Dr. Brenda Fitzgerald Appointed Director of the CDC; Dr. Jerome Adams Nominated to be Surgeon General
HHS Secretary Dr. Tom Price on July 7 officially named Dr. Brenda Fitzgerald as the new Director of the Centers for Disease Control and Prevention (CDC). The appointment does not require Senate confirmation and Dr. Fitzgerald assumed her position the same day. She is an obstetrician-gynecologist and was the Commissioner of the Georgia Department of Public Health (DPH) and Georgia State Health Officer. Reacting to the appointment, ASPPH Chair Dr. Donna Peterson said, “Dr. Brenda Fitzgerald is a solid choice as the new director of the CDC. Her leadership of the Georgia Department of Public Health has given her first-hand experience in dealing with the many challenges facing state and local health departments. Dr. Fitzgerald recently participated in an ASPPH population health roundtable and we were impressed by her commitment to cross-sector engagement to advance population health. The academic public health community looks forward to working constructively with Dr. Fitzgerald to advance our shared agenda of improving health locally, nationally, and globally through the creation, transmission, and application of public health knowledge and a well-prepared and resourced public health workforce.” Dr. Petersen’s comments on the appointment were quoted in Science, Nature, Modern Healthcare, The Scientist, and Bloomberg/BNA. Tony Mazzaschi was quoted on the appointment in the Washington Post. Dr. Phillip Williams (Univ. of Georgia) was quoted on the appointment in Nature, Dr. Michael Eriksen (Georgia State) was quoted in the Wall Street Journal and Dr. James Curran (Emory) in Science.
Dr. Price also announced that Dr. Anne Schuchat, who has been the acting CDC director since January 20, will return to her role as CDC’s principal deputy director.
Donald Trump on June 29 announced the nomination of Dr. Jerome Adams as Surgeon General. Dr. Adams currently is the Indiana State Health Commissioner and holds an adjunct appointment at the Indiana University Richard M. Fairbanks School of Public Health. Previously, he served as a Staff Anesthesiologist and Assistant Professor of Anesthesia at the IU School of Medicine. The Surgeon General serves a four-year term by statute and must be confirmed by the Senate. Sylvia Trent-Adams has been acting surgeon general since Trump ousted Vivek Murthy on April 21.
Congressional Funding Debates Highlight Ideological Divisions Within and Between the Political Parties
During the early months of the Trump Administration, Congress focused on funding issues, trying to complete action on fiscal year 2017 appropriations while also reacting to the new Administration’s fiscal year 2018 budget proposals. In both cases, Congress is largely ignoring the Administration’s proposals and priorities. A summary of the FY 2017 funding agreement is available here.
Trump’s Fiscal Year 2018 Proposal Draws Fire from All Sides: The new administration released its FY 2018 budget proposal on May 23. The Administration proposed to increase defense spending by $54 billion and to reduce domestic spending by a like amount. The Trump proposal was filled with draconian cuts to safety net programs, along with funding and policy proposals that attack higher education with a vengeance. One veteran budget observer commented, “The Trump 2018 budget clearly is designed to appeal to no one but the Trump base. Not only does it make no effort to broaden interest in and support for the president’s program, but the budget’s extremely harsh spending cuts are almost certain to make opposition from both Democrats and moderate Republicans much, much easier.” There is a growing consensus that a year-long Continuing Resolution in FY 2018 is likely.
Agency Summary (Program Level): The Administration proposed cutting the NIH budget by 21 percent, the CDC budget by 21 percent, HRSA by 4.4 percent and moving AHRQ to NIH and slashing its budget at the same time.
Indirect Costs Cap: The Administration proposed capping the Facilities and Administrative (or indirect) costs at 10 percent on NIH awards.
Fogarty International Center: The Administration is proposing the elimination of the NIH’s Fogarty International Center, which supports international research capacity and training of researchers overseas. The budget would provide “a total of $25 million in mission-critical international research and research related activities within NIH Office of Director.” Fogarty was funded at $72.2 million in FY 2017.
Agency for Healthcare Research and Quality: The Administration is proposing to eliminate AHRQ and to transfer its functions to NIH. It is proposing to create a new NIH institute, titled the National Institute for Research on Safety and Quality. The budget provides $379 million for the new institute, of which $107 million would come from the Patient Centered Outcomes Research Trust Fund. The budget document purports that NIH already spends $1.5 billion on health services research.
Centers for Disease Control and Prevention: The Administration is proposing to eliminate the following programs of importance to academic public health:
The proposal would slash the CDC’s environment health budget by $60 million (to $157 million). The Administration would provide $551 million in cooperative agreements to states and local health departments for preparedness and response activities, but the total funding for Public Health Preparedness and Response would be cut by $136 million.
Health Resources and Services Administration: The Administration’s budget proposal eliminates the entire “Public Health and Preventive Medicine Programs” budget line, which is the source of funding for the Public Health Training Centers program (funded at $9.9 million in FY 2017) and grants for the Preventive Medicine Residency program.
Student Loans: The Administration is proposing to eliminate the Public Service Loan Forgiveness (PSLF) program, which is scheduled to forgive the loans of its first qualified applicants in October. The Administration is also proposing to consolidate and make major changes to various income based repayment programs.
Appropriators Oppose the Administration’s Priorities: Dr. Francis Collins and several of the NIH institute directors testified on June 22 before the Senate Labor-HHS-Education Appropriations Subcommittee. No member of the subcommittee spoke in favor of Donald Trump’s proposed 22 percent budget cut for NIH.
Senator Lamar Alexander (R-TN) spoke out strongly against the proposed cap on Facilities and Administrative (F&A or indirect) costs. He said: “The proposed cap is one of the more harebrained recommendations in the budget…The only way I can think of to make that money up is either higher tuition or less research. And less research is not our goal because less research means to me more jobs overseas… If there’s to be any changes to this, Congress wants to be involved. I’m going to get in the middle of that, and I’ll bet I can get a bipartisan group up to make sure we are. I hope we can nip this idea in the bud. It’s a thoroughly awful idea and bad policy. It would not do what I know the president would want it to do, which is to create more American jobs.”
During the hearing, Dr. Anthony Fauci, director of NIAID, spoke out against the proposed elimination of the Fogarty International Center. He said, “The Fogarty International Center is truly integral to all that we do both directly and indirectly, internationally and domestically.” He added: “The impact of the Fogarty training has been extraordinary and we really need to continue it.”
Subcommittees to Begin Considering Appropriations Bills Without a Budget Resolution: Plans to advance an FY 2018 budget resolution in the House were shelved on June 27 due to disputes over how much to reduce entitlements such as food stamps, welfare and Medicaid. House Budget Committee Chair Diane Black proposed including instructions to relevant committees to produce $200 billion in mandatory cuts that would be considered using reconciliation procedures, which limit the ability to filibuster the measure in the Senate. However, members of the House Freedom Caucus say the proposed cut isn’t enough. Freedom Caucus Chair Mark Meadows said that lawmakers have agreed on topline budget targets of $621 billion for defense and $511 billion for non-defense. The budget resolution is now not likely to move to the House floor until mid-July.
ASPPH Primary Reps Weigh in on Fogarty Elimination and F&A Cap Proposals
ASPPH on June 21 delivered two letters to key Congressional leaders, each signed by more than 60 ASPPH primary representatives, strongly opposing the proposed elimination of the NIH Fogarty International Center and opposing the proposed 10 percent cap on Facilities & Administrative (F&A or indirect) costs on NIH awards. Concerning the cap proposal, the deans and program directors’ letter said, “We strongly urge Congress to oppose proposals to cap Facilities and Administrative cost rates and to recognize that these costs are essential to a healthy and viable academic-federal research partnership.” The leaders noted that “Such a fundamental change …will end the ability of many public health schools and programs to undertake important federally-sponsored research.” In their letter on the Fogarty proposal, the academic public health leaders said, “Eliminating the important work of the Fogarty International Center is shortsighted and contrary to the best interests of the U.S. and its citizens.”
The leaders of more than 25 associations and academic societies, including ASPPH, wrote to HHS Secretary Dr. Tom Price on May 16 urging the Administration drop its proposed elimination of the NIH Fogarty International Center. The letter, which was signed by ASPPH Board Chair Dr. Donna Petersen, said, “Although Fogarty’s financial footprint is small relative to other NIH Institutes and Centers, its impact has been large and its elimination would be costly to our scientific sector and to our nation’s public health. The human capital created through Fogarty serves as a diplomatic resource for America, and the program’s elimination would come at a cost to our nation’s global standing…Breakthroughs made possible by Fogarty funding directly benefit U.S. patients and researchers.” The letter was organized by the Infectious Diseases Society of America.
ASPPH’ Congressional Briefing on Public Health Approaches to the Opioid Epidemic Draws a Standing Room Only Crowd
ASPPH on June 19 sponsored a Congressional Briefing titled, “The Opioid Epidemic: Findings from Public Health Research Experts.” The session was sponsored by Representatives Harold Rogers (KY), Tim Murphy (PA), Evan Jenkins (WV) and Bill Johnson (OH). Rep. Jenkins opened the session, expressing Congressional concern with the impact of the addiction crisis on constituents.
The briefing was attended by almost 200 House and Senate staff members, along with various addiction research and treatment leaders and advocates. The 90-minute briefing was recorded and is now available:
Leaders from public health schools in five states in the Appalachian region participated in the briefing:
They discussed the complex and dynamic processes at work in the opioid crisis and shared their findings on unique public health approaches to address the course of the epidemic. The leaders also discussed how academic public health is assisting affected communities by bringing traditional and novel epidemic control strategies to bear on the disease, including the development and evaluation of treatment options, law enforcement methods, prevention approaches, and state and local policies. The session concluded with a robust Q&A session. The speakers also visited with their state’s Congressional delegations and staffs both before and after the briefing to discuss local aspects of the opioid epidemic crisis.
ASPPH Joins Amicus Brief on Immigration Ban
ASPPH and almost two dozen other associations on June 9 filed an amicus curiae (friend of the court) brief with the Supreme Court in response to the Trump Administration’s request for a stay of two district court injunctions in the travel ban litigation. The travel ban applies directly to citizens from six Muslim majority countries and includes a total suspension of the Refugee Admission Program. The brief argues that a fair and efficient immigration system strengthens the American healthcare system and advances the nation’s health security. The brief makes the case that the executive order inhibits global research and public health collaboration opportunities. It also stresses that barring or discouraging public health scientists from coming to the United States has the potential to set back efforts to prevent pandemics and other public health threats to Americans.
The U.S. Supreme Court on June 26 announced it would hear arguments in October in the case. The court also limited the implementation injunctions imposed by lower courts. It allowed the immigration ban to be implemented “with respect to foreign nationals who lack any bona fide relationship with a person or entity in the United States.” The injunctions stand in regard to those with a relationship to a person or entity in the U.S. Examples offered by the court of such relationships included students admitted or accepted to a U.S. educational institution and lecturers from affected countries.
ASPPH has engaged the Trump Administration related to the Federal hiring freeze and the January 31 executive order on refugees and immigrants. The Association is also preparing for the upcoming legislative fights on health insurance and the fiscal year 2017 and 2018 appropriations bills.Read more
Many of the ASPPH’s 2016 legislative and policy initiatives will inform the Association’s 2017 advocacy efforts. Among the highlights of 2016 include the development of a white paper distributed to presidential candidates that focuses on the Association’s policy priorities, efforts to enhance the role of prevention research in the Cancer Moonshot initiative, and efforts to promote population health. The Association’s advocacy activities related to Federal appropriations continues to be a top priority as well.Read more