VACCINES FOR CHILDREN PROGRAM Mr. Regula: What is the most current estimate for the Vaccines for Children program? Dr. Fleming: The most recent estimate for the VFC program was provided in the FY 2003 President's budget: $990 million in 2002 and $824 million in 2003 (these figures represent both operations and vaccine purchase). However, CDC continually monitors vaccine purchases and adjusts vaccine estimates accordingly. CDC will provide updated estimates in OMB's Mid-Session Review in June, 2002. NIOSH Mr. Regula: NIOSH had planned to complete certification standards for selfcontained breathing apparatus by December 2001. What is the status of these standards? Dr. Fleming: On December 28, 2001, NIOSH issued a respirator certification standard for Self-Contained Breathing Apparatus (SCBA). As of January 22, 2002, NIOSH began accepting applications to test and evaluate SCBA for use against chemical, biological, radiological, and nuclear (CBRN) agents. NIOSH continues working with many partners to develop standards for other classes of respirators effective against CBRN agents and to address other needs of emergency responders for personal protective equipment. BIOTERRORISM Mr. Regula: As part of your bioterrorism initiative, CDC established a cooperative agreement with the Association of American Medical Colleges to strengthen the public health component of medical school curricula. How is this different from the $60 million requested for Educational Incentive for Curriculum Development and Training program? Dr. Fleming: The AAMC-CDC cooperative agreement was established in the fall of 2000 to support activities that would enhance collaborations between public heath and medicine. The AAMC represents 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teaching hospitals, including 74 Veterans Administration medical centers; 91 academic and professional societies representing nearly 88,000 faculty members; and the nation's 67,000 medical students and 102,000 residents. In response to 9/11 and the anthrax outbreaks, the AAMC, in collaboration with CDC, has developed an educational plan that is intended to ensure that in the future, the physician workforce will be prepared to respond appropriately to terrorist attacks. The plan has been designed to address the preparedness of the workforce, in both the near and distant futures, by including specific educational experiences for medical students, resident physicians and practicing physicians. In addition to establishing a faculty/staff expert liaison on terrorism preparedness in each medical school, components of the plan include: (1) changes in undergraduate mcdical education curriculum; (2) urging medical schools and teaching hospitals with residency programs to incorporate preparedness educational materials; (3) establishing a health education coalition on bioterrorism to coordinate development of educational materials among specialty societies, medical schools, public health and scientific organizations; and (4) utilizing the CDC-AAMC cooperative agreement to operationalize elements of the First Contact, First Response initiative. Specifically, regional medicine-public health education centers will be established to facilitate preparedness education activities and foster collaboration between medical schools and state/local public health agencies. Implementation of "First Contact, First Response: Ensuring Physician Readiness for Biological, Radiation and Chemical Terrorism" initiative is in its early stages. All training activities for the clinician bioterrorism preparedness area will be integrated with state preparedness work plans, the national collaborative training plan for bioterrorism and the strategic plan for public health workforce development, which are cornerstones of CDC efforts in strengthening national preparedness. Mr. Regula: What is the status to develop plans that will address how CDC and the Department will respond once the larger Federal response plan is activated by FEMA during a national emergency? Dr. Fleming: CDC has developed an agency specific emergency response plan that is reviewed and updated yearly. The plan addresses Centers, Institutes, and Offices' responsibilities for public health emergency response as described by the functional support areas of the Health and Medical Services Emergency Support Function (ESF) #8, of the Federal Response Plan. For Bioterrorism, The National Center for Infectious Diseases, through coordination of the Bioterrorism Preparedness and Response Program, is developing disease specific emergency public health response plans for each Category A biological agent of highest public health concern. Draft plans for biologic agents on the Critical Agent A list are in various stages of development at this time. CDC and DHHS keep in regular contact with FEMA and the other Federal agencies who are in charge of the three major Federal emergency response plans, the Federal Response Plan, the Federal Radiological Response Plan, and the National Contingency Plan. These plans and the related Departmental and Agency level response and operational plans are kept current and integrated through these regular interactions. In order to assure that our state and local partners have similarly comprehensive, integrated, and well implemented planning and preparedness programs, CDC has made over $900 million in emergency preparedness and response grants to all of the states and territories, and several of the major cities. These funds will be used to assure that public health emergency preparedness and response plans are in place and have been tested at all levels within the United States. Initial responses from each grantee are due back to CDC by April 15, at which time CDC will begin to review each grantee's proposed programs, plans, and concepts of operation. All of these efforts will go a long way toward ensuring that, should FEMA activate a Federal response plan, officials at all levels will be prepared and able to respond to whatever conditions may arise. Mr. Regula: How many Centers for Genomics and Public Health have been created and at what cost? What do these Centers do? What are your plans for establishing additional Centers? Dr. Fleming: CDC has awarded funding to three Schools of Public Health establishing the first "Centers for Genomics and Public Health" of a national network of Centers to bridge the widening gap between genetic discoveries and the practical use of this knowledge to reduce disease and improve the health of the public. Genomics represents the study and translation of all elements of our human genome, how genes interact with environmental factors and each other to cause disease, and how this knowledge can lead to improved health outcomes. The University of Michigan, the University of North Carolina, and the University of Washington received $300,000 for the initial year of this project, and continue to be funded for an additional two years. The Centers for Genomics and Public Health will develop a regional hub of expertise for using genetic information to improve health and prevent disease. They will build on and complement existing programs at the universities, both within and outside the schools of public health, and will create links with local and state health departments. Centers may also draw on other regional resources, such as professional organizations, the clinical community, and industry. Specific Center activities will focus on three priority areas. First, the Centers will contribute to the knowledge base on genomics and public health, focusing on chronic diseases with modifiable environmental risk factors such as diet, exercise, or exposure to chemicals. Second, they will provide technical assistance to local, state, and regional public health organizations. Third, the Centers will develop and provide training for the current and future public health work force. For instance, 1) the University of Michigan will focus on cardiovascular disease with initial topics to include family history of coronary artery disease, control of hypertension, and sudden cardiac death in young people; 2) the University of North Carolina will focus on cancer with initial topics to include family history of colorectal cancer and colorectal cancer screening tests; and 3) the University of Washington will focus on asthma and diabetes, type 1 and type 2, with initial topics to include family history of asthma and type 2 diabetes and newborn screening for susceptibility to type I diabetes. Future Centers for Genomics and Public Health could allow specialization in certain disease areas and provide a valuable resource to state and local health officials as they integrate genomics into their public health programs. COORDINATED GENETIC TESTING INFORMATION SYSTEM Mr. Regula: What is the status of the development of a Coordinated Genetic Testing Information System? Dr. Fleming: CDC has developed a draft proposal for a national Coordinated Genetic Testing Information System in response to recommendations made by the Secretary's Advisory Council on Genetic Testing. In developing this proposal, CDC engaged representatives of the Food and Drug Administration, Centers for Medicare and Medicaid Services, National Institutes of Health, Health Resources and Services Administration, and Agency for Health Care Research and Quality, to outline options and issues associated with enabling more efficient access to information on genetic testing. A draft strategy was developed and presented to HHS which focused on preventing duplication of effort, increasing coordination with non-governmental sources of information, and improving linkages across HHS for public access to "what we know and do not know about genetic testing?". CDC continues development of human genomic epidemiology data bases to fill gaps in available knowledge and stands ready to participate in development of a Coordinated Genetic Testing Information System as a key element of Department-wide efforts to improve understanding of, access to and quality of genetic testing. Mr. Regula: In 2001, a new module containing nine adult asthma history questions and two questions on child asthma were made available to States to use as part of the Behavioral Risk Factor Surveillance Survey. Eight States opted to use the module and results are expected to be available in the spring of 2002. What can you tell us about these results? Dr. Fleming: CDC is in the process of cleaning, editing, and weighting the data from this survey. CDC estimates the asthma data findings will be available for analysis before June 2002. Mr. Regula: The highest rates of suicide are among persons seventy years of age and older. What are you doing to address this problem? Dr. Fleming: Injury from suicidal behavior is a major public health problem in the United States. In 1999, suicide was the eleventh leading cause of death in this country. Each year suicide claims about 30,000 lives. In 1999, 5,489 of the total suicides were among persons aged 65 years or over and 83% of older adult suicides were males. Surveillance of elder suicidal behavior has shown us several disturbing trends. Since 1933, when the entire U.S. started uniformly reporting information on death certificates, the highest suicide rates have always been among persons aged 65 years and older. There are several contributions that CDC, working closely with States and communities, can make towards improving the understanding and prevention of suicide: Describe and track the problem of suicidal behavior among older persons. CDC is working with state and local partners to implement monitoring systems that will tell us how often suicidal behavior occurs, who is at greatest risk, and whether the problem is improving or worsening over time at national and local levels. Increase our knowledge of the causes and consequences of suicidal behavior among older persons. CDC is supporting prevention-oriented research that will lead to greater knowledge of modifiable factors associated with elder suicide and the development of new prevention strategies. Evaluate and demonstrate ways to prevent suicidal behavior among older persons. CDC is undertaking activities to determine the effectiveness of specific interventions in preventing elder suicide, to find how to combine specific interventions into effective programs, and to demonstrate the effectiveness of suicide prevention programs and policies in community settings. Communicate scientific information about elder suicide prevention. CDC is working with state and local partners to undertake educational, training, and public awareness activities to disseminate scientific information about suicide prevention to the public, policy-makers, health departments, community-based organizations and other entities. Integrate a wide array of suicide prevention and support services. CDC is working to support and establish private/public partnerships, coalitions, and networks that bring together national organizations, federal agencies, foundations, businesses, state and local health departments, community-based organizations and others in efforts to prevent elder suicide. CDC's surveillance activities include an ongoing series of surveillance summaries. The National Center for Injury Prevention and Control recently contributed to a publication entitled Surveillance for Selected Public Health Indicators Affecting Older Adults which included an examination of trends in suicide among that population. To monitor non-fatal self-directed injuries, CDC funds the National Electronic Injury Surveillance System to assess injuries in a national sample of hospital emergency departments. Research on risk factors has shown that suicidal behavior result from an interaction of multiple factors. Among older adults mental illness, social isolation, being widowed or divorced, and hopelessness contribute to suicides. CDC has supported systematic reviews of the state of the field in suicide in later life along with a series of consensus conferences that will review what is known and what is needed in the field of |