cannot be specifically planned for in the usual budget cycle. Question: What essential activities were not addressed expeditiously because funds were not available in the past year? Answer: The medical screening of Southeast Asian refugees and the health studies of residents of the Love Canal neighborhood. Question: How was the $4 million figure arrived at? Answer: It was based on the review of our experiences in such activities as Legionnaires' Disease investigations, the response to the Mount St. Helen's eruption, and the Three Mile Island emergency. We feel that had an emergency fund been available, the response coule have been even better and would have clearly been less disruptive to out on-going programs. Question: OTHER ENVIRONMENTAL HAZARDS The Carter budget asks for $4 million to establish an Environmental Health Emergency Response Fund. Do you expect to request in your budget, funds to establish an Emergency Response Fund? Answer: The Reagan Administration budget will ask for funds to provide for immediate support for a number of emergencies including, but not limited to, environmental emergencies. Question: If so, how much would you request for this purpose? Answer: The revised FY 1982 budget requests $20 million. During emergencies in the past, PHS could draw upon resources such as the PHS hospitals and health professions employed in its categorical programs. The revised budget however, proposes the elimination of direct Federal support for these resources. The current request would provide the financial resources essential to assure immediate and effective services, including direct patient care, dependent upon the nature and extent of the emergency, and the resource requirements of the local community and the State. Question: How would CDC mitigate confusion and delay which reportedly has plagued the Public Health Service's response to emerging environmental problems? Answer: The Department has made significant progress in recent months in improving internal coordination for environmental emergency planning and response through a small formal policy group under the Chairmanship of the Director of CDC, through a Memorandum of Understanding between CDC and FDA for radiologic emergency response and by improving relationships with State and local officials. Question: How would the funds be administered? Answer: The fund would be administered by the Assistant Secretary for Health. Any expenditure would require the approval of the Secretary. There would be a system of checks established to prevent use of the fund to "bail out" programs which were poorly planned, budgeted for or managed. There will also be a strict time limit for use of monies from the fund. CONSULTANTS Question: To what extent do you expect to use consultant services in the coming year? Answer: The request for consultant services in 1982 is 13.8 percent or $362,000 less than 1981. The primary use of these services will be for evaluation projects to determine what is effective and not effective in disease prevention and/or control. HEALTH EDUCATION Question: Why should the federal government continue to fund this project? Answer: Funds already obligated for FY 1981 will support completion of the current phase of the American Hospital Association patient education project. No further Federal funding is anticipated for FY 1982. IMMUNIZATION GOALS AND ACCOMPLISHMENTS Question: What are your specific goals for the coming year in the immunization program? Answer: Our major goals for vaccine-preventable diseases in 1982 are to eliminate indigenous measles by the end of the year, and to see a continued downward trend in rubella, mumps diphtheria, and tetanus--all of which reached all-time lows in 1980. Our major operational goals are to implement immunization systems in all States directed toward newborns which will prevent the development of large numbers of susceptible children and adults in the future; to ensure that the supply of childhood vaccines is obtained in a cost-effective manner; and to continue to add to our store of knowledge about the safety, efficacy, and appropriate use of existing and new vaccines. The accomplishment of these important objectives depends on the continued emphasis on immunization by the States after categorical grant support is replaced by block grants. Question: What problems do you expect to encounter in achieving these goals? Answer: We believe that the nation has the necessary tools to achieve precedent-setting reductions, and in some cases elimination, of childhood vaccine-preventable diseases. The key to success is continued commitment to the implementation of aggressive programs in all States so that disease problems in one State do not compromise the control of disease in neighboring States. The major focus of activity in 1982 will be the refinement of newborn followup systems in all States to ensure that children begin and complete immunizations on time; the elimination of persisting pockets of susceptible children in junior and senior high schools; and a coordinated, interstate effort to eliminate the spread of measles in the United States by the end of the year. Also critical to success is the maintenance of a cost-effective supply of vaccines and the responsiveness of the Federal government to the individual needs of State programs. Emphasis at the Federal level will be placed on ensuring that all federally-assisted child health programs do their part in supporting State immunization programs; elimination of disease spread from military recruits to the general public; coordination of the interstate exchange of information on measles cases and contacts; and continued surveillance and investigation of possible vaccine reactions. FLUORIDATION Question: Why should the Federal Government continue to sponsor such a program instead of it being left to the States and communities? Answer: The fluoridation of community water supplies is the most effective public health measure available for preventing dental caries. It is the only means whereby all children in an area can be reached from birth and at low cost. The cost of children's dental care in fluoridated areas can be less than onehalf the costs in fluoride-deficient areas. For every dollar spent on community water fluoridation, an estimated $50 is saved in dental treatment costs. Although there is compelling evidence of the substantial benefits to be derived from water fluoridation, many communities have not undertaken the fluoridation of their water supplies because of a lack of resources for the purchase and installation of fluoridation equipment. A Federal focus for fluoridation was established in 1979 with the initiation of the fluoridation grant program. Through the resulting cooperative effort among Federal, State, and local levels, more than 300 community water systems serving 5.2 million people have been fluoridated. HEALTH INCENTIVE GRANTS Question: The Health Incentive formula grants program, more popularly known as Section 314(d) of the Public Health Service Act, has sustained large cutbacks in recent years. What would be the effect of eliminating this program, as proposed by the Carter Administration? Answer: The States and local areas use these flexible block funds to assist in addressing a core of 60 public health problems such as: reduction of radiation exposure; control of disease outbreaks associated with unsafe water supplies; tuberculosis control and preventive health services that can reduce disease rates. Within these categories, nationwide, the funds support 4,400 local public health professionals. Some States have elected to use 314 (d) funds to support large proportions of specific programs such as tuberculosis control and public health laboratories. These grants also provide a flexible mechanism to respond to unusual events, such as outbreaks and emergency environmental hazards. It is not known what actions each individual State will take to compensate for the loss of the $27 million. In addition, the funds support 63 federal professional positions assigned to and at the request of the States. Most of the positions are assigned to Tuberculosis Control activities. the rescission all assignments will be terminated. With Question: What would you do with the remaining $9 million in fiscal year 1981, assuming Congress agrees with the $27 million rescission proposal of the Carter Administration? Answer: The $9 million distribution, as required by the statute, is based on a pro rata share of the amount received for fiscal year 1979. The 57 eligible recipients are States, Territories and the District of Columbia. ALOSH CONSTRUCTION Senator Byrd: I noted in your fiscal year 1982 budget requests that there are no funds for construction of this facility. Could you explain why? Answer: A request for $25,000,000 in funds for the construction of this facility was included in the original FY 1981 budget. In response to the economic concerns of the Nation, the Administration has placed a moratorium on all new Federal construction. Senator Byrd: What is the latest cost estimate for construction of the proposed facility? Answer: At this time the approximate cost estimate is $28,000,000 for construction of the building. SUBCOMMITTEE RECESS Senator SCHMITT. Let me thank you for your tolerance and for the information you provided the subcommittee. It is going to be very helpful in our examination of the budgetary issues before us. The subcommittee will stand in recess until 9:30 a.m. tomorrow, when we will meet again in this room to hear testimony on appropriations requests for the National Institutes of Health. [Whereupon, at 4:30 p.m., Tuesday, February 17, the subcommittee was recessed, to reconvene at 9:30 a.m., Wednesday, February 18.] DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1982 WEDNESDAY, FEBRUARY 18, 1981 U.S. SENATE, SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, Washington, D.C. The subcommittee met at 10:10 a.m., in room 1114, Everett McKinley Dirksen Senate Office Building, Hon. Harrison Schmitt (chairman) presiding. Present: Senators Schmitt, Andrews, Hollings, and Specter. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH STATEMENT OF DR. DONALD S. FREDRICKSON, DIRECTOR ACCOMPANIED BY: DR. THOMAS E. MALONE, DEPUTY DIRECTOR CALVIN B. BALDWIN, JR., ASSOCIATE DIRECTOR FOR ADMINISTRA TION NORMAN D. MANSFIELD, DIRECTOR, DIVISION OF FINANCIAL MANAGEMENT ANTHONY L. ITTEILAG, ACTING DEPUTY ASSISTANT SECRETARY, BUDGET SUBCOMMITTEE PROCEDURE Senator SCHMITT. The subcommittee will come to order, and the chairman apologizes for a mixup in schedules. Today the subcommittee begins 2 days of hearings on one of the most important programs in our labor, health, human services, and education appropriations bill, the National Institutes of Health. NIH is the Federal Government's principal program for conducting and supporting biomedical research. NIH seeks to advance the capabilities of medical science to diagnose, treat. and prevent disease. To achieve this goal, NIH supports biomedical research in institutions throughout the United States, conducts research in its own laboratories, and supports the training of promising researchers. I believe it is not too much to say that NIH is known and respected throughout the United States and throughout the world. Before going further, let me reiterate that we have set the stage for (235) |