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1 under this section is made. The amount by which any such 2 grant is so reduced shall be available for payment by the 3 Secretary of the costs incurred in furnishing the supplies, 4 equipment, or personal services on which the reduction of 5 such grant is based, but such amount shall be deemed a part 6 of the grant to such recipient and shall, for the purposes of 7 this section, be deemed to have been paid to such agency. “(k) Any grant awarded pursuant to this section shall

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9 be subject to the condition that all information obtained by 10 the personnel of the project from participants in the project 11 related to their examination, care, and treatment, shall be 12 held confidential, and shall not be divulged without the indi13 vidual's consent except as may be necessary to provide service 14 to the individual. Information may be disclosed in summary, 15 statistical, or other form or for clinical and research purposes 16 in such a way as not to identify particular individuals."

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Mr. KENNEDY, from the Committee on Labor and Public Welfare, submitted the following

REPORT

[To accompany S. 3442]

The Committee on Labor and Public Welfare, to which was referred the bill (S. 3442) to amend the Public Health Service Act to extend the authorization for grants for communicable disease control and vaccination assistance and for other purposes, having considered the same, reports favorably thereon with an amendment and recommends that the bill as amended do pass.

I. SUMMARY

TITLE I

The Committee's bill, The Communicable Disease Control and Vaccination Assistance Amendments of 1972, would authorize a five-year program of project grants to maintain a federal commitment to State and local governments for assistance in programs for 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. Communicable diseases know no geographic boundaries and the threat which they pose is needless. This Nation has the medical skill and knowledge to prevent or control illness resulting from communicable diseases.

Ninety million dollars is authorized to be appropriated for each of the next five fiscal years to enable the Secretary to make grants to States and in consultation with the State Health Authority, to agencies and political subdivisions of the States. In making these awards, the Secretary shall give consideration to the relative extent of communicable disease and vaccination problems and to the design of the public

health program to insure effective performance in preventing and controlling such diseases. Grants may be used to meet the cost of such programs, including the costs of attendant laboratory services and studies to determine program needs and the best means to meet the need. The diseases to be combatted include tuberculosis, venereal disease, rubella, measles, poliomyelitis, diphtheria, tetanus, whooping cough, and RH disease.

Because of the serious need for greater public awareness regarding communicable diseases and programs available to treat them, the bill also provides for a new authorization of $5 million a year for the next five fiscal years for such purposes.

Title I of S. 3442 also increases for the next fiscal year levels of authorization for section 314 (e) and section 1001 (c) of the Public Health Service Act as requested by the Administration.

A new provision limits funding for such communicable disease programs as authorized under this bill to the legislative authorities encompassed by the bill, namely sections 317 and 318 of the Public Health Service Act. This provision emphasizes the need for a categorical authority to develop long-term planning and a national commitment to focus on programs to combat and prevent communicable diseases.

TITLE II

Title II of S. 3442 creates a new section 318 of the Public Health Service Act to provide a specially targeted program for venereal disease prevention, control, diagnosis, and treatment.

This title reflects the increasing concern that intervention is imperative to meet a venereal disease crisis, currently reaching epidemic proportions. To meet the health care crisis represented by the widespread threat of venereal disease, Title II of S. 3442 amends the Public Health Service Act to create a new section 318 by authorizing a three-year program for research, training and public health programs in the prevention and control of venereal disease. For research, training and public health projects relating to the prevention and control of venereal disease, $15 million is authorized for each of the next three fiscal years.

To meet the needs for effective diagnosis and treatment of venereal disease, $30 million is authorized for each of the next three fiscal years. $30 million for project grants to states and cities to conduct defined comprehensive prevention and control programs is also provided for each of the next three succeeding fiscal years.

II. HEARINGS

The need for the extension of the authority contained in section 317 of the Public Health Service Act in respect to communicable diseases and the need for a special authority in respect to venereal disease control was supported by testimony from James R. Kimmey, M.D., of the American Public Health Association; Samuel L. Katz, M.D., of the American Academy of Pediatrics; Bruce Webster, M.D., and John Hume, M.D., of the American Social Health Association; Leo Reichman, M.D., of the New York City Department of Health; William Schaffner, M.D., of the Action Committee for Child

hood Immunization; Robert J. Anderson, M.D., of the National Tuberculosis and Respiratory Disease Association; and Mack I. Shanholtz, M.D., of the Virginia Department of Health. The Administration recommended against the enactment of both titles I and II of the Committee's bill.

III. BACKGROUND

The impact of communicable disease control on our nation's history is perhaps nowhere better defined than in the conquest of poliomyelitis. A generation of young Americans now exist to which the term, "infantile paralysis," is essentially meaningless; yet less than two decades ago the annual arrival of summer brought to America's parents a sombre fear of the predictable epidemics of polio about to begin.

Only slightly less dramatic have been the changes wrought by controlling tuberculosis, diphtheria, and measles, and by preventing the devastating late sequelae of syphilis.

As a result of communicable disease control activities, communicable diseases have long since given way to chronic degenerative diseases as major causes of death in the United States. However, the efforts to control communicable diseases in this country have also brought with them repeated lessons in the harsh reality that without persisting vigilance, communicable disease control is a sometime thing. In the late 50's following curtailment of assistance provided under the Poliomyelitis Vaccination Assistance Act of 1955 (extended through 1957) epidemics appeared in Providence, Chicago, and Detroit, taking a needless toll among the urban poor. A special appropriation of one million dollars in May 1960 was necessary to provide oral polio vaccine for purposes of controlling epidemics. The apparent need to continue support for polio prevention led to passage of the Vaccination Assistance Act of 1962 which provided funds to combat poliomyelitis, whooping cought, diphtheria, tetanus and when an effective vaccine became available, measles. The subsequent years constituted a "Golden Age" of gains against diseases preventable by immunization. But on June 30, 1968 the Vaccination Assistance Act expired and funds appropriated under that legislation were exhausted in 1969. The incidence of measles resurged briskly in 1969 and 70 and in 1971 reached the highest level of incidence recorded since widespread use of measles vaccine began. Significant increases were also seen in the incidence of diphtheria and poliomyelitis. The epidemiological pattern of resurgence in all these diseases was remarkably similar to the earlier experience with poliomyelitis, to wit, the occurrence of outbreaks among the urban and rural poor who had not been afforded the protection of vaccination.

The history of syphilis control activities confirms the need for viewing communicable disease control as a long term commitment. Following World War II syphilis incidence fell sharply under the combined influences of the introduction of penicillin, and the availability of federal budget support for State and local V.D. control projects. With syphilis at an all time low level, close to elimination, federal support was sharply reduced from 1952 to 1955. In 1957, syphilis began to briskly resurge and increased steadily until 1965. Increased federal support for syphilis control activities, following the report of the Surgeon General's Task Force on the Eradication of Syphilis in 1961,

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