Webster, Bruce, M.D., Cornell University School of Medicine, and John Hume, M.D., School of Public Health, Johns Hopkins University, on Articles, publications, etc.: Measles (Rubeola) occurrence and Federal assistance for immuniza- Report of the National Commission on Venereal Disease to the Assist- ant Secretary for Health and Scientific Affairs, Department of Davis, Hilton, legislative action general manager, Chamber of 194 Parish, Ned F., president, National Association of Blue Shield 193 Reichman, Lee B., M.D., MPH, director, Bureau of Tuberculosis, Illustration: Blue Cross/Blue Shield Public Affairs Commercial__ Bureau of Community Environmental Management Lead-Based Paint_ Funding of immunization and tuberculosis programs by authority.. Questions submitted by Senator Edward M. Kennedy to Lee B. Reich- man, M.D., MPH, director, Bureau of Tuberculosis, New York City APPENDICES COMMUNICABLE DISEASE CONTROL AMENDMENTS ACT OF 1972 MONDAY, APRIL 10, 1972 U.S. SENATE, SUBCOMMITTEE ON HEALTH, COMMITTEE ON LABOR AND PUBLIC WELFARE, Washington, D.C. The subcommittee met, pursuant to notice, at 9:40 a.m., in room 4232, New Senate Office Building, Senator Edward M. Kennedy (chairman of the subcommittee) presiding. Present: Senators Kennedy, Eagleton, Hughes, Schweiker, Javits, and Dominick. Staff members present: LeRoy G. Goldman, professional staff member; and Jay B. Cutler, minority counsel. Senator KENNEDY. The subcommittee will come to order. Today, the Senate Subcommittee on Health holds hearings on legislative proposals which concern the prevention and control of communicable diseases. Such diseases affect millions of Americans each year and especially present a serious threat to the health of the Nation's children, a most vulnerable population. As chairman of the Health Subcommittee, I am most concerned that the Nation's health care system respond to the health care needs of all Americans in the most effective and efficient means possible. The efforts to prevent and control communicable diseases reflect the strengths and weaknesses of our present health care system. Communicable diseases were the leading causes of death at the turn of the century. In 1900, influenza, tuberculosis, and gastritis accounted for nearly a third of all deaths. However, outstanding medical research achievements have today dramatically reduced the mortality rates for infectious diseases. Many effective vaccines have been developed which could eradicate several of our common communicable diseases. Effective drugs are now available to treat the acute infections and thereby prevent serious medical complications. We have the means available and yet there are serious gaps in the application of such effective remedies to eradicate many communicable diseases. We are currently committing significant Federal support to scientific research for effective means to prevent and control heart disease, cancer, and stroke, the three leading causes of death in America today. Yet such effective approaches are available for many communicable diseases. It is imperative that the Federal Government play a leadership role in implementing the research tools available. Unfortunately, there often has not been a consistent and coordinated plan to control communicable diseases. Inadequacies in health care delivery have resulted in unnecessary infections with needless human suffering and economic loss. (1) The cases reported for venereal diseases represent alarming increases which this Nation has not faced since the post-World War II period. Gonorrhea and syphilis are clearly approaching epidemic proportions and there is no indication that the present escalating trend will be abated in the near future. Gonorrhea is the most prevalent reportable communicable disease in the Nation. In 1971, 624,000 cases were reported. If unreported cases were included, cases would total more than 2,500,000! In the past 4 years gonorrhea has increased on the average of 15 to 16 percent per year. Some cities have had nearly 50-percent increases in the past year. Of special concern are the estimated 800,000 women with asymptomatic cases of gonorrhea who constitute a silent reservoir of infection. Prenatal clinic exams have shown one out of 12 pregnant women infected with gonorrhea who were unaware of the infection. Serious complications can result to the newborn of an infected mother (such as severe eye infections). Up to 10 percent of women infected may develop severe infections which can cause infertility and may warrant abdominal surgery. Syphilis with declining rates of infection for 4 consecutive years (1965-69) rose 8.1 percent in 1970 and 8.9 percent in 1971. Reported cases for 1971 were 23,000 with estimates of more than 95,000 if unreported cases are included. Without prompt diagnosis and treatment, severe medical disabilities may develop years after the initial infection. Syphilis can cause blindness, paralysis and insanity. Institutional care for the syphilitic insane amounts to more than $40 million per year. As a cosponsor of Senate bill 3187 which was introduced by Senator Javits for prevention and control of venereal disease, I believe the Federal Government must respond to this health crisis. There must be a Federal commitment to launch a national campaign in cooperation with State and local agencies, public and private, to develop better programs to detect and treat infected individuals and educate the public to recognize the disease and seek treatment. The upward spiral must be halted if we are to prevent serious medical problems caused by these diseases. Basic research must also be supported to find more effective means of prevention. Despite tremendous strides in vaccination and immunization programs there continue to be serious gaps in levels of immunization for the Nation's children. In 1964 87.6 percent of children between the ages of 1 and 4 were immunized against polio; 1971 levels are 67.3 percent. Comparable immunization levels in 1971 include: measles, 61.4 percent; rubella, 51.2 percent and diphtheria-pertussis-tetanus, 78.7 percent. Overall these figures indicate an increase from 1970 levels, but still they demonstrate a serious lack of protection for many children. Furthermore, comparable levels are lower for the inner city and economically disadvantaged children. Because of inadequate immunization, reported cases of such diseases continue. There were 75,000 cases of measles reported in 1971 in contrast to 47,000 for 1970. The reported cases of rubella have decreased from 56,500 cases in 1970 to 44,000 cases in 1971. Vigorous immunization programs have significantly reduced the impact of these diseases because of available vaccines, but a concerted effort must continue to immunize all children. Each disease may cause serious medical complications, and it is foolish to gamble with a child's health when vaccines are effective for prevention. The paralysis of polio is well known. Measles may cause encephalitis and mental retardation. Rubella in the 1964-65 epidemic resulted in 20,000 brain damaged children with estimated costs of rehabilitation put at more $2 billion. Diphtheria which continues to occur in sporadic outbreaks can result in heart and brain damage and death by suffocation. Mortality rates for tetanus are as high as 70 percent. Whooping cough may readily cause death especially to the child under 1 year of age and also can produce convulsions, brain damage, and chronic lung disease. With an effective immunization available for the susceptible woman one must also include the effects of Rh incompatibility on the unborn baby; namely, death before birth, or serious jaundice with the possibility of severe brain damage after birth. In the health area generally we still have few measures which can produce primary prevention of disease. Yet such tools are available for several communicable diseases. Effective vaccines are available to eradicate many infections which wreak such havoc on children. There must be a Federal commitment to universal immunization for all children. If we can eradicate smallpox, we can also eradicate such diseases as polio, measles, and rubella. Support must not falter for such programs. Tuberculosis which had continued to decline significantly now appears to be declining less rapidly and may actually be increasing in the inner city population. Decreased funding for tuberculosis programs contributes to such a result. I have introduced Senate bill 3442 which extends legislative authority for communicable diseases prevention and control under section 317 of the Public Health Service Act. This legislation is essential to mandate a concerted attack on a broad spectrum of communicable diseases. This legislation will increase the effort for coordinated plans and programs to prevent and control communicable diseases by research, immunization, treatment, and public education. In 1962, when President Kennedy first proposed a vaccination assistance program in a special message to Congress, he said: "There is no longer any reason why American children should suffer from polio, diphtheria, whooping cough, or tetanus diseases which can cause death or serious consequences throughout a lifetime, which can be prevented, but which still prevail in too many cases." Our national communicable disease programs have in many instances significantly reduced the toll these diseases exact in human and economic terms. Yet much more needs to be done. These hearings shall provide the impetus for continued congressional commitment to communicable disease prevention and control. Our goal must be (1) universal immunization of children to eradicate those communicable diseases for which vaccines are available; (2) expanded program support to halt the cycle of infection for such diseases as tuberculosis, gonorrhea, and syphilis; (3) continued basic research to develop new vacines and other effective treatment; and (4) program support for public education. I am committed to such a goal. (A copy of the bills S. 3442 and S. 3187 follow :) 92D CONGRESS 2D SESSION S. 3442 IN THE SENATE OF THE UNITED STATES MARCH 29, 1972 Mr. KENNEDY (for himself, Mr. CRANSTON, Mr. EAGLETON, Mr. HUGHES, Mr. JAVITS, Mr. MONDALE, Mr. PELL, Mr. RANDOLPH, Mr. SCHWEIKER, Mr. STEVENSON, and Mr. WILLIAMS) introduced the following bill; which was read twice and referred to the Committee on Labor and Public Welfare A BILL To amend the Public Health Service Act to extend the author 1 ization for grants for communicable disease control and vaccination assistance and for other purposes. Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 3 That this Act may be cited as the "Communicable Disease 4 Control Amendments Act of 1972". 5 SEC. 2. (a) Section 317 (a) of the Public Health Serv6 ice Act is amended to read as follows: "There are authorized 7 to be appropriated $90,000,000 for the fiscal year ending 8 June 30, 1972; $90,000,000 for the fiscal year ending June 9 30, 1973, and each of the next four succeeding fiscal years II |