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Steady She Goes: Epi Mostly Flat-Funded in “CRomnibus”

Posted By Emily J. Holubowich , Wednesday, December 31, 2014
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Emily Holubowich, Senior Vice President at CRD Associates, is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital.

On December 16, President Obama signed the bipartisan Consolidated and Further Continuing Appropriations Act, 2015 or “CRomnibus”—part continuing resolution (CR), part omnibus legislation. The massive spending bill includes a CR through February 27, 2015 for the Department of Homeland Security and 11 separate spending bills for the remaining months of the fiscal year (FY), including the Departments of Labor, Health and Human Services, Education and Related Agencies Appropriations Act (Labor-HHS).

This typically controversial Labor-HHS bill, which includes spending for the Centers for Disease Control and Prevention (CDC), holds funding essentially flat for most public health activities providing only a slight increase for CDC overall. Specifically, the legislation provides the agency $6.26 billion in FY 2015, which includes $6.024 billion in base discretionary funding, $887 million in transfers from mandatory Prevention and Public Health Fund (PPHF)—a new high—and $15 million in Public Health and Social Services Emergency Fund (PHSSEF) unobligated balances from pandemic influenza supplemental appropriations.

The agency also received an additional $1.77 billion in one-time, emergency supplemental funding to support the nation’s Ebola response. CSTE is expected to receive funding to send medical epidemiologists into surrounding, unaffected West African countries as part of the Ebola containment strategy.

Even with the slight increase for CDC, most core epidemiology programs were held flat—about the best anyone can hope for in this austere fiscal environment—while some surveillance activities saw substantial increases. For example, the CRomnibus provides the National Center for Emerging and Zoonotic Infectious Diseases a significant, 20 percent increase ($66 million), but still less than the administration’s requested 31 percent increase. This increase will “trickle down” to many of the programs epidemiologists xrely upon to do our work.

Provided below is a summary of the final funding levels for some of CSTE’s key advocacy priorities:
  • Epidemiology and Laboratory Capacity Grants. The ELC “program”—a grant mechanism used by CDC to support core infectious disease surveillance capacity at state and local health departments—is once again awarded $40 million from the Prevention and Public Health Fund (PPHF), consistent with FY 2012, FY 2013, and FY 2014. Total funding for ELC grants will be determined based on emerging needs throughout the year.

    Given that the Prevention Fund was cut by $73 million due to sequestration (the Prevention Fund and other mandatory funding streams are not provided any sequestration relief), we are very pleased and relieved to see this funding re-allocated at current levels, especially as other CSTE priorities that had previously received PPHF did not receive allocations through this mechanism in FY 2014 or FY 2015.

  • Advanced Molecular Detection. The CRomnibus provides $30 million for the “AMD” initiative, consistent with FY 2014 and the administration’s FY 2015 request. This funding will be used both to improve CDC’s capability and to initiate state projects that will improve the application of genome sequencing to public health issues of concern.

    For the first time, the CRomnibus includes some of CSTE’s recommended report language on the importance of public health surveillance:

    Responding to Emerging Threats.—The agreement continues to support the Epidemiology and Laboratory Capacity and Advanced Molecular Detection Programs to strengthen epidemiologic and laboratory capacity by providing critical resources to address 21st Century public health challenges.”

  • Food Safety. The CRomnibus provides nearly $48 million for foodborne disease surveillance, an increase of 19 percent over FY 2014 but less than the administration’s request of $52 million. This includes $8 million to apply advanced DNA technology to improve and modernize diagnostic capabilities; and enhance surveillance, detection, and prevention efforts at the state and local level.

  • Epidemiology Fellows. The “Public Health Workforce” program—through which the CSTE/CDC Applied Epidemiology Fellowship Program receives funding—is slated to receive $52.2 million, a 14 percent increase over FY 2014 but still less than the administration’s request. Once again, this program is not provided any PPHF dollars—compared to $25 million in FY 2012 and $15 million in FY 2013. That means that Public Health Workforce funding remains below the high watermark of years past.

  • Ebola Containment Strategy. CSTE is expected to receive funding to send up to 24 epidemiologists to unaffected countries in West Africa within the next 6 months.
Surprisingly, the CRomnibus does not include any funding to support the nation’s response to the antibiotic resistance (AR) epidemic, despite the administration’s request for $30 million. As you know, in 2013, CDC released a comprehensive report, Antibiotic Resistance Threats in the United States about this most serious of public health threats. Earlier this year the President’s Council of Advisors on Science and Technology (PCAST) issued a report and recommendations on combatting AR, and President Obama himself issued an Executive Order to implement some of these recommendations. The administration had hoped this new funding would support implementation of the report’s recommendations, including expansion of the AR detection and response program and full integration of enhanced surveillance capacity at the local, state, and national levels. Despite the lack of new funding, our understanding is the administration will continue to move forward in its plans to combat AR.
For more information about funding levels for your specific priorities, please click here for a copy of the legislation and the explanatory statement or “report language” (health is in Division G) that includes more specificity about the funding levels.
For a copy of CSTE’s funding request letter co-signed by the Association of Public Health Laboratories, click here.
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