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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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