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PREPARED STATEMENT

AIDS has already claimed more American lives than all our recent wars, including, Vietnam. Congress must now commit to spending what is needed to fight this war. Simply, the lives of over 1 million American men, women, and children, already infected with HIV, and the lives of all those many others who are bound to become infected over the next years, depend on it.

Thank you.

[The statement follows:)

STATEMENT OF MATHILDE KRIM I am Mathilde Krim. I hold a Ph.D. degree and am Founding Co-Chair of the American Foundation for AIDS Research. I am honored by your invitation to speak before your Subcommittee on behalf of AmFAR and I first want to thank you for your dedicated past efforts in the fight against AIDS. But, much remains to be done.

The AIDS epidemic has highlighted many deficiencies in our social welfare and health care delivery systems because people most at risk for, or suffering from, AIDS are often individuals who can neither access nor afford appropriate health care. Much of the very high cost of this epidemic will therefore be borne by the whole of society. This cost must be measured not only in dollars for medical care but in lives lost, suffering and loss of national productivity. To combat this epidemic Congress must address a variety of issues.

You will hear from other groups about social and medical care programs needed by those with HIV disease and AIDS. Today, speaking for AmFAR, I want to emphasize the importance of research in the face of the new and ever growing deadly epidemic and I want to stress the fact that only the results of research will make it possible to bring this particular epidemic under control. Indeed, because of the mode of transmission of the Human Immunodeficiency virus (HIV) that causes AIDS; because of the very long incubation period of AIDS (on average, 11 years, during which infected people are unaware of being infected but transmit the virus) and because no protective immunity results from HIV infection, this epidemic, un. like others will not be self-limiting. It will continue to grow and kill until research has produced a vaccine for the protection of the uninfected and effective treatments for the infected.

The agencies with the heaviest responsibilities in the crucial research effort are the National Institutes of Health (NIH), the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA), and the Centers for Disease Control (CDC). Progress in the war against AIDS depends almost entirely upon new knowledge developed by or through these agencies.

NATIONAL INSTITUTES OF HEALTH Through both its intramural and extramural programs, the NIH has contributed most of the basic knowledge we have today about AIDS. The NIH identified HIV as the cause of AIDS and developed the first life-prolonging antiviral drug, now marketed for the treatment of HIV disease. The NIH is now studying many other drugs in order to develop the arsenal of treatments that will be necessary to turn this now fatal illness into a chronic manageable one. The NIH is also testing several preparations with potential as vaccines against HIV infection.

These advances could not have occurred if the NIH had not, over the years, steadily built a broad base of knowledge in the biological sciences and developed sophisticated technologies for the analysis of fundamental biochemical and biophysical mechanisms.

Our country's capacity for scientific discovery is far from being fully reached at this time: in 1990, only 24 percent of all peer review-approved requests for research grants were actually funded by the NIH. (Twenty years ago, nearly half of all approved grant requests were funded.) Therefore, AmFAR supports increased funding for all basic biomedical research at the NIH, and it joins with the Coalition for Health Funding and the Ad Hoc Group for Medical Research Funding in requesting $9.77 billion, overall, for the NIH in fiscal year 1992.

As for the NIH's AIDS Program, the Administration requested $851.2 million for fiscal year 1992, a 6 percent increase over the fiscal year 1991 budget. Such a small increase will not allow NIH to exploit the many potentially life-saving, new treatment and prevention opportunities discovered through earlier work. AmFAR, in conjunction with the National Organizations Responding to AIDS, urges Congress to invest $1 billion for the NIH’s fiscal year 1992 AIDS program, only slightly less than a 20 percent increase.

This proposed increase is justified by the high cost of clinical research, the testing of new treatments in human beings, which now can and must be expanded. It is also justified by an urgent need to intensify basic and clinical research on the many deadly opportunistic infections that plague people with AIDS and that continue, to this day, to be the immediate cause of their death.

The university-based AIDS Clinical Trials Group (ACTG) is the principal instru. ment for NIH-sponsored AIDS clinical trials. However, the ACTG's capacity is severely limited, and achieving demographic diversity in ACTG-funded clinical trials has been difficult, which remains a serious concern. Community-based primary care physicians participating in the clinical research effort as members of NIH-funded Community Programs for Clinical Research on AIDS (CPCRA) are greatly expand. ing the NIH's capacity to evaluate new treatments, to include trial participants from medically underserved groups and to offer them urgently needed access to promising experimental treatments.

The CPCRA is an innovative and cost-effective program that accelerates the pace at which new treatments are evaluated and made accessible to all those who need them, including women. The CPCRA program deserves continuing and much increased support.

In women and children with AIDS the spectrum of opportunistic diseases is different than in adult men, and so may be their response to treatment. Clinical trials must not only include them but, whenever appropriate, special trials must be designed for them. AmFAR commends the effort of the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute for Child Health and Human Development (NICHD) for having undertaken trials in pediatric AIDS and for coordinating their efforts in this area.

A recent report from the Institute of Medicine (IOM) on the NIH AIDS Program concludes that the NIH should continue to give AIDS research high priority and that current opportunities and needs could

justify an immediate increase of as much as 25 percent in NIH’s budget for AIDS research.” AmFAR commends the IOM's efforts in producing this report and it endorses its recommendations.

CENTERS FOR DISEASE CONTROL

The CDC is the primary Public Health Service agency responsible for tracking the epidemic of AIDS and for controlling the spread of HIV through broad ranging and all Important activities in education for HIV/AIDS prevention.

It is through the CDC's work that the mode of transmission of HIV became known and the epidemiological pattern of HIV infection and AIDS understood. Women and infants have recently been found by the CDC to be the two populations in whom the incidence of AIDS is now growing very rapidly, in fact, faster than in men. By the year 2000, the CDC predicts that women will make up 30 to 40 percent of all AIDS cases in the Unites States. As the demographics of the epidemic change, the CDC must be able to continue to track it so that sound public health policies and correctly targeted educational programs can be developed and implemented. The Administration has requested no new funding for fiscal year 1992. AmFAR joins with the National Organizations Responding to AIDS in requesting funding of $809.7 million for the CDC for fiscal year 1992.

ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION The link between intravenous drug abuse and the spread of HIV imposes a very heavy burden of AIDS cases on society. A national strategy for AIDS prevention that includes drug treatment on demand and concomitant culturally appropriate education on risk reduction is crucial. It is also essential that further research on the behavioral and physiological aspects of addictive disorders be pursued intensively so that a better understanding of these disorders can lead to more rational and more cost-effective treatments. While the Administration's request of $244.9 million for ADAMHA does represent a significant increase, it is still inadequate. We join with the Ad Hoc Group on Medical Research Funding and the National Organizations Responding to AIDS in requesting funding of $331.8 million for fiscal year 1992.

The National AIDS Demonstration Research Project, under ADAMHA's National Institute on Drug Abuse, is the only federal prevention program in the country concerned with increasingly at risk intravenous drug users (IVDU's) not in drug treatment facilities, sexual partners of IVDU's, prostitutes as well as runaway or "throw away" and delinquent youth. Data from the NADR project provides essential information to both public health officials and the private sector. This project should be fully funded rather than phased out as surprisingly called for in the President's budget.

The need for additional resources for expanded biomedical and other research is great. These resources should, however, not come from other domestic programs, nor should they be provided at the expense of medical care for those with AIDS or prevention education for those at risk for AIDS. AmFAR is aware of the constraints of the Budget Enforcement Act. But, we also know of the ever-growing numbers of people with HIV infection and AIDS, of the terrible toll of suffering extracted by AIDS and of the need of the American people for a better understanding of why it must, and how it can, protect itself from HIV/AIDS.

AIDS has already claimed more American lives than all our recent wars, including Vietnam. Congress and America must commit now to spending the critical level of resources necessary to fight this war. The lives of over one million American men, women and children already infected with HIV, and those of many others bound to become infected in the years ahead, are at stake.

Senator HARKIN. Dr. Krim, thank you very much for your testimony again this year. Your request is for a 17.5-percent increase for NIH, 64 percent for CDC. The AIDS Action Council, which just testified before you, said the highest priority is to first fund the Ryan White bill. Within our limited budget, what are your feelings on that?

Dr. KRIM. I said that the solution to the problem can come only through research. And, therefore, that must be a high priority. We have a moral obligation as a Nation to take care of our sick and our dying. So one is a practical priority, and the other one is a moral priority. And there is no way of balancing one against the other. We must do both.

Senator HARKIN. Thank you very much, Dr. Krim. STATEMENT OF DR. PETER D. WALLACE, AMERICAN ACADEMY OF

PEDIATRICS Senator HARKIN. Next is Dr. Peter Wallace, American Academy of Pediatrics.

Dr. WALLACE. Mr. Chairman, I am Dr. Peter Wallace, a pediatrician in practice in Iowa City, IA. I am pleased to be here today on behalf of the infants, children, adolescents, and young adults in this country, as a representative of the 41,000 pediatricians of the American Academy of Pediatrics, and also note that this statement is supported by the 1,300 members of the Ambulatory Pediatric Association, and the 1,100 members of the Society for Adolescent Medicine.

I am especially pleased to be here on the first day of the hearings this subcommittee will hold pertaining to the many health, social, and education programs affecting America's youth. You have, and will hear from many organizations and individuals discussing the merits and needs of all these programs. As the time for decisions near, the academy urges you to remember one key fact: insuring the health of our children means providing for today's needs plus planning for tomorrow's.

Our testimony, as well as those who will come before you in the next few days, will give this subcommittee the information regarding present and future needs. Fortunately for all of us, most infants are born healthy, and continue to grow and develop if they have access to and receive basic health care services.

Unfortunately, there are still far too many that suffer needlessly from disease, injury, abuse, or a host of societal problems. Our task as pediatricians is to treat them all, to provide such services as we are able. Your task is to provide the funds to allow vital Federal programs to continue.

We ask that you recognize the correlation among preventive and chronic health services, research and the training of new health professionals, and not increase one program at the expense of another. As pediatricians in practice, we see the integral tie between basic research and the care we provide in our practices, and see the impact of poverty and the environment on the health of our children in adolescence. And we know that the future of our work force depends upon the decisions we make today.

The testimony of the academy offers several recommendations and has been submitted to you, Mr. Chairman, but I want to stress, in my last minute, immunizations. In my State of Iowa, which boasts a 97-percent fully immunized rate at kindergarten, we have only 54 percent of our 2-year-olds adequately immunized. As I speak, we have an outbreak of measles in Waterloo, and we have had cases of all the diseases that we could immunize against in this last year. To give every child in Iowa a second dose of the measles-mumps-rubella, which will be shortly mandated by the Iowa Department of Public Health, prior to kindergarten, we need $8 million more.

PREPARED STATEMENT

The request that we have made from the academy for increased funding for this vaccine alone is only $24 million for the whole country. So I think you can appreciate the dire straits we face.

Mr. Chairman, we pediatricians feel the subcommittee must know that we feel no better money can be spent than that used for insuring the health of our children. Thank you.

[The statement follows:]

STATEMENT OF DR. PETER D. WALLACE

Mr. Chairman, I am Dr. Peter Wallace, a practicing pediatrician from lowa. I am pleased to be here today to speak on behalf of the infants, children, adolescents, and young adults in this country as a representative of the 41,000 pediatricians of the American Academy of Pediatrics. This statement is also supported by the 1300 members of the Ambulatory Pediatric Association and the 1100 members of the Society for Adolescent Medicine.

I am especially pleased to be here on the first day of the hearings this subcommittee will hold pertaining to funding the many health, social, and education programs affecting America's youth. You will hear many organizations and individuals discussing the merits and needs of all those programs. As the time for decisions nears, the Academy urges you to remember one key fact -- ensuring the health of our children means providing for today's needs plus planning for tomorrow's. Our testimony, as well as those who will come before you through the next few days, will give this subcommittee the information regarding present and future needs.

First, I would like to state that the Academy was pleased to see that the President's budget for fiscal year 1992 placed a priority on children's programs, especially the preventive health programs. The budget acknowledges that in recent years federal spending on most of these programs have not kept pace with increases in other areas. The Academy hopes this subcommittee will use its limited resources this year to reverse the trend.

Fortunately, most infants are born healthy and continue to grow and develop if they have access to and receive basic health care services. Unfortunately, there are still far too many that suffer needlessly from disease, injury, abuse, or a host of societal problems. Our task as pediatricians is to treat them all, to provide such services as we are able. Your task is to provide the funds to allow vital federal programs to continue. We ask that you recognize the correlation among preventive and chronic health services, research, and the training of new health professionals and not increase one program at the expense of another. As pediatricians we see the integral tie between basic research and the care we provide; we see the impact of poverty and the environment on the health of our children and adolescents; and we know that the future of our workforce depends on the decisions we make today.

The testimony of the Academy will offer recommendations for many programs, but I will focus primarily on only a few.

Childhood Immunization Program

This subcommittee is well aware of this preeminent preventive health program for infants and children. Yet, armed with this knowledge and the means to prevent a growing number of serious childhood illnesses, preventable diseases are on the rise in virtually every state in this country. We are experiencing outbreaks of measles, mumps, and whooping cough, and we anticipate the incidences of rubella to increase. Unless we declare an all out effort to conquer these diseases now many of our children will needlessly suffer or die.

The President's budget includes a $40 million increase, targeted mainly at fortifying the infrastructure of our immunization program and stimulating innovative outreach programs, which we strongly support. However, it falls short of the necessary dollars it will take to immunize the increasing numbers of children who depend on the public clinic for their immunizations and to provide for these children the newly recommended second dose of MMR and the newly approved conjugate HiB vaccines for the prevention of meningitis. There is also a strong possibility that the varicella (chicken pox) vaccine will be licensed for routine use this year. If that occurs, additional monies would be needed in a supplemental next spring.

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