Threat to Prevention and Public Health Fund Defeated

By Peter Kyriacopoulos, Senior Director of Public Policy, APHL

On September 14, the U.S. Senate defeated an attempt to eliminate the funding for the Prevention and Public Health Fund -- created in the Affordable Care Act (ACA), the federal health reform law.

Voting on a procedural matter, the Senate rejected an amendment offered by Senator Mike Johanns of Nebraska that would have used the resources in the Fund as an off-set for a new federal income tax reporting requirement that will be implemented by the Internal Revenue Service in 2012. The vote was especially significant because of the eight vote margin by which it was defeated, even though there was an extremely strong push by the business community that encouraged the Senate to pass the amendment.

The final vote tally can be found here; a letter of support from Secretary Sebelius (Health and Human Services) and Secretary Geithner (Treasury) is here.

The public health community has never come together so quickly and worked together as cohesively as it did in the effort to preserve the Prevention and Public Health Fund. This accomplishment will be easily replicated for any future attempts to reduce or eliminate the Fund and should send a very clear message to those who seek other uses for it: “Hands Off!”

Approaches to Combating HIV/AIDS

At a recent amFAR (The Foundation for AIDS Research) sponsored Congressional briefing* on AIDS research at NIH, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease (NIAID), described what he viewed as the three essential approaches in combating HIV/AIDS: 

• controlling disease progression
• preventing new infections; and
• curing existing infections.

Antiretroviral therapy (ARV) is one of the most potent interventions available in medicine today and can significantly prolong a patient’s life. Continued expansion of ARV therapy, especially in the developing world, is essential to controlling disease progression and improving patient outcomes.

 

For a sustainable response to the pandemic, however, preventing new infections will be crucial. A significant focus of NIH funding supports vaccine development and treatment research (Pre-Exposure Prophylaxis, test & treat programs, and microbicides). Dr. Fauci cited the positive results of a vaccine trial last year as a significant first step towards developing an effective vaccine.

 

In the coming years, NIAID plans to continue investing in vaccine research to build on this preliminary success. The ability to cure existing infections would be an incredible breakthrough, but as Dr. Fauci mentioned, HIV is capable of hiding in the body making a true sterilizing cure very difficult to develop. Research is continuing, though, especially on so-called “functional cures” that wouldn’t completely eliminate the virus from the body but would prevent its proliferation and pathogenesis without the need for additional treatments.

 

While it is clear that a great deal of research funding is directed toward HIV vaccines and cures, NIH is also committed to researching new approaches in testing and treatment. It is estimated that 21% of HIV-infected individuals are unaware of their status. In efforts to expand testing, public health laboratories will continue to play an important role in the public health response to this pandemic.

 

*The briefing was held in collaboration with the offices of Congresswoman Rosa DeLauro (D-CT), Congresswoman Barbara Lee (D-CA), and Congressman Eliot Engel (D-NY). Thank you to those offices for their support.

 

CDC Creates New Office of Prevention Through Health Care

By Peter Kyriacopoulos, Director of Public Policy, APHL

The Centers for Disease Control and Prevention (CDC) recently notified Scott Becker, APHL’s Executive Director, about a newly created office: the Office of Prevention Through Health Care (OPTH). This new office will enable CDC to more aggressively and effectively develop and disseminate policies that leverage the health care system to improve health through prevention. According to CDC, OPTH will coordinate health care activities across CDC programs and will lead engagement with external partners on health care issues.

There is no better way to achieve an immediate improvement in health through prevention than increased surveillance and detection of disease outbreaks. State and local laboratories performing tests of public health significance are on the frontline of this activity and are under extreme pressure to continue their exemplary performance because of the staffing reductions that have resulted from budget cuts caused by the economic downturn. Work on food safety, pandemic influenza, and other infectious diseases is imperiled because of these budget cuts.

An infusion of federal support for state and local public health workforce retention would produce an immediate high-value preventive intervention by preserving the much-needed laboratory professionals who are responsible for surveillance and detection on a daily basis. Improved surveillance and detection coupled with expedient delivery of that information through a robust laboratory informatics network would lead to a reduction in the instances of disease and reductions in the number of individuals seeking health care because of disease. It is hard to imagine a smarter engagement with the health system than by reducing the number of people it is struggling to serve. The positive implications for the payers, public and private, of this care are similarly obvious.

The corollary is also true, the path we are travelling with continued losses of state and local laboratory professionals coupled with the antiquated mechanisms for transmitting laboratory test orders and results can only lead to reduced surveillance and detection and increased incidents of disease that causes public and private payers to expend ever increasing amounts on the delivery of health care to increased numbers of people.