June 2004

Amidst the unremitting, cutthroat partisanship of an election year in Washington, DC and the unremitting horrors in the headlines, it is rare to find some good news. But there is some good news this month. Let's start with that.
 

Legislators Introduce Breakthrough Bipartisan Tobacco Control Bill

Key legislators from both parties introduced a bill providing for strong FDA regulation of tobacco products on May 20, 2004. Hailed as a breakthrough by tobacco control advocates, the Youth Smoking Prevention and Public Health Protection Act meets criteria for strong legislation established by the Campaign for Tobacco-Free Kids, the American Cancer Society, the American Heart Association, and the American Lung Association, which NACCHO has also endorsed. It is the first time ever that identical, bipartisan tobacco control bills have been introduced in both House and Senate.

Senators Michael DeWine (R-OH) and Ted Kennedy (D-MA) are the principal Senate cosponsors of the bill, while Representatives Tom Davis (R-VA) and Henry Waxman (D-CA) are the House co-sponsors. In a divided industry, Altria (corporate parent of Phillip Morris USA) endorsed the measure, while other companies did not. It is thought that tying this bill to a popular measure to provide buy-outs for tobacco farmers will provide the best chance for Congressional action this year, although such action is far from certain.
 

Administration Proposes to Redirect BT Funds to Cities

The Department of Health and Human Services has formally proposed a change in how the grants for state and local bioterrorism preparedness should be used. In a May 19, 2004 letter to Congressional appropriators, the HHS Secretary informed Congress of a plan to reduce each state's award by about $1 million and direct some of those funds to a new "Cities' Readiness Initiative" involving 21 of the nation's largest cities. The cities would be required to use the redirected funds to achieve and sustain a capacity to deliver antibiotics from the National Pharmaceutical Stockpile to their entire populations within 48 hours. CDC would keep another portion of the funds to expand a biosurveillance program known as "BioSense" (see below), and $12 million would go to the United States Postal Service to aid in distribution of stockpile medications. HHS officials indicated that they would not release the guidance for the use of the upcoming year's funds (for the program year beginning August 31, 2004) until the expiration of a 10-day Congressional comment period.

Congressional reaction has been mixed. Pennsylvania Senator Arlen Specter (R-PA), chair of the Senate health appropriations subcommittee, signaled approval, while his Democratic counterpart, Sen. Tom Harkin (D-IA) objected strenuously. The respective roles of the Administration and Congress with respect to this action are in a "gray" area; the rules that will be applied are unclear. Normally, the Administration cannot reprogram funds that have been appropriated for one purpose to another purpose without explicit permission from both Senate and House appropriations committees. However, Secretary Thompson couched his letter to Congress as a "notification" rather than a "request." One Congressional staffer characterized this approach as "pushing the envelope" of the Administration's authority.

NACCHO wrote to Congress approving the principle of allocating funds to localities, but noting that this particular reallocation will likely adversely affect all but the 21 specified cities, and that the impact on other state funding to those 21 cities also is unknown. Copies of the HHS request and NACCHO's reaction, along with a table showing the impact of the reallocation for each state, can be found at http://www.naccho.org/project90.cfm. It is possible that a decision will have been made final and the guidance issued by CDC before this newsletter reaches you. The cities that would receive increased funding (through the state or city health department) for stockpile distribution are: New York City; Los Angeles; Chicago; Houston; Philadelphia; Phoenix; San Diego; Dallas; Detroit; San Francisco; Boston; District of Columbia; Seattle; Denver; Las Vegas; Cleveland; Atlanta; Miami; Minneapolis; St. Louis; and Pittsburgh.

"Bio" Programs Proliferate as Congress Nears Passage of Research Program for Vaccines and Antidotes

If you weren't already aware that federal policy makers are taking bio-defense seriously, consider the following growing programs: BioWatch; BioSense; BioShield. If your head is spinning, here is a primer and a status report on each of these federal efforts.
 

BioWatch: a program coordinated by the Department of Homeland Security, with involvement by the Environmental Protection Agency (EPA) and the Centers for Disease Control and Prevention (CDC). Sensors to detect air-borne pathogens have been placed in about 30 locations. The Administration's FY 2005 budget proposes to more than double the funding for BioWatch to a total of $118 million. NACCHO has requested that half of the $65 million proposed increase be designated for local health departments who incur costs in planning consequence management and responding when a sensor returns a positive result.
 

BioSense: a term that HHS is using to encompass a collection of activities aimed at building a national bio-surveillance system. The premise is that there are existing data sets with prediagnostic and diagnostic data that can be analyzed in new ways to enable earlier warnings of adverse public health events. Under BioSense, CDC is acquiring data sets and developing algorithms for analysis. BioSense is also an evolving web-based application for use by state and local health departments to access these data sets. Under the Administration's plan to reprogram funds for state and local capacity-building for bioterrorism preparedness, $11.9 million would be taken from state grants and used for BioSense.
 

BioShield: a new program for providing federal funds primarily to the pharmaceutical industry for research, development, and purchase of medical countermeasures for biological, chemical, and radiologic terrorism, including vaccines, biologics, and diagnostics. The House and Senate have both passed legislation that is needed to establish this new program (including accelerated Food and Drug Administration approval of such countermeasures) and it is likely that they will agree on a compromise version and the President will sign the bill before the year is out. Congress has already created a reserve fund that will provide $5.6 billion to BioShield over a period of 10 years.

What's Next on the Budget Front

Congress has not yet agreed on a budget and it is unclear whether any agreement will be reached. However, the appropriations committees, who decide how the money gets spent, are moving forward anyhow, basing their "bottom line" assumptions on the caps in the disputed budget. These caps are so tight that many unpopular cuts will be required. For this reason, it is not yet known whether the House and Senate appropriations committees will act on the bills before the election. There is widespread agreement that, regardless of the course that the appropriations committees take, final Congressional passage of the FY 2005 funding bill for health, human services and education is highly unlikely to occur before the November election. As was the case this year, it will probably wait until early 2005, several months after the October 1, 2004 start of the new fiscal year.