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 Iowa. 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 w focus primarily on only a few.

Childhood Immunization Program

This subcommittee is well aware of this preeminent preventive health program for infarts 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 is 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 ther 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 menings 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 supplementai next spring.

The Academy request includes the following increases over the President's

recommendation: $5.8 million for HiB, $24 million for the second MMR, and $15 million for the first year of a three-five year phase in for Hepatitis B; $30 million additional for CDC infrastructure to support the outreach and demonstration needs; and, finally, $4 million for the vaccine stockpile. The Academy recommendation for the entire Childhood Immunization Program is $336.8 million.

National Vaccine Program Office

We still have goals we have not reached in the quest to wipe out vaccine-preventable diseases. The National Vaccine Program Office and other related programs are a part of our overall strategy to achieve these goals. The Academy recommends $15 million.

Infant Mortality Initiative

While the recent announcements regarding the decrease in the infant mortality rate are encouraging, it is still unacceptably high. The Academy commends the President and Secretary Sullivan for choosing to increase federal efforts to reduce infant mortality in this country. There are many areas, both urban and rural, where infant mortality is unacceptably high. The announced initiative is to examine social and other non-financial barriers preventing pregnant women from receiving prenatal care, to develop target treatment programs, and to link existing programs. Existing studies and reports could be utilized which would eliminate the cost of further examination of the barriers; some of these also outline successful treatment programs. We do agree that reinforcing the linkages among various federal programs (i.e., Medicaid and the Maternal and Child Health Block Grant) could be helpful. However, the proposed budget would fund this initiative through a combination of reprogramming monies from existing programs and new money. The Academy urges this subcommittee to not support the reprogramming concept -- taking money from the Maternal and Child Health Block Grant does not solve the infant mortality problem since much of what this program does is to ensure such needed services. Maternal and Child Health Block Grant

This program is designed to assure mothers, infants, children, and adolescents access to quality health care that reduces infant mortality and morbidity, helps children with special needs, ameliorates chronic illnesses, and encourages healthy lifestyles. Through cooperation with other federal programs limited resources can be used effectively to reduce duplication and fragmentation of services. The Academy recommends this program be funded at its full authorization level of $686 million.

The remainder of our testimony consists of a listing of all the programs of concern to the Academy with our recommendations. The Academy joins with its many friends in other organizations and coalitions in presenting these recommendations.

Senator HARKIN. Thank you very much, Doctor. Let me get this straightened out here. The Childhood Immunization Program-the President's request is $257 million. You are requesting $336.8 million, 31 percent over. And you say that is necessary to respond to the increased outbreaks of measles, and what, rubella?

Dr. WALLACE. Mumps. And, of course, we have increased our needs for the second MMR. We also are increasing our needs for HIB vaccine. We had an unfortunate and fortunate example with young Caitland this morning, who is deaf from the haemophilus influenza B meningitis she suffered as an infant. If we had given her the vaccine, she almost assuredly would not have had that meningitis.

Senator HARKIN. How early can you give that vaccine?

Dr. WALLACE. We can now give it at 2 months. And part of the problem is that the old vaccine we have been using for the last 3 or 4 years, we could give only at 5 months of age. We have a new one that we can give at 2 months, 4 months, 6 months and 15 months, which immunizes the very susceptible first year of life, that is when most of the cases of meningitis occur. Obviously this is a four-shot series instead of a one-shot series. It costs a lot more. Senator HARKIN. What does that series cost? Do you know what that series costs?