On May 2, the Senate Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee held a hearing on the FY2008 budget for global health.
Chair Tom Harkin (D-IA) stated that this subcommittee “shows the world the best side of America” by appropriating funds for national and international health initiatives. He cited “a true success story,” the U.S.-China collaboration on folic acid: “The idea was hatched by a Chinese scientist, Dr. Li Zhu, who was visiting [the] Centers for Disease Control and Prevention (CDC) headquarters in 1987. At the time, research suggested that folic acid could help prevent birth defects such as spina bifida, but no large-scale studies had been conducted. For a variety of reasons, Dr. Li Zhu thought China would be a good place to test the theory. This Subcommittee began funding the collaborative in 1992, and data collection ended in 1996. Thanks to this study, we now know that taking folic acid during pregnancy can reduce neural tube birth defects like spina bifida by up to 70 percent. As a result, the FDA ruled in 1996 that breads, cereals, and other appropriate foods must be fortified with folic acid, and the incidence of spina bifida has dropped dramatically.”
Noting that, since 2002, “a total of more than $1.2 billion…has resulted from the initiatives taken by this subcommittee, which have been subscribed to by the full committee, the Senate, the Congress, and signed into law by the president,” Ranking Member Arlen Specter (R-PA) highlighted the subcommittee’s support for “very important” health initiatives: increasing NIH [National Institutes of Health] funding from $12 billion to $29 billion; “focusing on the problems of embryonic stem cell research;” and providing funding for global health issues, such as HIV/AIDS, TB and malaria, polio and measles, and the avian flu.
Secretary of Health and Human Services (HHS) Michael Leavitt focused his testimony on five global health challenges: HIV/AIDS, tuberculosis, malaria, polio, and pandemic influenza. Explaining that HHS is one of the federal agencies implementing the President’s Emergency Plan for AIDS Relief (PEPFAR), Secretary Leavitt said, “With the overall U.S. contribution of approximately $4.6 billion for the Emergency Plan in the current fiscal year (FY), and the President’s unprecedented $5.4 billion request for FY2008, there can be no doubt that the United States will continue to lead the world in responding to the AIDS crisis. The Emergency Plan has financed care for almost four and a half million people, including two million orphans and vulnerable children. We have supported counseling and testing for 18.6 million 69 percent of whom are female. To meet our treatment goals, the Emergency Plan has supported treatment for over 822,000 individuals in 15 countries 61 percent of whom are women, and nine percent of whom are children. We have also supported anti-retroviral treatment for HIV-positive women during more than 530,000 pregnancies, and experts estimate these treatments have averted more than 100,000 infant HIV infections.”
Secretary Leavitt said that a goal of the President’s Malaria Initiative (PMI), another inter-agency effort, is to “reach 85 percent of those most vulnerable to malaria children under five years of age and pregnant women with a package of four proven and highly-effective prevention and treatment measures.” He added, “In each country, PMI works closely with national malaria-control programs to strengthen their efforts, complement ongoing activities, and meet the PMI targets of 85 percent coverage with proven interventions, including indoor spraying of homes with insecticides, the distribution of insecticide-treated mosquito nets, the use of life-saving anti-malarial drugs, and expanding access to prevent malaria in pregnant women.”
Affirming that “CDC is on the frontlines of international disease eradication and health promotion,” CDC Coordinating Office for Global Health Director Stephen Blount stated, “CDC is working to deploy known strategies to address Global HIV/AIDS in support of PEPFAR through new biomedical interventions. For example, we are conducting clinical trials on the safety and effectiveness of carageenan, a vaginal gel microbicide in Thailand, and on the safety and effectiveness of daily use of the antiretroviral agent tenofovir in the United States, Thailand, and Botswana. As part of the Partnership for AIDS Vaccine Evaluation, CDC is developing new animal models for the evaluation of vaccine candidates. CDC’s current research priorities include microbicides, pre-exposure prophylaxis (PrEP), HIV vaccine development, and emerging retroviruses.” Dr. Blount highlighted the prevention of mother-to-child transmission (PMTCT) of HIV/AIDS as “a main focus and strong component of PEPFAR” and cited an example of CDC research conducted in Thailand that “reduced rates of maternal to child transmission through effective treatment of mothers infected with HIV.” He noted that the research “led to a policy change in Thailand that eventually became the world’s standard.” Dr. Blount said that “the vast majority of maternal, fetal, and neonatal deaths occur in the developing world,” with maternal deaths estimated at over half a million annually and both late fetal deaths and neonatal deaths estimated at 4 million each year.
Concerning hepatitis B, he said, “Perinatal transmission of hepatitis B also remains an international concern. The good news, however, is that through support for WHO [World Health Organization] and work with the Global AIDS Vaccine Initiative (GAVI) Alliance and other partners, CDC has contributed to the substantial progress in control of global hepatitis B. To date, 158 of 192 WHO member states have introduced hepatitis B vaccine into routine infant immunization programs.” Dr. Blount also outlined CDC injury, violence, and safety initiatives, which included support for the “WHO multi-country study on domestic violence against women.”
Roger Glass, director of the Fogarty International Center at the National Institutes of Health, also testified.
