To implement the professional education program, there must be developed teaching aids-film strips, movies, exhibits, manuals, and an assortment of other literature at professional levels. This calls for extension of the work the Federal Public Health Service is now doing, together with increased responsibility and activity by State and local health departments. Involvement of the schools will require strong leadership, and local parents, teachers, and health officials must take the initiative to provide educational resources and support for local educational institutions.

The second part of the educational effort must concern itself with the public. It will require energetic use of the mass media. Its character and function will be promotional, and it will require the support of high-level leadership, both national and local. It will require a staff of qualified experts in media presentation.

The Task Force believes that if personnel can be secured and developed to the required level by 1963, and if a comprehensive, dynamic, promotional education program is developed, the epidemic spread of syphilis in this country can be stopped within ten years.

The Task Force believes that present research should be continued and, where results are promising, expanded. It is particularly impressed with the need for further research in the area of human sex behavior. Efforts by the American Social Health Association in Los Angeles, St. Louis, and New York City constitute pilot exploration in the area of teenage sex behavior. The American Social Health Association and the Public Health Service, as a result of these pilot studies, are now in a position to launch a significant study of adolescent and young-adult sex behavior directed toward the establishment of criteria for control of the venereal diseases and for approaching the problems of sex delinquency, unwed motherhood, and the attitudes of youth toward the society in which it is expected to grow and become effective.

The Task Force has restricted its recommendations to action programs and their continuing evaluation. This is in keeping with the charge of the Surgeon General which was to recommend a program to “eradicate syphilis as a public health problem." This we consider to be achieveable through accelerated and intensified programs developed through improved use of existing facilities in this country and with present experience and knowledge. However, world-wide eradication is, we think, a proper goal for the World Health Organization and should be a theme for international planning. Without it, no State or nation can remain secure in its efforts to control syphilis.

NEED FOR ALERTNESS ON THE PART OF THE PEOPLE

Senator HILL. This is not your business, the business of the Public Health Service, but I would think one of our able writers could write an awfully good article on this task force to get the facts to the American people. What we need is an alertness on the part of the people so they will support their local units, support the doctors, and support the U.S. Public Health Service, too.

Now, the task force finds that in 10 years, if we go forward with its recommendations, we can eradicate syphilis?

Dr. BROWN. We can eradicate syphilis as a public health problem. Senator HILL. That means that all of the bad, evil effects of syphilis, such as paresis and other effects?

Dr. BROWN. It would mean no more cases would be developing to add to the present reservoir.

PRESENT STATUS OF SYPHILITIC CASES

Senator HILL. When you speak about a reservoir, have you any figures as to what that reservoir might be today?

Dr. BROWN. Well, there are, sir, 28,000 individuals confined to mental hospitals today with psychoses due to syphilis. There are, by the best estimate, 1,200,000 people who should have treatment for syphilis that are not known about today.

Senator HILL. We just had in Washington, as you know, a National Conference on Mental Health, mental illness. I hope this story was told in that conference. It is certainly a challenging one.

Now, would you proceed with the rest of your statement, about gonorrhea.

RESEARCH, TRAINING, AND TECHNICAL SERVICES

Dr. BROWN. The next item is "Research, training, and technical services." No other increases are requested in this budget.

Venereal disease research is progressing in two fundamental areas: (1) basic research on the problems of producing syphilis immunity artificially, and (2) research on practical and effective diagnostic and screening tools for gonorrhea.

In the area of syphilis immunity, we are slowly accumulating information on antigen-antibody patterns, on the protein fractions of the spirochete itself, and on the nature of immune response in man and animals. But at present we do not foresee any major breakthrough which would permit optimistic forecasts on the development of an antisyphilis vaccine in the immediate future.

WORLD FORUM ON VENEREAL DISEASES

It is hoped that the World Forum on Syphilis and Other Treponematoses, sponsored by the Public Health Service and other interested agencies, in Washington next September will provide additional information on and an impetus to the search for a vaccine.

TREATMENT OF GONORRHEA

In gonorrhea, however, although field trials of the use of fluorescent antibody techniques in gonorrhea diagnosis are still going on, we feel that the fluorescent antibody technique will provide a practical solution to the problems of diagnosis which have plagued control efforts for years. Syphilis eradication must now receive a major portion of our attention and resources, but there is real hope that we can now anticipate, for the years to come, real progress against gonorrhea as well.

Mr. Chairman, I shall be glad to answer any questions you may have about this program and the budget request.

Senator HILL. How does gonorrhea respond insofar as antibiotics are concerned?

Dr. BROWN. Penicillin is still the drug of choice in the treatment of gonorrhea and although there are some strains of gonococcus which show increasing resistance to penicillin, if the dosage is high enough, penicillin still will cure gonorrhea.

ACTIVITIES OF STATES

Senator HILL. Doctor, are not most of the States making provision to carry on this fight against syphilis today? What are they doing? Dr. BROWN. Their contribution, Mr. Chairman, continues. A few States have been able to increase their appropriations at State or local levels and they are bringing this to the attention of their legislatures. In this program of eradication, they will participate by providing treatment for these additional numbers which will be brought to their clinics and by participating in contacts with medical societies, working with them, and in getting the full cooperation of private medicine.

APPROPRIATIONS OF FUNDS BY STATES

Senator HILL. You could not tell us offhand, I guess, how much the 50 States are appropriating today in this fight to eliminate venereal disease?

Dr. BROWN. In the neighborhood of $16 million.

Senator HILL. $16 million?

Dr. BROWN. Yes, sir.

Senator HILL. This is the amount today for all the 50 States.
Dr. BROWN. Yes, sir.

Senator HILL. What would be the highest amount spent by any State?

Dr. BROWN. By any one State?

Senator HILL. Yes; by any one State.

Dr. BROWN. I do not have that figure.

Senator HILL. You can get that; is that right?

Dr. BROWN. Yes.

Senator HILL. I can realize why you would not have it this morning. Dr. BROWN. I will supply it for the record.

Senator HILL. Supply that for the record and also supply the smallest amount; and if any States are not making any contributions to this fight against venereal disease, give us that information also; will you not?

Dr. BROWN. Yes, sir.

Senator HILL. In other words, give us pictures as to what the States are doing at this time.

(The information referred to follows:)

State and local funds budgeted for venereal disease control, fiscal year 1961, as reported to U.S. Public Health Service

Senator HILL. When did this report come out?

Dr. BROWN. This task force report came out about the end of December, the 29th of December.

Senator HILL. That means that really they have not had much time

to step up their programs, have they?

Dr. BROWN. No, sir. I presume you are referring to the States? Senator HILL. That is just a little over 2 months' time. Perhaps too many of the legislatures have not met.

ALLERGY TO PENICILLIN

Now you spoke about penicillin as a treatment for syphilis. Some people are allergic to penicillin, are they not?

Dr. BROWN. Yes, sir.

Senator HILL. Are many of them allergic?

Dr. BROWN. I am not in a position to give you the percentage, but there are a number that are sensitive to penicillin and when this occurs our other antibiotics can be used for treatment.

Senator HILL. Although penicillin is the drug that has proved, over a period of time, to be best for this use?

Dr. BROWN. Penicillin is the drug of choice for this treatment. Senator HILL. Is there anything you would like to add, Dr. Terry? Dr. TERRY. I have nothing except I would like to mention, in relation to the timing of this report, and our budget, that obviously we did not have any opportunity to adapt our budgetary proposal to the report. This matter is under consideration at the moment in the Department in terms of the hope of making some adjustments which would be in keeping with this report and, if I may, I would like to ask Mr. Kelly to make a remark or two along that line. Senator HILL. All right, Mr. Kelly.

REPORT RECEIVED SUBSEQUENT TO BUDGET DEVELOPMENT

Mr. KELLY. Mr. Chairman, the Secretary, when he was testifying before the House, had an inquiry with respect to this report and indicated that it had been received subsequent to the final development of the 1963 budget and he further indicated that he would like to have it reexamined in the light of this report. He asked the Surgeon General for an estimate of how much the first year cost would be associated with this program of eradication and the Surgeon General has provided the figure of $3.1 million, which is $2.1 million more than is in the budget. This is now under consideration in the executive branch; and while I think there is a real probability that the budget amendment will be forthcoming, it probably will not be forthcoming within the next week or 10 days.

Senator HILL. Do you think maybe it will get here before we finally act on this bill in committee?

Mr. KELLY. I would think so, when you consider you will not be able to act on the bill until after the House has completed its action.

Senator HILL. All right. It seems to me that Dr. Brown and you gentlemen have made out a very strong case here on what is relatively a small amount of money.

Is there anything else that any of you gentlemen would like to add? Doctor, we certainly want to thank you. I said yesterday the witnesses from the Public Health Service have set a very high standard in their testimony and you certainly measured up to theirs in every way.

We appreciate your statement very much.

Dr. BROWN. Thank you very much, Mr. Chairman.