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THE CSTE
WASHINGTON REPORT
Marcia S. Mabee, MPH, PhD
Editor
11479 Waterview
Reston, Virginia 20190
mmabee@ix.netcom.com
703-709-3001
November 8, 2001 Volume 5, Number 21
EDITOR’S NOTE: The U.S. Department of Health and Human Services made a
bold move last week in announcing the appointment of Dr. Donald A. Henderson
to serve as director of a newly created Office of Public Health Preparedness.
It is hard to conceive of a better pick for this job, coming at a critical
time in the nation’s response to terror attacks. A summary of Dr. Henderson’s
considerable achievements are included in this Washington report – everyone
can sleep a little better each night knowing that Dr. Henderson is on the job
in Washington.
The CSTE Washington Report is provided as an information resource for members
of the Council of State and Territorial Epidemiologists on federal
legislation and regulation affecting public health and epidemiology in the
U.S. Regulations cited can be accessed via http: www.gpo.gov
BIOTERRORISM UPDATE – There are three main legislative vehicles
currently underway that seek to increase funding for bioterrorism
preparedness and response in FY 2002 and/or beyond. All claim to address
state and local public health needs and do so in varying degrees. The
legislation most likely to be enacted is the $20 billion emergency
supplemental appropriations bill. The Bush Administration, as reported in the
October 24th CSTE Washington Report, has proposed $1.5 billion for the
Department of Health and Human Services within the total, but of this amount
fully $1.1 billion is for smallpox vaccine and other drugs and vaccines.
There is very little in the HHS funding proposal that would address true
state and local public health infrastructure strengthening. Until the
President threatened to veto any amount over the $20 billion earlier this
week, there had been significant bipartisan interest in adding money,
including money for state and local public health. However, the House is now
unlikely to boost funding. While some of the priorities within the
Administration’s proposal for HHS may change in an effort to support state
and local health departments, it will be minimal. The support for drugs and
vaccines is strong, and the smallpox request for $506 million – to provide
250-300 million doses and speed up the current production process – is
undertargeted by about $1.5 billion. The House full Appropriations Committee
is currently scheduled to take up the emergency supplemental appropriations
bill on Tuesday, November 13th. The Senate is likely to challenge the
President’s veto threat and provide funding beyond the $20 billion limit.
Senator Harkin (D-IA), Chairman of the Labor-HHS-Education Subcommittee on
Appropriations, has said he has prepared a version that includes $2.3 billion
for HHS. The Chairman of the full Senate Appropriations Committee, Senator
Byrd (D-WV) wants to add $20 billion in spending for a number of defense, and
homeland security needs. However, the Senate bill must be reconciled with the
House bill and the President’s veto threat looms large.
Other legislative vehicles are the economic stimulus package which is being
marked up in the Senate Finance Committee today, November 8th. The House has
finished its version which provides no funding for public health bioterrorism
preparedness. The Senate version purportedly contains $3 billion for
bioterrorism, including public health, but it has been difficult to obtain
details. The Senate package, which differs greatly overall from the House
bill in the emphasis on unemployment and extended health benefits rather than
business tax breaks, is headed for a major fight on the Senate floor.
Finally, the key authorizing Committees in the Senate and House are working
on specific bioterrorism bills that would provide significant funding for state
and local public health departments. The Senate bill is a strong bipartisan
effort between Senators Kennedy (D-MA), the Chairman of the Senate Health,
Education, Labor and Pensions (HELP) Committee, and Senator Frist (R-TN) the
Ranking Minority Member of the key HELP Public Health Subcommittee. While
they are still working out details, they have agreed on an overall funding
level of $3 billion, with approximately one-fourth going to state health
departments in the form of a block grant. States would receive a base amount
of funding immediately, plus an added amount based on population, but funding
would be contingent upon producing a bioterrorism preparedness and response
plan within six months. The plan must undergo public comment involving
emergency response, health care providers, federal, state, and local
government agencies, law enforcement, etc. It would need to reflect an
assessment of the states core capacity in meeting public health threats as
specified under the Public Health Threats and Emergencies Act enacted last
year and a delineation of what the state is doing to achieve core capacity.
It would also need to address “... a description (including amounts expended
by the State for such purpose) of the programs, projects, and activities that
the State will implement using amounts received in order to detect and
respond to bioterrorism, including the manner in which the State will manage
State surveillance and response efforts and coordinate such efforts with
national efforts;”
Still other elements that the plan must address: training initiatives to
improve the State’s ability to detect and respond to a biological attack;
cleanup and contamination prevention efforts; assurance that hospitals and
health care providers have adequate capacity and plans in place to provide
health care items and services (including mental health services); plans to
provide appropriate health care during and after a biological attack; other
information that the Secretary may require.
The House
Energy and Commerce Committee is also working on a corresponding bill, but it
is still in preliminary stages.
The bottom line challenge for the authorizing bills is funding – if the
measures pass they must be funded under the regular, appropriations process.
At least for now, the President is holding fast to his veto threat of no
additional spending for the regular FY 2002 appropriations bills, and for the
emergency supplemental bill. He has indicated, and Congress expects, there
will be another supplemental request around February of 2002. This will have
a large focus on defense needs, but there could be room for public health
funding as well, hopefully for state and local and not just the added funding
that is clearly going to be needed for the smallpox vaccine.
REGULAR APPROPRIATIONS
UPDATE – Both the House and the Senate have finished work on the regular
FY 2002 Labor-HHS-Education Appropriations bill. Conferees have not yet been
appointed, but are expected to be shortly and a conference will probably meet
next week to begin the process of reconciling differences in the two bills.
Both bills include $181 million for CDC’s bioterrorism activities.
SECRETARY
THOMPSON NAMES HENDERSON TO HEAD OFFICE OF PUBLIC HEALTH PREPAREDNESS -- HHS Secretary Tommy G.
Thompson November 1 named Donald A. Henderson, M.D., to serve as director of
a newly created Office of Public Health Preparedness, which will coordinate
national response to public health emergencies.
Dr. Henderson was the founding director of the Center for Civilian Biodefense
Studies at the Johns Hopkins Bloomberg School of Public Health. In his new
position, he will work with all agencies within the department to enhance the
response to the anthrax attacks, as well as any possible incidents in the
future.
"Dr. Henderson brings a lifetime of preparation for the demands of this
job, and we are fortunate to have him join the department on a full-time
basis," Secretary Thompson said. "His distinguished record speaks
for itself, and his expertise will only improve the excellent job the public
health system is doing at the local, state and federal levels."
HHS has primary federal responsibility for public health in emergencies and
works with state and local health departments. HHS emergency health resources
include deployment of emergency health personnel under the Office of
Emergency Preparedness, disease surveillance and other responsibilities of
the Centers for Disease Control and Prevention, food and pharmaceutical
safety responsibilities of the Food and Drug Administration, medical
resources of the National Institutes of Health, emergency mental health
response capabilities of the Substance Abuse and Mental Health Services
Administration, as well as services needed from HHS' other operating
divisions.
Secretary Thompson also announced today that Phillip Russell, a retired U.S.
Army major general, who was the director of the Army's Medical Research
Institute of Infectious Diseases, will join the department as a special
advisor on vaccine development and production. Russell is an expert on
virology.
"Since arriving here nine months ago, we have moved aggressively to
strengthen the department's bioterrorism preparedness and response,"
Secretary Thompson said. "This is part of our ongoing effort to bring in
America's most talented experts in bioterrorism as well as strengthen our
responsiveness. We're working hard every day to build our capabilities even
stronger."
Previously, Secretary Thompson named Dr. Henderson the chairman of a new
national advisory council on public health preparedness, a position he will
continue to hold. The council is charged with recommending improvements to
the nation's public health infrastructure to better prepare it for
bioterrorism attacks.
Dr. Henderson directed the World Health Organization's global smallpox
eradication campaign from 1966 to 1977 and was instrumental in 1974 in
initiating WHO's global program of immunization, which is now vaccinating 80
percent of the world's children against six major diseases and has a goal of
eradicating of poliomyelitis.
Dr. Henderson is a Johns Hopkins University Distinguished Service Professor
with appointments in the Departments of Epidemiology and International Health
at the School. For the past four years, he has directed the Johns Hopkins
Center for Civilian Biodefense Studies. The Center was established to
increase national and international awareness of the medical and public
health threats posed by biological weapons.
From 1977 through August 1990, Dr. Henderson was dean of the Johns Hopkins
School of Public Health. He rejoined the Hopkins faculty in June 1995 after
five years of federal government service in which he served initially as
Associate Director, Office of Science and Technology Policy, Executive Office
of the President (1991-1993) and later as Deputy Assistant Secretary and
Senior Science Advisor in the Department of Health and Human Services.
Dr. Henderson has been recognized for his work by many institutions and
governments. In 1986, he received the National Medal of Science, presented by
the President of the United States. He is the recipient of the National
Academy of Sciences' highest award, the Public Welfare Medal, and, with two
colleagues, he shared the Japan Prize. Most recently he received from the
Royal Society of Medicine the Edward Jenner Medal. In all, 13 universities
have conferred honorary degrees and 14 countries have honored him with awards
and decorations.
MODEL STATE EMERGENCY POWERS ACT DEVELOPED –
“The
reality of bioterrorism is a challenge to all of us to work together
effectively in the most difficult circumstances,” said HHS Secretary Tommy
Thompson in releasing the model law. “We need not only a strong health
infrastructure and a full stockpile of medical resources, but also the legal
and emergency tools to help our citizens quickly.”
Over the past six months, the Centers for Disease Control and Prevention
(CDC) led a process to develop a Model State Emergency Health Powers Act that
will be an important tool for state and local officials to respond to bioterrorism
and other public health emergencies.
The current draft, which was developed by the Center for Law and the Public's
Health at Georgetown and Johns Hopkins universities, will serve as the basis
for further CDC collaboration among interested partners, including the
National Governors Association, the National Conference of State
Legislatures, the National Association of Attorneys General, the Association
of State and Territorial Health Officials, and the National Association of
City and County Health Officers.
Our goal is to develop a consensus-based model legislation to assist states
that are considering new emergency public health legislation. States may
adopt any or all of the resulting model legislation, as well as tailor it to
meet their individual needs.
HHS is dedicated to working with state and local officials to strengthen
America's capacity and ability to respond to public health emergencies. This
draft model act is one more example of the continued work that CDC and others
in the department are undertaking to strengthen our public health
infrastructure on the federal, state, and local levels and protect the
nation's health.
Note: A copy of the Model Emergency Health Powers Act is available at http://www.publichealthlaw.net
Donna Knutson
Executive Director
Council of State and Territorial Epidemiologists
770-458-3811
770-458-8516
dknutson@cste.org
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