INTERNATIONAL HEALTH AND MEDICAL RESEARCH

ACT OF 1959

TUESDAY, MARCH 10, 1959

U.S. SENATE,

COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C.

The subcommittee met at 10 a.m., pursuant to recess, in room 4232, Senate Office Building, Senator Lister Hill (chairman) presiding. Present: Senators Hill (presiding), Yarborough, Williams, Cooper, and Javits.

Also present: Senator Hubert H. Humphrey of Minnesota.

Committee staff members present: Stewart E. McClure, chief clerk; John S. Forsythe, general counsel; William G. Reidy and Raymond Hurley, professional staff members.

The CHAIRMAN. The committee will kindly come to order.

Secretary Flemming, we are very happy to have you here this morning, as well as the members of your staff accompanying you, Surg. Gen. Leroy Burney, Dr. Hyde, Miss Mary Switzer, and Mrs. Oettinger. We welcome all of you here and we are very glad to have

you.

Now, Mr. Secretary, we will be glad to have you proceed in your own way.

STATEMENT OF HON. ARTHUR S. FLEMMING, SECRETARY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Secretary FLEMMING. Thank you very much, Mr. Chairman. I certainly appreciate this opportunity, for myself and my colleagues, to appear before your committee in connection with your consideration of Senate Joint Resolution 41.

On January 9, 1958, while I was still president of Ohio Wesleyan University, I was thrilled, in reading President Eisenhower's state of the Union message, to note the following reference to "works of peace":

Another kind of work of peace is cooperation on projects of human welfare. For example, we now have it within our power to eradicate from the face of the earth the age-old scourge of mankind, malaria. We are embarking with other nations in an all-out 5-year campaign to blot out this curse forever. We invite the Soviets to join with us in this great work of humanity.

Indeed, we would be willing to pool our efforts with the Soviets in other campaigns against the diseases that are the common enemy of all mortalssuch as cancer and heart disease.

If people can get together on such projects, is it not possible that we could then go on to a full-scale cooperative program of science for peace?

A program of science for peace might provide a means of funneling into one place the results of research from scientists everywhere and from there making it available to all parts of the world.

There is almost no limit to the human betterment that could result from such cooperation. Hunger and disease could increasingly be driven from the earth. The age-old dream of a good life for all could, at long last, be translated into reality.

I believe firmly in the philosophy that underlies this proposal on the part of the President.

When I was invited by the President to assume the duties of this office, one of the first things that occurred to me was that the Secretary of Health, Education, and Welfare might have the opportunity of helping to implement a "health for peace" program.

Consequently, soon after I took office, I made inquiries as to what had been done and what was being done in order to follow through on the concept the President had lifted up as a challenge to our Nation and to other nations.

I was delighted to discover that in the fiscal year 1959 our Nation will spend approximately $80 million in the international health field. I am even more delighted to note that the budget for 1960 submitted by the President contemplates increases in expenditures in this area that could lead to total expenditures in 1960 of approximately $100 million.

Activities in the field of international health can be broken down into three categories, namely:

(1) The mass control or eradication of communicable disease; (2) The building of strong and sound health services; and

(3) The development and intensification of scientific and medical research.

We can be proud of the fact that as a Nation we are making significant contributions in all three of these areas.

First, let us consider the mass control of communicable disease. Here are some of the activities to which our Nation is making a significant contribution:

(1) Control, through improved sanitation, of the dysenteries and diarrheal diseases which are, with malaria, the leading cause of death throughout the underdeveloped areas.

(2) Control, through sanitation and antibiotic ointments, of trachoma, a widely prevalent blinding disease afflicting tens of millions of persons in the Near East and Asia.

(3) The eradication of malaria through a worldwide program coordinated by the World Health Organization.

Of all of these activities, probably the most significant is represented by the more than $25 million that we are spending in 1959 and the $35 million that we propose to spend in 1960 for the eradication of malaria.

Secondly, I would like to refer briefly to the contributions that we are making to the development of strong and sound health services throughout the world. It is in this area also that the program of the Interantional Cooperation Administration is of far-reaching significance. It enables other nations to support programs such as the following:

(1) The training of thousands of health and medical workers at all levels of professional and subprofessional competence, to render service to populations that have been without such services through the centuries.

(2) The development and staffing of rural health centers, such as the 1,200 or more now rendering service in the barrios of the Philippines.

(3) Providing technical assistance in the raising of standards of medical and nursing education, as well as of public health organization and administration.

Under the proposed budget for 1960, it is estimated that approximately $26 million will be spent by ICA for such activities.

In addition to the contributions that we make directly to other nations, we are also making a very meaningful investment in multilateral programs through the international organizations that are seeking to strengthen health services throughout the world.

Here are some of the things that are being done:

(1) Providing teams and supplies for fighting yaws, a painful, chronic crippling disease, that affects some 50 million persons, and is usually cured by a single injection of penicillin.

(2) Equipping thousands of maternal and child-health centers and training midwives in remote areas.

(3) Testing children-now over 200 million-for tuberculous infection and vaccinating the uninfected.

We are spending in 1957 $21,800,000 for these activities and in 1960 the budget allows for expenditures of approximately $23,400,000. Finally, it is interesting to take note of the support that we are already giving to medical research outside of our Nation.

Last May, for example, the World Health Organization was provided with a grant of $300,000 from the U.S. Public Health Service to enable it to plan its role in the field of research.

The proposed Mutual Security Act budget for 1960 contains an item of $1 million to be used to assist the World Health Organization in getting its program underway, once their planning is completed and approved by the World Health Assembly.

This year, the National Institutes of Health are making approximately $4 million available for the support of international medical research and research training and it is estimated that this figure may reach $5 million in 1960.

In summary, it seems to me that our Nation has already made a real start in the direction of making meaningful contributions to the attainment of the goal that was so effectively set forth in the President's state of the Union message in 1958.

Obviously, however, more can and must be done to improve the effectiveness of our participation in these international health activities.

There is no doubt in my mind, for example, but that the various activities that are now being carried on within the executive branch of the Government can be coordinated in a better manner than is the case at the present time. Plans are now being developed within the executive branch to effect this coordination and I am confident that the results of this planning will be announced within a few weeks.

The aspect of our international health program that is covered by Senate Joint Resolution 41 provides another illustration of steps that can be taken to enable us to exercise meaningful leadership in the total international health field.

Although most of the activities which Senate Joint Resolution 41 would authorize are now authorized under existing laws, it is clear

that it would be advantageous, as this resolution does, to bring these authorizations together into one law.

In so doing, we will be underlining the joint support of the executive and legislative branches for these activities.

In addition we will be taking a significant step in the direction of strengthening these programs as well as improving their coordination and administration.

We should, as a Nation, make it very clear that we are desirous of achieving the health and rehabilitation objectives that are set forth so effectively in section 2 of this joint resolution.

In our letter reporting on this bill, we have suggested certain changes which in our judgment will help, from an administrative point of view, to achieve the purposes of the bill, I would be very happy, at the conclusion of this statement, to discuss with the committee some of the more significant suggestions.

Mr. Chairman and members of the committee, I would like to say this: that I am looking forward to the opportunity of working with this committee in this very important area. A large percentage of the citizens of our Nation recognize the existence of spiritual laws. They recognize that one of these laws places upon us an obligation to help other peoples realize their highest possibilities.

They are willing to apply this law to the life of our day. They are willing to do so, not because of what we as a Nation may get out of such an application, but because of what we as a Nation can do to help other peoples.

I believe that every time we act as a Nation in this spirit toward other peoples, we are focusing attention upon these spiritual laws of life. As we focus attention on them by our deeds, it is altogether possible that other peoples will embrace them. The more progress we make in this direction the better chance there is of a spiritual breakthrough that will bring peace to the world.

The field of international health provides us with an opportunity to demonstrate our interest in helping other peoples. I am delighted that both the executive and legislative branches believe that the time has come to go on record once again to this effect. There is no question in my mind but that the assistance we are rendering and will continue to render will produce beneficial results for mankind.

I am confident that the "health for peace" program will take its place alongside the "atoms for peace" program as a program that will provide substantial grounds for hope as together we face the future.

The CHAIRMAN. Thank you for your statement, Mr. Secretary.

Mr. Secretary, yesterday I received, as chairman of the committee, for the committee, your letter dated March 9 with reference to the Senate Joint Resolution 41 (see p. 5). In it you stated:

First of all, we want to make it clear that we are in accord with the purposes and objectives of this bill.

Then you made a recommendation which I will now quote:

We recommend that basic statutory authority under the bill be vested in the President, with the expectation that it would be exercised by him through the Secretary of Health, Education, and Welfare, under the policy guidance of the Secretary of State.

You know the high regard, Mr. Secretary, in which I hold you, sir, and I realize that you have your problems. In other words, when you come before this committee to speak for the administration, you do not speak just for yourself as the Secretary of Health, Education, and Welfare, but, no doubt, you have been in conference with the Bureau of the Budget on this matter, and, I am sure, with representatives of the State Department and representatives of other departments of the Government, and perhaps, with the President himself.

So I must say, with all due respect to you, that I recognize that, in writing this letter, you were not just speaking for the Secretary of Health, Education, and Welfare, but for the administration.

This statement "with the expectation that it would be exercised by him" is rather unusual, I think unprecedented. It is a rather strange an amazing suggestion-in view of the fact that the Congress has a very definite responsibility to the people to make certain just how a law will be administered, just who is going to administer it and just where the responsibility will rest. Not on the basis of expectation, but definitely and assuredly. We are obligated to decide who is going to administer the law, who is going to do the job, and who will have the responsibility. To rely on "expectations" would be to shirk our responsibility.

Secretary FLEMMING. Mr. Chairman, I would be very happy to comment on the recommendation. The recommendation rests on the assumption that the primary and basic responsibility for the conduct of activities that are related to our relationships with other nations is vested in the President, and it is our feeling that because of the fact that this bill deals definitely with our relations with other nations that it would be wise to vest the basic statutory authority in the President and leave to the President the decision as to how he desires to have the various departments within the executive branch participate with him in the discharge of this responsibility.

As you know, there is some precedent for this in connection with the language of the Mutual Security Act. It is true that in certain instances in the Mutual Security Act the responsibility is placed in the President to be exercised through certain designated officials.

In other instances the responsibility is vested in the President. I, as you know, Mr. Chairman, have had the opportunity of working on organizational problems within the executive branch. I first had that opportunity as a member of the first Hoover Commission and then also as a member of the second Hoover Commission and then during this administration I have served as a member of the President's Advisory Committee on Government Organization; and, as a result of those periods of service, I have been asked from time to time to look into and to advise on matters affecting the organization of the executive branch in the field of international affairs; and I am frank to say that the longer I work on it the more convinced I am that it is wise to place the responsibility in the President and to give him flexibility in assigning duties and responsibilities to various departments and agencies.

As you appreciate, our activities in the international field are becoming more widespread and are becoming more complex and I feel very definitely that it is wise for us to do everything we can to insure