Big Cities Health Coalition urges highest CDC funding for FY25

April 2024


Chrissie Juliano, Executive Director of the Big Cities Health Coalition submitted the following written testimony for the record to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

On behalf of the Big Cities Health Coalition (BCHC), we respectfully request that the Subcommittee provide the highest possible funding for the U.S. Centers for Disease Control and Prevention (CDC), central to protecting the public’s health, for Fiscal Year 2025 (FY25). Our key CDC programmatic priorities include those most critical to our members: immunization; epidemiology and laboratory capacity (ELC); public health data modernization, workforce, infrastructure and capacity; disease modeling and analytics; opioid overdose prevention, violence prevention; public health preparedness; and the social determinants of health (SDoH).

BCHC is comprised of health officials leading 35 of the nation’s largest metropolitan health departments, who together serve more than 61 million, or about one in five, Americans. We thank you for your continued leadership and support for our nation’s public health workforce and systems. As the Subcommittee members recognize, sustained, predictable annual funding is necessary to build public health capacity not only for the next health emergency, but also the everyday work that helps keep communities as healthy and safe as possible.

CDC-wide Activities – Local Health Departments

BCHC respectfully requests the continued inclusion of report language directing CDC to work with states to ensure federal resources go to local communities and to track how funds are passed on to local health departments (LHDs).

National Immunization Program

We respectfully request $1.1 billion in FY25 for the National Immunization Program. The CDC Immunization Program funds vaccine purchase and immunization program operations. Increased and sustained investment is needed to modernize immunization information systems (IIS), establish state-to-state IIS data sharing, and engage with communities to build vaccine confidence and continue to reduce disparities. Additional funds are also essential to annual rollouts of flu, COVID, and RSV vaccines.

Adult Vaccine Program

BCHC supports the creation of a Vaccines for Adults program that is essential to the nation’s health security. This requires building and sustaining a network of adult immunization providers to reduce vaccination coverage disparities, improve outbreak control, and enhance and maintain vaccine infrastructure.

Epidemiology and Lab Capacity (ELC)

We respectfully request $120 million in FY25 for the ELC program. ELC provides critical support to epidemiologists and laboratory scientists who are instrumental in addressing various food-, water-, and vector-borne outbreaks. ELCE also funds improvements in health informatics. Current annual funding levels are not adequate to maintain public health preparedness or address routine challenges, particularly at the city or county level. As emergency supplemental dollars wane, an increase to ELC is needed to at miniumum sustain, and ideally increase, support to LHDs to maintain their jurisdiction-specific needs. Such dollars should be sent to large, urban jurisdictions directly, and we urge you to encourage the CDC to do so. Further, ELC dollars sent to the states should be better tracked through CDC reporting structures and shared publicly to contribute to transparency.

Public Health Data Modernization

We respectfully request $340 million in FY25 for data modernization efforts to create modern, interoperable, and real-time public health data and surveillance systems at the state, local, tribal, and territorial levels. This work will ensure health officials across the country are prepared to address routine and emerging threats to their communities—whether it be measles, mpox, a foodborne outbreak like E. coli, or another crisis. Investments to date have been critical and are already paying off through increased electronic case reporting and electronic laboratory reporting as just two examples. Furthering this progress requires long-term, sustained, and predictable investment to build capacity not just at the federal and state level, but also at health departments in cities and counties across the country. We encourage the committee to include directive language to ensure these dollars reach the local level.

Public Health Workforce

We respectfully request $106 million in FY25 for CDC’s public health workforce and career development programs. These funds support CDC’s fellowship and training programs including the Public Health Associate Program and Epidemic Intelligence Service that extend the capacity of local and state health departments and strengthen the pipeline for careers in public health. Investments must be made to build and develop the public health workforce, as well as attract and retain diverse candidates with varied skill sets.

Public Health Infrastructure and Capacity

We respectfully request $1 billion in FY25 to support an investment in public health infrastructure and capacity. Because public health is largely funded by specific disease or condition, there has been little investment in cross-cutting capabilities that are critical for effective prevention and response, such as policy development, communications, community engagement, and other organizational competencies. We urge ongoing investment to ensure our governmental public health system is maintained as emergency supplemental funding expires for pubilc health infrastructure grants expire leaving health departments facing a funding cliff.

Center for Forecasting Epidemics and Outbreak Analytics

We respectfully request $100 million in FY25 for the Forecasting Center to facilitate the use of data, modeling, and analytics to improve pandemic preparedness and response. With additional resources, CFA will be able to enhance local and state capacity, enabling stakeholders at multiple levels to make quicker and better-informed decisions. BCHC also recommends funding the Response Ready Enterprise Data Integration platform (RREDI) separately from CFA as both are each necessary components of CDC’s data strategy.

Opioid Overdose Prevention and Surveillance

We respectfully request $713 million in FY25 for opioid overdose prevention and surveillance. Overdoses (ODs) are increasing rapidly across the nation, erasing gains of recent years. CDC’s funding to LHDs through the Overdose Data to Action (OD2A) program is a critical resource for prevention of opioid and polysubstance use, as well as ODs. Prevention efforts include harm reduction and linkage to care initiatives with a focus on highly impacted communities and reducing stigma. Local communities need additional funding to meet the growing demand for substance use prevention services. LHDs also need to be able to use federal funds to purchase naloxone to prevent additional OD deaths.

Gun Violence Prevention Research

We respectfully request $35 million in FY25 for gun violence prevention research. Firearm violence impacts the health and safety of all Americans and continues to be an acute issue in our nation’s largest cities. Significant gaps remain in our knowledge about how best to prevent gun violence.

Community and Youth Violence Prevention’s Community Violence Intervention Initiative

We respectfully request $250 million in FY2025 for a Community Violence Intervention initiative to implement evidence-based community violence interventions locally. BCHC wholeheartedly supports an increased investment to scale up this initiative and believes it is critically important to have CDC engaged in this effort in concert with the Department of Justice. Such an increase would allow CDC to support actionable, proven, community-driven public health strategies that can prevent and reduce violence among those facing the highest burden of violence. Importantly, violence is preventable, not inevitable, when we invest in a robust public health approach. A public health approach is highly collaborative and driven by local needs, bringing together community members most impacted by violence with different sectors—including health care, public health, schools, parks, housing, law enforcement, local businesses, faith-based institutions, and others—to collectively implement locally-informed strategies.

Public Health Emergency Preparedness Cooperative Agreements

We respectfully request $1 billion in FY25 for the public health emergency preparedness (PHEP) grant program. PHEP provides funding to strengthen public health departments’ capacity and capability to effectively respond to public health emergencies. PHEP funding awards have been cut by nearly 30% in the last two decades. America’s public health preparedness systems need increased and stable funding to be ready for every day public health threats and the next outbreak of a pathogen of pandemic potential. Finally, we encourage the committee to include directive language to ensure these dollars reach the local level and to oppose combining CDC’s three preparedness lines into one.

We thank the committee for the opportunity to provide this written testimony.