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FY 2006 Budget in BriefCenters for Disease Control and PreventionOn this page:
The Centers for Disease Control and Prevention promotes health and quality of life by preventing and controlling disease, injury, and disability. The FY 2006 budget requests a total program level of $7.5 billion for the Centers for Disease Control and Prevention (CDC), a net decrease of $491 million below the FY 2005 enacted level. This net change includes programmatic increases of $339 million, including expanded funding for influenza vaccine; improvements in childhood immunizations; expanded global disease detection efforts; and expansions of the Strategic National Stockpile, including a new focus on portable mass casualty treatment units. These increases are offset by completed facility construction projects, one-time projects, reductions in programs that overlap other areas of CDC, internal management efficiencies, and one-time costs in the Vaccines for Children (VFC) program. CDC's total program level includes $1.6 billion in mandatory VFC funding, and $265 million in Public Health Service evaluation transfers. An array of new challenges face America's public health system: an aging population; increasing population diversity; global travel that can spread diseases; bioterrorism threats; and an epidemic of chronic diseases. At the same time, technology improvements offer CDC new opportunities to increase program efficiency, including health information technology, global communication, rapid diagnostic tools, and public health genomics. As a result, CDC undertook a two-year reorganization process, the Futures Initiative, to maximize the benefit CDC provides to the American people in the 21st century. CDC's budget has been realigned to support this new structure. CDC is reorganizing most of its programs under four coordinating centers and three coordinating offices. These include Infectious Diseases, Health Promotion, Public Health and Information Services, Environmental Health and Injury, Terrorism, Global Health, and Workforce and Career Development. The coordinating centers and offices lead collaboration within each thematic area and across other areas of CDC. They work with CDC's Office of the Director to improve business practice efficiency; ensure high quality, goal-oriented programs; and provide leadership to operational units. Management and administrative funding has been consolidated from most program lines into two areas: Public Health Improvement and Leadership, and Business Services Support. Two units formerly located in CDC's Office of the Director (OD), the Epidemiology Program Office (EPO) and the Public Health Practice Program Office (PHPPO), will be relocated to integrate core functions across CDC. For example, functions within EPO have been consolidated with Health Information and Services activities, Global Health, and Public Health Improvement and Leadership. This restructuring is consistent with the goals of the Futures Initiative, and the findings of a recent PART review for the Epidemic Services program activity, in that programmatic and administrative redundancies will be reduced and program functions will have a clear and coherent purpose. Infectious DiseasesThree major programs are overseen by the new Infectious Diseases Coordinating Center: the National Immunization Program; the National Center for Infectious Diseases; and the National Center for HIV, STD, and TB Prevention. The President's FY 2006 budget includes a total of $1.7 billion in discretionary funding for efforts related to the prevention and control of infectious diseases and to provide immunization services for children and adults nationwide. Immunization: CDC's $2.1 billion immunization program is focused on achieving two major health goals of the Nation. CDC seeks to ensure that at least 90 percent of all two-year olds receive the recommended series of vaccines, and CDC has also expanded its role in assuring the adequacy of annual influenza vaccine supplies. This work will be carried out through two streams of funding: Vaccines for Children (VFC) and the Section 317 program. The mandatory VFC program provides free vaccine to approximately 42 percent of the childhood population, including Medicaid recipients, the uninsured, American Indians and Alaskan Natives, and children with limited health insurance that does not cover specific immunizations. VFC also funds the development of a six-month stockpile of all routinely recommended childhood vaccines. The discretionary Section 317 program provides funds for State immunization operational costs and many of the vaccines public health departments provide to individuals not eligible for VFC. Influenza Vaccine CDC's agency-wide influenza budget totals $197 million, nine times more funding than in FY 2001. A year ago, HHS worked with vaccine manufacturers to expand production. This was accomplished in part by making influenza a routinely recommended vaccine for young children, and setting aside $40 million in new budget authority in VFC for a pediatric stockpile of finished doses. In FY 2006, CDC will supplement the pediatric stockpile with $30 million in contracts to expand the production of bulk monovalent influenza vaccine. This will occur through back-end guarantees to manufacturers to increase influenza supply and guarantee higher production levels. CDC will also purchase an estimated additional two million doses of influenza vaccine through a $20 million discretionary funding increase. Near-term action is being taken to improve the availability of influenza vaccine for this winter and the upcoming (2005-2006) flu season. The Administration's plan reallocates up to $37 million in FY 2005 to expand the availability of influenza vaccine for this and the upcoming (2005-2006) flu season. This includes up to $25 million in reallocations from CDC programs the budget proposes to eliminate in FY 2006, and $12 million provided through the Secretary's authority to transfer funds from accounts in other agencies. Within this amount, $20 million will be used to expand bulk monovalent vaccine production for next winter. The remaining $17 million will be used to finance the importation of foreign influenza vaccine for this winter under Investigational New Drug (IND) authorities. This vaccine has been made available to States, and a contract research organization has been retained to manage IND process requirements of vaccination drives.
Childhood Immunization Improvements Children who are Medicaid recipients, uninsured, American Indians and Alaskan Natives, and children with limited health insurance that does not cover specific immunizations are entitled to receive VFC vaccines. These children, however, must do so at a Community Health Center or a specially designatedFederally Qualified Health Center. Legislation is sought to enable these children to obtain VFC vaccines at public health clinics as well. This improved access is projected to expand the VFC program by $140 million while also reducing by $100 million the demand for vaccines purchased with discretionary appropriations. The proposed legislation would also eliminate the price caps on VFC that have excluded some vaccines from the VFC program. The budget anticipates substantial FY 2005 progress toward HHS's goal of establishing a six month vendor-managed stockpile of all routinely recommended pediatric vaccines, and catching up on immunizations that were missed during vaccine shortages in recent years. With catchup vaccinations finished, and the stockpile nearing completion, FY 2006 costs will be $166 million below FY 2005 estimates. The stockpile serves dual purposes: vaccines from the stockpile can be distributed in the event of a disease outbreak; and the stockpile will mitigate the effect of any supply disruptions that might occur on the manufacturing side. HIV/AIDS, STD & TB Prevention: HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis (TB) are among the most prevalent, costly and preventable infectious diseases in the United States. The President's FY 2006 budget request is $956 million to develop, implement, and evaluate effective domestic prevention programs for these diseases through the National Center for HIV, STD, and TB Prevention (NCHSTP). Domestic HIV/AIDS Prevention CDC's core set of prevention activities include surveillance and case reporting, community involvement and intervention, capacity building, and program evaluation. NCHSTP's budget requests $658 million for HIV/AIDS prevention. The CDC-wide domestic HIV/AIDS budget of $727 million also includes funding in school health programs (Chronic Diseases) and blood disorders programs (Birth Defects, Disability, and Health). CDC's HIV prevention activities over the past two decades have focused on helping uninfected persons at high risk for HIV change and maintain behaviors to keep them uninfected. Despite these efforts, the number of new HIV infections is estimated to have remained stable, and the number of people living with HIV continues to increase. In FY 2003, CDC launched a new prevention initiative, Advancing HIV Prevention (AHP) that capitalizes on new rapid testing techniques that provide on-the-spot results. AHP seeks to expand early diagnosis of HIV infection; facilitate earlier access to quality medical care and treatment; and provide prevention services to reduce the risk of transmission to others. STD and TB Prevention The STD and TB prevention programs provide grants and technical assistance to State and local governments and organizations for prevention and control services, as well as conducting surveillance and supporting research related to the prevention, control, and elimination of these diseases. A recent PART review determined that both the STD and TB activities have a clear purpose and address specific and ongoing problems. The review suggested some improvements that the programs have already begun to make, including the distribution of State funding for TB based on need, rather than historical distributions. The program will also examine additional ways to better target State and local funding for STDs. Infectious Diseases: The National Center for Infectious Diseases works in partnership with State and local public health officials, other federal agencies, medical and public health professional associations, infectious disease experts from academic and clinical practice, and international and public service organizations to prevent illness, disability, and death caused by infectious diseases in the United States and around the world. Although modern advances have conquered some diseases, the outbreaks of severe acute respiratory syndrome (SARS), avian influenza, West Nile virus, and monkeypox are recent reminders of the extraordinary ability of microbes to adapt and evolve. The President's FY 2006 budget includes $225 million to conduct surveillance, epidemic investigations, epidemiologic and laboratory research, training, and public education programs to develop, evaluate, and promote prevention and control strategies for infectious diseases. A recent PART review indicated that the Infectious Diseases program has a clear purpose and evidence of its impact on controlling disease. The program collaborates with a broad range of partners to target resources and accomplish its mission. The program is measuring progress on new long-term measures focused on foodborne pathogens, bloodstream infections, pneumococcal disease, and hepatitis A. The program will also measure progress in global influenza surveillance and detection as one key indicator of our preparedness for a pandemic influenza outbreak Global HealthEvery day, two million people cross national borders as tourists, business travelers, immigrants, or refugees. World trade moves produce and manufactured goods from one end of the earth to another in a matter of hours or days. However, disease vectors like mosquitoes have no regard for borders. Health events far from our shores are significant in their own right, but also have the potential to influence health within the United States. As a result, CDC supports a range of efforts to both track and prevent the international spread of infectious diseases. CDC has consolidated funding and policy oversight of many of these activities into a new $306 million Global Health budget line. While the Office of Global Health provides policy guidance on the use of funds, the work is carried out by the operating centers that received these funds directly in the past. Global Disease Detection: The FY 2006 budget requests $34 million, a $12 million increase, for CDC's global disease detection initiative. This initiative aims to recognize infectious disease outbreaks faster, improve the ability to control and prevent outbreaks, and to detect emerging microbial threats. CDC will continue the implementation of a comprehensive system of surveillance by expanding programs and sites abroad. Additional activities include the improvement of early warning systems; researching new viral strains; aiding in collaborations with multinational organizations; and increasing surveillance. Global AIDS: Through the Global AIDS Program (GAP), CDC works in partnership with USAID; HRSA; the Departments of State, Labor, and Defense; other federal agencies; and multilateral and bilateral partners to ameliorate the global devastation caused by HIV/AIDS. The FY 2006 budget includes $124 million in direct funding for on-going prevention, care, treatment, surveillance, and capacity-building programs in 25 countries in Asia, Africa, Latin America, and the Caribbean. CDC is also a key federal partner in the President's Emergency Plan for AIDS Relief (PEPFAR) that is financed through the Department of State. Approximately $185 million in PEPFAR funding was allocated to CDC in FY 2004 from the Department of State. Global Polio and Measles: CDC's request allocates $137 million for global polio and measles activities. While tremendous progress has been made with the number of polio-endemic countries declining from 120 in 1988 to six in 2004, a major international effort continues to strive for the 2005 eradication goal set by the World Health Organization. If that goal is achieved, continued vigilance will be required to guard against reappearance. TerrorismThe request allocates $1.6 billion to bioterrorism preparedness, a net increase of $56 million over FY 2005. Within this total, priority is given to direct Federal responsibilities to ensure a sufficient supply of countermeasures and portable treatment units are available to protect and care for victims of an attack. The Strategic National Stockpile (SNS) is funded at $600 million, an increase of $203 million above FY 2005. This increase includes $50 million in funding for the Federal Mass Casualty Initiative. The SNS will use these funds to purchase, maintain, and operate portable hospital units that can be deployed to increase hospital surge capacity in the event of a bioterrorist attack. The remaining funding will be used to procure commercially available countermeasures; provide secure, temperature controlled storage for the wide range of medicines and vaccines in the SNS as well as those being procured by Project BioShield; replace medical products that are nearing the end of their useful life; and maintain the capacity to move SNS assets to any location in the United States within 12 hours. In January 2004, the Administration set a goal of having sufficient antibiotics in the SNS to protect 60 million Americans from the effects of exposure to anthrax. The financing plan included special transfer authorities in FY 2005 to secure coverage of 50 million people and purchase the remaining courses necessary to reach the final 10 million in FY 2006. Since the requested funding flexibilities were not provided in the FY 2005 appropriation, CDC has modified the SNS operating plan to stay on track and achieve the 50 million target in FY 2005. HHS plans to use the Secretary's authority to transfer funds between appropriations to redirect $12 million from bioterrorism grant programs to the SNS, so that the anthrax antibiotic coverage goal can be reached on schedule. Improving biosurveillance continues to be a high priority, with $79 million provided to continue the interagency biosurveillance initiative. The centerpiece of CDC's efforts in biosurveillance concentrating on electronic disease surveillance is BioSense. BioSense automatically analyzes electronically available health data to highlight a potential public health problem, rather than relying solely on individual case reports from healthcare providers to local public health officials. BioSense will provide public health officials with early warnings on potential outbreaks in their communities. CDC will engage in contracts with health departments and health systems to expand access to local information in the highest risk urban areas. In addition to BioSense, CDC will continue other aspects of the biosurveillance initiative, including improvements to laboratory reporting capacity and increasing the number of border health and quarantine stations at ports of entry. CDC's commitment to State and local preparedness remains strong; between FY 2002 and FY 2006, CDC will have invested a total of $4.5 billion in this activity. The FY 2006 budget retargets some preparedness resources, making modest reductions in awards to States, and concentrating efforts in directed investments that will benefit the Nation as a whole. Efforts are continuing, as in the Department of Homeland Security, to ensure that the allocation and use of funds reflects the best information on risk and needed performance improvements. For example, CDC will continue the Cities Readiness Initiative that is essential to ensuring local governments can provide medicines to their citizens in time to protect them from released bioterrorism agents. This includes targeted grants and, in FY 2006, additional funding for cooperative work among CDC, the United States Postal Service, and participating cities. Investments in States have markedly improved capacity. The Laboratory Response Network (LRN) now consists of 134 reference laboratories in all States, up from 91 in 2001. Most can confirm the presence of anthrax and tularemia, as well as perform presumptive screening for smallpox. More than 8,800 clinical laboratory personnel have been trained to play a role in the detection and reporting of public health emergencies. CDC is also expanding the number of trained Federal staff that are available to States to up to 500. (States can request CDC to detail staff in lieu of a portion of their cash grants.) In addition to assistance to States and communities, CDC will invest $140 million to continue to upgrade its internal capacities by improving epidemiological expertise in the identification and control of diseases caused by terrorism, including better electronic communication, distance learning programs, and cooperative training between public health agencies and local hospitals. No funding is earmarked for research on older anthrax vaccines as the project is nearing completion; funds were redirected into stockpile purchases. Health PromotionChronic diseases - such as heart disease, cancer, and diabetes - are the leading causes of death and disability in the United States. These diseases account for 7 out of every 10 deaths and affect the quality of life of 90 million Americans. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. In addition, birth defects are the leading cause of infant mortality in the United States. The direct and indirect costs associated with disabilities in the United States exceeds $300 billion annually. The Health Promotion Coordinating Center includes the National Center for Chronic Disease Prevention and Health Promotion, and the National Center on Birth Defects and Developmental Disabilities. The President's FY 2006 budget includes a total of $964 million to fund a large number of programs that are focused on improving the quality of medical care targeted at chronic diseases, prevention programs, and disabilities. Chronic Disease Prevention and Health Promotion: Chronic disease prevention programs at CDC have grown continually since 2001, as CDC has broadened its focus beyond preventing infections and seeks to reduce the human and financial impact of chronic diseases. The budget seeks $840 million to maintain at the FY 2005 level a wide range of activities, including support for: programs to promote healthy behaviors; studies to better understand the causes of these diseases; and surveys to better monitor the health of the nation. CDC will maintain its focus on reducing obesity, diabetes, and tobacco use as the $47 million Steps to a Healthier US program matures and the newly-funded State tobacco quitlines become well-established. Youth Media Campaign (VERB) The budget does not include funds to continue the VERB: It's What You Do Youth Media Campaign, for which $59 million was provided in FY 2005. VERB was originally designed as a 5-year demonstration project; FY 2005 is the fifth year. Birth Defects, Developmental Disabilities, Disabilities and Health: CDC's National Center on Birth Defects and Developmental Disabilities works to identify the cause of birth defects and developmental disabilities, to help children develop and reach their full potential, and to promote the health and well-being among people of all ages with disabilities. The budget for activities related to Birth Defects, Developmental Disabilities, Disability and Health for FY 2006 includes $124 million. This funding will be used for many disability programs, including those related to Fetal Alcohol Syndrome, Autism, attention-deficit/hyperactivity disorder (ADHD), Duchenne and Becker Muscular Dystrophy, Disability and Health, monitoring developmental disabilities, limb loss, and spina bifida. Health Information and ServiceThe budget for the Health Information and Service Coordinating Center includes $224 million for the National Center for Health Statistics (NCHS) and new centers for Health Marketing and Public Health Informatics. Health Statistics: The budget requests $109 million for Health Statistics, which maintains funding at the FY 2005 level. Major investments in Health Statistics over the past several years reflect the importance of the data systems of the National Center for Health Statistics (NCHS) to track our progress and inform solutions on a myriad of problems in the public and private health sector. Areas of focus have been to preserve and modernize the Nation's vital statistics system; to expand contracts with States to purchase birth and death data; and to move forward with e-government initiatives to update the content of birth and death records. Additionally, funds have been used to increase the sample sizes necessary for the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS) to provide needed information on a wide range of conditions, diseases, and population subgroups and to address major emerging data gaps in the National Health Care Survey, such as long-term care and assisted living facilities. Public Health Informatics: The request includes $68 million for Public Health Informatics. Effective public health response involves many organizations working together and exchanging information. The new realities of terrorism and naturally occurring disease trends require a new level of interoperability that facilitates rapid, secure, and effective communication. The new National Center for Public Health Informatics is responsible for ensuring that public health departments' new disease outbreak detection and reporting systems incorporate the common standards that facilitate real-time sharing of key data among public health officials responsible for verifying, investigating, and responding to outbreaks. The request reflects a $5 million reduction in funding for the Public Health Information Network as CDC moves from standards design to system implementation. Health Marketing: CDC's new National Center for Health Marketing will work to connect the agency's research, surveillance, programmatic services, and communication efforts to CDC's customers, the American public. Funding for the Health Marketing activity in FY 2006 is requested at $47 million. The initiatives related to Health Marketing will enhance communication support and improve outreach to CDC's five priority sectors: public health communities; business and workers; education; health care; and other federal agencies. Environmental Health and InjuryThe budget for the Environmental Health and Injury Coordinating Center includes $285 million to maintain funding levels for the National Center for Environmental Health and the National Center for Injury Prevention and Control. Environmental Health: The budget includes $147 million to maintain ongoing environmental disease prevention programs. The National Center for Environmental Health (NCEH) assists State and local health agencies in developing and increasing their ability and capacity to address environmental health problems, especially asthma and childhood lead poisoning. Additionally, NCEH provides complete, timely, and accessible data on environmentally related diseases and conditions, including asthma, childhood lead poisoning and genetic diseases; improves the understanding of risk factors for, and causes of, environmentally related diseases and conditions; and develops effective prevention programs. The CDC's state-of-the-art environmental laboratories use modern technology to assess human exposure to environmental chemicals, and its effects. Injury Prevention and Control: Injuries are the leading cause of death of children and young adults in the United States. Injury is a fundamental threat to human health and life, and CDC employs the same scientific methods that prevent infectious diseases to prevent injuries - defining the health problem, identifying the risk and protective factors, and developing and testing prevention strategies. The budget request for FY 2006 includes $138 million to support programs focused on residential fire deaths, intimate partner violence, non-fatal fall traumatic brain injury, child abuse and neglect, rape prevention and education, and other injury prevention and control initiatives. Occupational Safety and HealthAs American workers are getting older and becoming more diverse, working longer hours, and more workers are in temporary positions, the estimated annual cost of occupational injuries in the United States has grown to over $250 billion. The National Institute of Occupational Safety and Health (NIOSH) is the primary federal entity responsible for conducting research and making recommendations for the prevention of work-related illness and injury. NIOSH translates knowledge gained from research into products and services that benefit workers' safety and health in settings from corporate offices to construction sites and coal mines. The budget for FY 2006 includes $286 million for NIOSH activities, level with FY 2005. This includes work on the National Occupational Research Agenda (NORA) and personal protective technology and respirator research for the nation's 50 million miners, firefighters, emergency responders, and health care, agricultural, and industrial workers. In addition to these ongoing activities, NIOSH assists in the implementation of the Energy Employees Occupational Illness Compensation Act of 2000; funds for this activity are provided by the Department of Labor. NIOSH's recent PART review indicated that the program has a clear purpose and a well-established mechanism for setting priorities to guide budget requests and funding decisions through the National Occupational Research Agenda (NORA). The program is working to further focus its research efforts on having an impact through a Research to Practice initiative. In addition, the program will advance its work with the National Academy of Sciences to develop a standard method of measuring the impact of their research on the occupational safety and health field. Public Health ResearchThe FY 2006 request includes $31 million to fund investigator-initiated prevention research projects. Prevention research at CDC is population-based, and targeted to health promotion and disease prevention. All research is proposed by researchers working with communities, health practitioners, and policymakers, and will address the need for a multi-disciplinary approach to health marketing, health communication, and innovative statistical methods to estimate the burden of disease. Research results are expected to form the basis of public health policies and best practices for a range of specific populations and settings. Public Health Improvement and LeadershipThe President's Budget for FY 2006 includes $207 million for Public Health Improvement and Leadership, a new budget line Congress created to more transparently reflect CDC's programmatic funding. This budget line funds the Office of the Director, the newly established coordinating centers, workforce development staff, and the central management costs in each of the operating Centers, Institute, and Offices at CDC. This budget line includes an $8 million Director's Discretionary Fund that will be used to finance developing public needs. In FY 2005, the Congress also included $60 million in one-time projects in this budget line; these projects are not continued in the FY 2006 request. Business Services SupportThe Business Services Support budget activity, as well as the Leadership and Management sub-budget activity, were created to consolidate CDC's administrative and management costs into two lines and more transparently reflect CDC's programmatic funding. The Business Services Support line includes a wide range of agency-wide operating costs, such as rent, utilities, and security. It also funds the business services functions at CDC (such as grants management, financial management, facilities management, etc.), and additional mission-support activities. CDC has made a variety of improvements in its business and management operations in recent years, as evidenced by recent scores of all green on the PMA scorecard. CDC consolidated 13 information technology infrastructure functions into the new Information Technology Services Office and is consolidating all budget execution functions within CDC's Financial Management Office. Over 40 public and medical professional inquiry hotlines will be merged into a single integrated customer service center. The $15 million reduction in FY 2006 reflects CDC's expectation of continued efficiency improvements under the new organizational structure. Preventive Health and Health Services Block GrantSince 1981, the Preventive Health and Health Services Block Grant has provided 61 States, tribes, and territories with flexible funding the grantee could direct as it deemed appropriate. Funding, however, is often duplicative and overlaps with other CDC programs. As CDC strives to improve efficiency, existing resources will be directed to programs which have traditionally addressed similar public health issues. Modern and Secure Laboratories and FacilitiesSince 2001, CDC has initiated or completed the construction of more than 2.7 million square feet of laboratory and other facility space. This year, CDC is completing an Infectious Disease Laboratory, the Scientific Communications Center, the Headquarters and Emergency Operations Center, and the Environmental Toxicology Laboratory. CDC is also initiating construction of a new Environmental Health office facility. The FY 2006 request allocates $7.5 million to fund repairs and improvements for existing facilities, and $22.5 million to complete construction of the Ft. Collins, Colorado Vector Borne Infectious Diseases Replacement Laboratory. No funding is requested to initiate new projects. The Buildings and Facilities program underwent a PART review for FY 2006. The program uses a master plan of CDC headquarters construction projects, developed by senior managers from CDC's Centers, Institute, and Offices, to target resources. The program is conducting analyses of trade-offs between costs, schedule, and risk for construction projects, and the program has supported targeted studies to guide program improvements. The program has adopted a new outcome measure that will track changes in areas such as the productivity and expansion of laboratory research and techniques resulting from new facilities. The program will also measure performance on meeting scope, schedule, budget, and quality targets. Agency for Toxic Substances and Disease RegistryThe request for ATSDR is $76 million, the same as FY 2005. ATSDR, managed as part of CDC, is the lead agency responsible for public health activities related to Superfund sites. ATSDR develops profiles of the health effects of hazardous substances, assesses health hazards at specific Superfund sites, and provides consultations to prevent or reduce exposure and related illnesses. Funds will also be used for the maintenance costs of the World Trade Center Exposure Registry. |
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Last revised: March 30, 2005
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