PRINCIPAL RECOMMENDATIONS

This section sets forth, in brief form, what are considered to be the major recommendations by the Commission.

For

a more detailed exposition of these and other recommendations, please refer to the following section, Recommendations and Comments.

THE NATIONAL COMMISSION ON VENEREAL DISEASE RECOMMENDS THAT:

(1)

(2)

(3)

an enlarged nucleus of capable scientists, both
inside and outside the Department of Health,
Education, and Welfare be recruited for active
engagement in venereal disease research;

studies be vigorously pursued for the development of vaccines for syphilis and gonorrhea, it being fully realized that few infectious diseases have been brought under effective control without suitable vaccines;

studies be pursued for the development of safe and effective topical or systemic prophylaxis for venereal diseases;

(4)

detailed studies of the microbiology and immunology of uncomplicated gonorrhea, complications of gonorrhea and the pathogenesis of gonococcal infection be intensified;

(5) investigations designed to improve diagnostic methods, including both immunological procedures and culture be more vigorously prosecuted;

(6) research into the effectiveness of current control programs be undertaken;

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7

(7)

a group of investigators with expertise in
sexually transmitted diseases other than
syphilis and gonorrhea be developed and an
appropriate unit with responsibilities for
these diseases be established at the Center
for Disease Control;

(8)

(9)

the Federal Government increase its support for
the study of human behavior and its relationship
to the venereal diseases including attitudes toward
education and prophylaxis as well as studies to
determine to what extent present methods of venereal
disease case reporting and contact tracing may de-
ter patients from seeking treatment and discourage
physicians from cooperating;

an advisory council on venereal diseases with appropriate governmental and nongovernmental membership be established to make recommendations to the Assistant Secretary for Health and Scientific Affairs of the Department of Health, Education, and Welfare for the implementation of the research and control programs designed to reduce the incidence of the venereal diseases;

(10)

(11)

(12)

strenuous efforts be made to reinstitute the teaching
of venereology in medical schools and that this teach-
ing be subsidized in each school by a federal grant
of $20,000-30,000 per year;

schools of public health be urged to include subject
matter relating to venereal diseases and their con-
trol and that a faculty position be supported in whole
or in part by a federal grant in the amount of $20,000-
30,000 per year;

education about the venereal diseases be introduced in the curriculum of public, parochial and private schools no later than in the seventh grade as a part of a basic education in health sciences;

(13)

the Federal Government initiate and support a
program of public education and information about
the venereal diseases similar to that of the
National Clearinghouse on Smoking and Health;

(14) the Federal Government make changes in existing
laws and regulations which (a) would authorize, as
under Public Law 91-623, the Department of Health,
Education, and Welfare to assign commissioned
officers to State and local areas for venereal
disease control activities; (b) require that all
health care facilities, which provide general
medical services or more limited health care
services, make available diagnostic testing for
the venereal diseases and treatment for these
diseases to those patients found to be infected
if the programs are to be considered eligible
for federal sponsorship; and (c) require that,
in order to be eligible for federal support,
facilities or programs which provide treatment
for venereal disease patients use adequate
treatment schedules which have been demonstra-
ted to be economical, safe and effective;

(15)

federal, State and local governments make a
strenuous effort to improve the organization and
management of venereal disease clinics, to up-
grade the quality of care rendered in these clinics
and to provide facilities which allow a maintenance
of reasonable standards of privacy and dignity for
patients;

(16) medical specialty groups establish standing

(17)

committees on the venereal diseases with mechanisms
for communication among and joint action by these
committees;

each State and, where appropriate, local governments,
establish permanent commissions or similar advisory
groups with representation from medical and other
professional health groups, legislative bodies and
the general public to advise the responsible health
officials on their venereal disease control program;
and State and appropriate local medical societies es-
tablish standing committees with similar responsibilities
and that special emphasis be placed on attempts to promote
the reporting of venereal diseases by practicing physicians
and to encourage epidemiological followup;

(18)

to reduce the incidence of venereal disease, known
control techniques, including case finding and public
education, be fully employed on a nationwide basis,
and such programs be funded primarily through federal
project grants;

(19) for all elements of the venereal disease control
efforts, the Federal Government appropriate and
expend through the Department of Health, Education,
and Welfare in fiscal year 1973 a total of $46,150,000,
this sum increasing to $68,035,000 in fiscal year 1977.*

Project grants to States 22,300 25,000 28,000 30,000 30,000 30,000

* Details of recommended budget, pages 46, 47, 48 and 50.

RECOMMENDATIONS AND COMMENTS

Earlier in this report the Commission has expressed its deep concern over the alarming increase of reported venereal disease; however, it is not surprising that the venereal diseases have once again reached epidemic proportions in the United States. Control efforts directed against these diseases have perforce been based upon early casefinding and treatment of those persons infected. In theory, it would be possible to eliminate syphilis and gonorrhea if each infected individual could be identified and rendered noninfectious through treatment before there was an opportunity to pass the disease on to another. Although it is impossible to achieve this ideal, it has been demonstrated that intensive control efforts can, indeed, slow down the rate of spread of these diseases. However, such programs must involve a concerted, nationwide effort and require the establishment of an extensive organization dedicated to this work. Such a program is expensive and as it begins to achieve success, the problem becomes less acute and the public, the health officials with general responsibilities, and the executive and legislative branches of government are increasingly less concerned about venereal disease. Understandably, it becomes more difficult for these groups to feel justified in allocating resources to venereal disease control when other competing demands begin to assume relatively greater significance. At this point, the individuals with primary responsibility and concern for control of the venereal diseases, the venereal disease control officials at federal, State and local levels and voluntary organizations such as the American Social Health Association, suddenly become "special interest groups" with a narrow, unrealistic outlook. This attitude is followed by gradually decreasing financial support of the program and a dismantling of the control organization. The inevitable Occurs. The rate of transmission increases until once again there is a clamor for renewed control efforts. This cyclic phenomenon will appear familiar not only to workers in other health programs but in many other fields.

Despite this seemingly unavoidable sequence of events, the Commission strongly feels it is essential that we move forward once again as a nation with an intensified, large-scale attack on these diseases utilizing all elements of our available armamentarium. However, if the wheel is not to turn once more, there must be greater and sustained dedication of funds and talents to the development of new knowledge which will provide more permanent solutions to the venereal disease problem. It is in recognition of the foregoing that the following recommendations and comments are made.