase involved receipt of public review and comment. We are currently engaged in leading Public Health Service-wide work to refine the draft objectives in time for their publication in final form in September 1990. O Other accomplishments include continued information service through the National Health Information Center, convening of numerous interagency and interdepartmental coordinating groups (e.g. school health education, DHHS Nutrition Policy Board, DHHS Prevention Coordinating Group, prevention of disabilities, health risk appraisal research, annual nutrition symposium, U.S. Preventive Services Coordinating Committee), and published Prevention Report with abstracts of recent prevention scientific literature. Mr. Natcher: Does the 1991 budget of the Office allow for initiation of any new activities? Dr. Mason: The FY 1991 budget of the Office of Disease Prevention and Health Promotion will support continuation of current activities. Mr. Natcher: Will the Office be discontinuing any current activities in 1991? Dr. Mason: The Office of Disease Prevention and Health Promotion has no plans to discontinue any current activities in 1991. |