Coalition Subcommittee Testimony on CDC FY 2022 Funding

May 2021

May 19, 2021

FY2022 Written Testimony for the Record

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 2022. Key priorities of the Coalition and our member health departments at the CDC include violence prevention, immunization, public health preparedness, epidemiology and laboratory capacity, opioid overdose prevention, and the public health data modernization initiative.

BCHC is comprised of health officials leading 30 of the nation’s largest metropolitan health departments, who together serve nearly 62 million – or one in five – Americans. Our members work every day to keep their communities as healthy and safe as possible. We thank you for your continued leadership and support for our nation’s public health workforce and systems during the ongoing COVID-19 pandemic.

As the Subcommittee members recognize, federal funding for CDC and the programs that support local and state public health departments have remained largely stagnant. Additional investments through sustained annual funding is necessary to build public health capacity for the next pandemic, as well as the everyday population health programs.

National Immunization Program
We respectfully request $1.1 billion in FY2022 for the National Immunization Program. The CDC Immunization Program funds 50 states, six large, BCHC member cities (Chicago, Houston, New York City, Philadelphia, San Antonio, and Washington, D.C.), and eight territories for vaccine purchase and immunization program operations. In addition to the challenges of COVID-19, recent growth of electronic health records and compliance with associated regulations, and new vaccines and school requirements, as well as continuing unpredictable disease outbreaks, have increased the complexity of vaccine management. Additional base funding is needed for each grantee to sustain improvements supported by emergency funding and maintain sound and efficient immunization infrastructure. We also ask that the Committee encourage CDC to be as flexible as possible in coordinating funding and guidance across immunization program streams as we do COVID vaccinations while still also carrying out routine immunizations.

Epidemiology and Lab Capacity (ELC)
We respectfully request $500 million in FY2022 for the ELC program, which is a single vehicle for multiple programmatic initiatives that go to 50 state health departments, six large, BCHC member cities (Chicago, Houston, Los Angeles County, New York City, Philadelphia, and Washington, D.C.), Puerto Rico, and the Republic of Palau. ELC grants strengthen local and state capacity to contain infectious disease by detecting, tracking and responding to threats in a timely manner, as well as maintaining core capacity of the nation’s public health eyes and ears on the ground. Increased funding will help build the workforce allowing health departments to begin to move towards establishing a minimum epidemiology workforce; to promote and offer training; and to monitor needs in state- and/or local-based epidemiology capacity. ELC dollars sent to the states should be tracked through existing CDC reporting structures and shared publicly to ensure funds are also supporting big city epidemiology activities.

Opioid Overdose Prevention and Surveillance
We respectfully request $650 million in FY2022 for Opioid Overdose Prevention and Surveillance. Many health departments have had to curtail opioid and other substance use disorder (SUD) activities during the pandemic. As such, overdose numbers are increasing in many communities, erasing gains of recent years. Previously, programs that connected with people in hospital emergency departments after an overdose had seen successful outcomes in steering people toward syringe services programs and treatment programs. However, these programs rely on in person interactions that have been scaled back during the pandemic. Funding is needed in local communities to ensure that SUD prevention efforts can stem the tide of overdose and death. We also encourage the committee to include directive language to ensure these dollars reach the local level in those communities that are not already directly funded, as well as have CDC and HHS better track state expenditures to determine what activities are happening at the community level.

Gun Violence Prevention Research
We respectfully request $25 million in FY2022 for Gun Violence Prevention Research. Firearm violence is a serious public health problem in the United States that impacts the health and safety of all Americans. Despite initial funding in FY 2021 to research key issues around firearm violence, significant gaps remain in our knowledge about the problem and ways to prevent it; we need to continue and expand the research. Addressing these gaps is an important step toward keeping individuals, families, schools, and communities safe from firearm violence and its consequences. The public health approach to violence prevention includes working to define the problem, identifying risk and protective factors, developing and testing prevention strategies, and then, assuring widespread adoption of targeted programs. Additional funds would be used to provide grants to conduct research into the root causes and prevention of gun violence focusing on those questions with the greatest potential for public health impact.

Community Based Violence Intervention Initiative
We respectfully request $100 million in FY2022 for a new Community Violence Intervention initiative as proposed in the President’s discretionary funding request to implement evidence based community violence interventions locally. BCHC whole-heartedly supports such an investment. Violence, like many public health challenges, is preventable. Yet, the majority of public investments are used to address the aftermath of violence, too often through systems that can cause further harm. Communities can be made safer when we understand the events that have led to present conditions and act on this knowledge by implementing policies and practices that address the root causes of violence. By making investments in public health strategies within communities that are most impacted by violence, cities can work across sectors to shift from an overreliance on the criminal justice system and move from reimagining to realizing community safety.

Data Modernization Initiative (DMI)
We respectfully request $250 million in FY2022 for the DMI that is working to create modern, interoperable, and real-time public health data and surveillance systems at the state, local, Tribal, and territorial levels. These efforts will ensure our public health officials on the ground are prepared to address any emerging threat to public health—whether it be COVID-19, measles, a foodborne outbreak like e coli, or another crisis. COVID-19 exposed the gaps in our public health data systems and since then Congress has provided funding for DMI through the CARES Act and American Rescue Plan Act. These investments have been critical, but the public health surveillance systems must live beyond COVID-19 and be ready for any and all future threats. This requires long-term, sustained investment that is not just to build capacity at the federal and state level, but also at health departments in cities and counties across the country.

Public Health Emergency Preparedness Cooperative Agreements
We respectfully request $1 billion in FY2022 for the public health emergency preparedness (PHEP) grant program. PHEP provides funding to strengthen local and state public health departments’ capacity and capability to effectively respond to public health emergencies, including terrorist threats, infectious disease outbreaks, natural disasters, and biological,
chemical, nuclear, and radiological emergencies. PHEP funding has been cut by over 30% in the last decade. Recent events, such as the response to the COVID-19 pandemic, demonstrate the need to invest in these programs to rebuild and bolster our country’s public health preparedness and response capabilities. America’s public health preparedness systems are stretched to the brink and will need increased and stable base funding for years to rebuild and improve. We also encourage the committee to include directive language to ensure these dollars reach the local level in those communities that are not directly funded, as well as have CDC better track and share publicly state expenditures.