11

1 ing of such supplies or equipment, or the detail of such officer

2

or employce (as the case may be), is for the convenience of 3 and at the request of such recipient and for the purpose of 4 carrying out the program with respect to which the grant

5 under this section is made. The amount by which any such

6

grant is so reduced shall be available for payment by the 7 Secretary of the costs incurred in furnishing the supplies, 8 equipment, or personal services on which the reduction of 9 such grant is based, but such amount shall be deemed a part 10 of the grant to such recipient and shall, for the purposes of 11 this section, be deemed to have been paid to such agency." (b) Section 314 (d) (2) of the Public Health Service

12

13 Act is amended

(1) by striking out ", and" at the end of clause

(K) and inserting in lieu thereof ";";

(2) by striking out the period at the end of clause (L) and inserting in lieu of such period "; and"; and (3) adding after clause (L) the following new clause:

"(M) effective July 1, 1973, provide for services

for the prevention and control of venereal disease.".

Senator DOMINICK. At this point we will receive for the record a statement from Senator Hart of Michigan.

PREPARED STATEMENT OF HON. PHILIP A. HART, A U.S. SENATOR FROM THE STATE OF MICHIGAN

Senator HART. Mr. Chairman, it isn't often we have a chance to testify in favor of a program that has proved as successful as the Federal Vaccination Assistance Act.

Between 1966 and 1968 the number of reported measles cases nationally dropped from 204,136 to 22,231. Over that span, the percent of children under four susceptible to measles dropped from 41 percent to less than 34 percent.

Victory over measles was in sight.

Unhappily, in 1968 the Department of Health, Education, and Welfare changed the administration of this program.

Since then, the number of reported cases jumped to 69,948 for the first 9 months of 1971 alone; the susceptible percentage rose to 38 percent.

These figures were reported to me by the U.S. Center for Disease Control in Atlanta, Ga. I ask that the data from the Center be included in the record.

As has been explained to your subcommittee by medical personnel more knowledgeable in this area than I, the change was the result of debates within the administration over whether money allocated categorically through this program, as done before 1968, would work as effectively as funds allocated under the block-grant approach of the partnership for health program, as done since 1968.

There should be no further doubt of the more effective method. The record is clear that disease rates were greatly reduced during the 6 years successful experience of categorical funding from the Vaccination Assistance Act. Partnership funding has been given an adequate 3-year trial and has not shown any successes in this health area. Disease rates have gone up, the number of unimmunized children has increased, epidemics in diphtheria and measles have been numerous and venereal disease is rampant throughout the country.

Four years ago there were 5 million unimmunized children against measles. Now there are 13 million measles-susceptible children. In 1968, 260 persons developed diphtheria while in 1970 it attacked 435 persons. Gonorrhea rose from 464,543 in 1968 to 600,072 in 1970, and syphilis is on the increase at the rate of 12 percent per year.

There are no grounds to continue the argument in favor of partnership funding to States in these categories, since disease knows no geographical boundaries. In this very mobile Nation, the preventable infectious diseases of children, tuberculosis and venereal disease demand a national responsibility.

Evidently what has happened under the block-grant approach is that as the number of reported cases of the various communicable

diseases decreased, other demands for partnership in health funds gained precedent at local and State levels. But again, the only way to prevent the spread of communicable diseases, particularly in a nation with a mobile population, is to continue high levels of immunization regardless of how few cases of a particular disease may be reported in a particular area.

It is obvious from experience that no matter how necessary local decision-making may be for certain medical problems, the prevention of communicable diseases among a mobile population should be attacked on a national basis.

Even more importantly, experience has shown that if money is made available for vaccination programs, the vaccinations reach the children.

I hope the administration will change its decision to appose extension of the Federal Vaccination Assistance Act.

Let us not retreat from the brink of victory against measles, and let us mount as an effective drive against other communicable diseases. I urge the subcommittee to report favorably S. 3442.

And I will support the administration's budget request for $179 million for the Partnership program, but I feel strongly that Congress should provide an additional $90 million for the categorical vaccination programs.

Thank you.

STATEMENT ON MEASLES (RUBELLA) OCCURRENCE AND FEDERAL ASSISTANCE FOR IMMUNIZATION PROGRAMS

Table I indicates the population, the number of children who received measles (rubella) vaccine, the number of children contracting measles, and the remaining percent susceptible to measles by age group in the United States, 1966 through 1970. In the age group 1-4, the remaining percent susceptible was 41.0 in 1966. This was reduced to 33.1 percent in 1969. However, in 1970 the percent susceptible increased to 37.7. Data for 1971 are not yet available. When these data are available, it is expected that the 1-4 year age group will show a further increase of children unprotected against measles.

Table II includes the number of doses of measles vaccine provided by Vaccination Assistance Act grant funds and used by States and communities in fiscal years 1966 through 1969. Use of vaccine under this authority was restricted to the preschool population. During fiscal years 1966 through 1969 more than 50 percent of preschool children immunized against measles received vaccine from Federal project grant resources. Table II indicates the Authorization, Executive Branch Requests, Appropriations, and Allocations of Funds for immunization programs for fiscal years 1966 through 1972. From July 1, 1969 to April 27, 1971, Federal grant assistance to States and communities was restricted to the control of rubella under Section 314(e) of the Partnership for Health legislation. However, at that time, concern about the resurgence of measles and the decreasing immunization levels resulted in a decision by the Department of Health, Education, and Welfare to permit the expenditure of $4.8 million of 314(e) grant funds for measles vaccine.

Table III shows reported cases of measles in the United States for the period 1966 through September 25, 1971. Based on data from investigation of measles epidemics and other surveillance activities, the incidence of measles far exceeds the number of reported cases.

The decision to assist States and communities by providing measles vaccine from existing grant resources should have a significant impact on checking the measles upward trend in the United States.

TABLE 1.-NUMBER AND PERCENT WITH HISTORY OF MEASLES (RUBELLA) VACCINE, PERCENT WITH HISTORY OF MEASLES VACCINE AND/OR INFECTION, AND PERCENT SUSCEPTIBLE, UNITED STATES, 1966-70

TABLE II-HISTORY OF IMMUNIZATION PROGRAM'S GRANT BUDGET BY AUTHORIZATION AND FISCAL YEAR

TABLE III-REPORTED CASES OF MEASLES (RUBELLA) IN THE UNITED STATES, JAN. 1, 1965-SEPT. 25, 1971

Senator DOMINICK. Our next witness is James R. Kimmey, M.D., executive director of the American Public Health Association.

STATEMENT OF JAMES R. KIMMEY, M.D., EXECUTIVE DIRECTOR, AMERICAN PUBLIC HEALTH ASSOCIATION

Dr. KIMMEY. I would like to make a couple of comments for the record rather than read my statement.

Senator DOMINICK. Proceed as you wish.

Dr. KIMMEY. The American Public Health Association is the largest national organization of public health workers with professional and consumer members. We number some 50,000 members now in our 50 State affiliates and our national organization. We have had a longstanding concern with the prevention of disease, and particularly communicable diseases and venereal diseases. We feel it is the area that is probably one of the greatest success stories in public health in the country.

Much, however, remains to be done. We look at the statistics on immunization levels and on venereal disease, and it seems strange that for the want of relatively small investment financially that these areas, which have a great cost-benefit ratio, are not receiving more attention than they are.

Rather than go into any details on the statistics on these conditions which other witnesses are going to present, I would only say that the American Public Health Association was a participant in the National Commission on Venereal Disease and in the preparation of a report, both of which will be placed before the committee by a later witness.

We agree with the recommendations of these reports. We support the extension of the VD control authority and communicable disease authority as proposed in the bills before the committee today.

At the same time, we find ourselves at least partially in agreement with Dr. DuVal when he says that a comprehensive funding authority is most effective in dealing with the emerging problems. It may seem inconsistent on our part to be supporting a categorical grant program and also holding out for comprehensiveness.

However, we have supported the comprehensive health planning and comprehensive health services programs since their inception in 1966. We feel the problems that have followed and the difficulties in dealing with categorical grants like venereal disease and immunization are not the failure of the comprehensive concept but rather the failure of providing adequate funds for this legislation.

In fiscal 1966 when the programs started, each program had approximately $90 million. We have heard a witness from the administration say this morning they are requesting something on the order of $150 million to $160 million this year. This would have been much more appropriate about 1969 or 1970. It is totally inadequate for today's needs.

Although it would be valuable to handle problems like venereal disease through a 314(e) mechanism, it is too late to catch up this year. We do favor, therefore, extension of the specific authorities, but we should keep in mind that we are now discussing issues like na