ASM Responds to Request for Information on CDC Reform
The Honorable Senator Bill Cassidy, M.D.
Ranking Member, Senate Health, Education, Labor and Pensions Committee
428 Dirksen Senate Office Building
Washington, D.C. 20510
Re: Request for Information from Stakeholders Regarding CDC Reform
Dear Senator Cassidy,
°®¶¹´«Ã½ (ASM) is the one of the largest life science societies, composed of more than 36,000 scientists and health professionals. Our mission is to promote and advance the microbial sciences. ASM members work on all aspects of public health, and our members include researchers, infectious disease physicians, clinical microbiologists, veterinarians and more. Through this work, ASM and its members regularly support, collaborate with and benefit from Centers for Disease Control and Prevention (CDC) programs and data. ASM appreciates the opportunity to respond to this request for information regarding reform at the CDC.
An example of successful innovation within the CDC is the Advanced Molecular Detection (AMD) program, located within the National Center for Emerging and Zoonotic Infectious Diseases. Starting a decade ago, the AMD program aimed to close a widening technological gap in pathogen genomics, through which the public health system was falling behind. It has succeeded beyond expectations. These technological advances played a key role in identifying, understanding, tracking and tracing SARS-CoV-2 and its variants, and plays a role in addressing and understanding other public health threats, such as antibiotic resistant organisms, seasonal influenza and foodborne illness, to name a few. The AMD program continuously adapts to use the latest genomic technologies and works to get these innovations into routine use in state and local public health departments. It does this by serving a bridge across sectors—academia, private sector and international entities—to improve the U.S. public health response through collaboration and sharing of technology.
ASM also commends the establishment of the CDC’s Center for Forecasting and Outbreak Analytics. This Center was established in 2022 to improve the nation’s ability to prepare for and respond to infectious disease threats using data, modeling and analytics. The Center for Forecasting and Outbreak Analytics aims to adapt cutting edge infectious disease forecasting and modeling into everyday public health practice, both at the CDC and in state and local health departments. This program will require a long term funding commitment to succeed. Like other areas in the agency, it is existing right now on short-term, supplemental funding.
Outside of the CDC, the newly established Technology, Innovation and Partnerships Directorate at the National Science Foundation provides a model for working to bridge gaps between basic research and commercialization to foster innovation.
5. What steps can CDC take to identify more, and engage in, external partnerships? This includes partnerships with the interagency, academia and the private sector.
ASM engages with and partners with agencies across the federal government and has found the CDC to be highly responsive and proactive about external outreach and partnerships.
One new and promising partnership between the CDC, state health departments and academia is the CDC’s Pathogen Genomics Centers of Excellence (PGCOEs). These centers, modeled in part after Vector-borne Diseases COEs, were first established in 2022, and consist of a network of 5 state public health departments, in partnership with academic institutions and other research-focused partners. Together, the entities work to improve innovation in pathogen genomics, molecular epidemiology and bioinformatics with the goal of preventing, detecting and responding to infectious disease threats to public health. Current PGCOEs are in Washington state, Virginia, Georgia, Massachusetts and Minnesota. We thank Senator Baldwin and Senator Cassidy for their leadership on the Tracking Pathogens Act, which Congress passed in December 2022, as part of a larger legislative package. This bill included an authorization of these centers. However, without sustained funding in the coming years, we risk losing this valuable infrastructure and these forward-looking programs.
The AMD program also has established strong partnerships through broad agency agreements (BAAs) to conduct smaller projects with academic entities and private sector partners related to pathogen genomics in public health.
ASM also supports the CDC’s efforts to address antimicrobial resistance globally. The CDC’s Global AR Lab and Response Network has supported ASM’s Global Health Program’s work to improve surveillance capacity to detect and monitor emerging antimicrobial resistance. U.S. and international universities, international nongovernmental organizations, foreign government agencies and other associations also partner with the CDC on this work. On the global stage, ASM has partnered with the CDC to bring attention to antimicrobial resistance at °®¶¹´«Ã½ Nations events.
1. How can Congress improve the flow of public health data to CDC and back to states within the current system?
Across the board, state and local health departments often lack the capacity to efficiently share data with the CDC, the public and other health departments. Until recently, some health departments relied on paper records, due to outdated equipment or lack of reliable internet. Congress could help improve the flow of data to the CDC by funding targeted grants to improve data infrastructure, collection, standardization and sharing.
For example, ASM has identified poor data infrastructure as an obstacle to addressing antimicrobial resistance (AMR). The CDC leads the U.S. public health response to AMR through its Antimicrobial Resistance (AR) Solutions Initiative, Lab Network and AR Isolate Bank (in coordination with FDA), which supports activities in all 50 state health departments, several local health departments, Puerto Rico, Guam and the U.S. Virgin Islands. Despite these efforts, most public health laboratories are not equipped with the trained personnel needed to translate AMR findings into rapid identification of emerging threats. Data modernization is needed for a systematic approach to detecting and tracking AMR.
Congress can improve public health data for AMR by providing robust and sustained funding for the CDC’s Antibiotic Resistance Surveillance and Laboratory Network, the National Healthcare Safety Network and the AMD program, which together coordinate AMR data collection and improve AMR surveillance.
The STAAR Act (), introduced in the previous Congress by Sen. Sherrod Brown (D-OH), contains provisions to strengthen monitoring capacity within intramural and extramural laboratories for stewardship and AMR emergence while making the data public facing. Passing this legislation would improve the flow of AMR data between the CDC, providers and state and local health departments.
6. How can Congress and CDC better leverage both disease-specific and disease-agnostic data collection strategies? What are the benefits of both approaches, when should they be used and how can we minimize potential silos between datasets?
Congress can improve public health data collection by permanently authorizing and providing sustainable funding for the National Wastewater Surveillance System (NWSS). This cutting edge, promising data collection tool was established to monitor wastewater for COVID-19 but, in time, has shown to have other important public health applications. The NWSS could be deployed to monitor spatial and temporal trends for a variety of health threats—from polio, to influenza, to AMR—but its future is uncertain, as the current network is funded through emergency supplemental funding.
ASM supports Section 105 of the HELP committee’s reauthorization of the Pandemic and All-Hazards Preparedness Act (S. 2333), which would authorize this system and allow it to provide continued value.
4. CDC’s Center for Forecasting and Outbreak Analytics intends to provide information to support timely decision-making and action. How can this approach be applied across CDC, and how can CDC’s data better inform the actions of other federal, state and local decision-makers?
ASM strongly supports the Center for Forecasting and Outbreak Analytics, which is central to the Moving Forward plan for CDC. This center coordinates closely with the AMD program given the cutting-edge technology, bioinformatics and epidemiology expertise it offers. AMD’s work has helped uncover previously unknown threats, helped pinpoint sources of outbreaks and improved understanding of disease transmission dynamics. Expanding this program could better support timely decision making and action.
Capacities similar to the Center for Forecasting and Outbreak Analytics could be used to perform risk-benefit analyses of proposed public health interventions. The incorporation of behavioral elements could improve the CDC’s models. For example, behavioral elements could be used to predict vaccine uptake and the effectiveness of other infection prevention and control measures.
2. How can CDC’s epidemiological, laboratory and other core public health and scientific work be encouraged further?
Support to maintain and expand laboratory capacity is paramount. This includes both human and financial resources. The cost of maintaining labs increases each year, from quality and safety initiatives to the cost of shipments and supplies, to recruiting and retaining specialized and highly trained staff. ASM urges Congress to devote the resources needed to bolster laboratory capacity, not only respond to public health emergencies, but also to address the real day-to-day challenges our labs face.
Another obstacle to maintaining and encouraging the CDC’s laboratory work and laboratory capacity across the country is the current shortage of medical laboratory scientists and infectious disease laboratory professionals. In 2016, the vacancy rate for medical laboratory scientists working in clinical microbiology laboratories was 6.25%, and the vacancies for supervisory positions was nearly 4%. By 2018-19, the vacancy rates had grown to 10.56% and nearly 7%, respectively. These shortages are expected to continue to grow, while demand for laboratory services increases. To combat these shortages, ASM recommends establishing federal loan forgiveness programs, including those that focus on laboratorians in public health, which include medical microbiologists and other medical laboratory scientists, and creating federal training grants for medical microbiologists.
We thank you for your leadership and appreciate your interest in strengthening CDC programs. Key public health programs at the CDC, such as the National Wastewater Surveillance System and the Advanced Molecular Detection program, require further attention from Congress to build on their successes. ASM and its members stand ready to assist you in this effort. If you have any questions, please contact Nicole Zimmerman, Senior Specialist, Federal Affairs at nzimmerman@asmusa.org.
Sincerely,
Allen Segal
Chief Advocacy Officer
Cc: Sen. Bernie Sanders (I-VT), Chairman, Senate Health, Education, Labor and Pensions Committee
Ranking Member, Senate Health, Education, Labor and Pensions Committee
428 Dirksen Senate Office Building
Washington, D.C. 20510
Re: Request for Information from Stakeholders Regarding CDC Reform
Dear Senator Cassidy,
°®¶¹´«Ã½ (ASM) is the one of the largest life science societies, composed of more than 36,000 scientists and health professionals. Our mission is to promote and advance the microbial sciences. ASM members work on all aspects of public health, and our members include researchers, infectious disease physicians, clinical microbiologists, veterinarians and more. Through this work, ASM and its members regularly support, collaborate with and benefit from Centers for Disease Control and Prevention (CDC) programs and data. ASM appreciates the opportunity to respond to this request for information regarding reform at the CDC.
Fostering Innovation and Collaboration
1. A hallmark of successful institutions is creating and sustaining a culture of innovation. Have any specific federal agencies or government-affiliated organizations achieved this? If yes, what actions have they taken to cultivate this environment?An example of successful innovation within the CDC is the Advanced Molecular Detection (AMD) program, located within the National Center for Emerging and Zoonotic Infectious Diseases. Starting a decade ago, the AMD program aimed to close a widening technological gap in pathogen genomics, through which the public health system was falling behind. It has succeeded beyond expectations. These technological advances played a key role in identifying, understanding, tracking and tracing SARS-CoV-2 and its variants, and plays a role in addressing and understanding other public health threats, such as antibiotic resistant organisms, seasonal influenza and foodborne illness, to name a few. The AMD program continuously adapts to use the latest genomic technologies and works to get these innovations into routine use in state and local public health departments. It does this by serving a bridge across sectors—academia, private sector and international entities—to improve the U.S. public health response through collaboration and sharing of technology.
ASM also commends the establishment of the CDC’s Center for Forecasting and Outbreak Analytics. This Center was established in 2022 to improve the nation’s ability to prepare for and respond to infectious disease threats using data, modeling and analytics. The Center for Forecasting and Outbreak Analytics aims to adapt cutting edge infectious disease forecasting and modeling into everyday public health practice, both at the CDC and in state and local health departments. This program will require a long term funding commitment to succeed. Like other areas in the agency, it is existing right now on short-term, supplemental funding.
Outside of the CDC, the newly established Technology, Innovation and Partnerships Directorate at the National Science Foundation provides a model for working to bridge gaps between basic research and commercialization to foster innovation.
5. What steps can CDC take to identify more, and engage in, external partnerships? This includes partnerships with the interagency, academia and the private sector.
ASM engages with and partners with agencies across the federal government and has found the CDC to be highly responsive and proactive about external outreach and partnerships.
One new and promising partnership between the CDC, state health departments and academia is the CDC’s Pathogen Genomics Centers of Excellence (PGCOEs). These centers, modeled in part after Vector-borne Diseases COEs, were first established in 2022, and consist of a network of 5 state public health departments, in partnership with academic institutions and other research-focused partners. Together, the entities work to improve innovation in pathogen genomics, molecular epidemiology and bioinformatics with the goal of preventing, detecting and responding to infectious disease threats to public health. Current PGCOEs are in Washington state, Virginia, Georgia, Massachusetts and Minnesota. We thank Senator Baldwin and Senator Cassidy for their leadership on the Tracking Pathogens Act, which Congress passed in December 2022, as part of a larger legislative package. This bill included an authorization of these centers. However, without sustained funding in the coming years, we risk losing this valuable infrastructure and these forward-looking programs.
The AMD program also has established strong partnerships through broad agency agreements (BAAs) to conduct smaller projects with academic entities and private sector partners related to pathogen genomics in public health.
ASM also supports the CDC’s efforts to address antimicrobial resistance globally. The CDC’s Global AR Lab and Response Network has supported ASM’s Global Health Program’s work to improve surveillance capacity to detect and monitor emerging antimicrobial resistance. U.S. and international universities, international nongovernmental organizations, foreign government agencies and other associations also partner with the CDC on this work. On the global stage, ASM has partnered with the CDC to bring attention to antimicrobial resistance at °®¶¹´«Ã½ Nations events.
Making Data Work for Everyone
1. How can Congress improve the flow of public health data to CDC and back to states within the current system?
Across the board, state and local health departments often lack the capacity to efficiently share data with the CDC, the public and other health departments. Until recently, some health departments relied on paper records, due to outdated equipment or lack of reliable internet. Congress could help improve the flow of data to the CDC by funding targeted grants to improve data infrastructure, collection, standardization and sharing.
For example, ASM has identified poor data infrastructure as an obstacle to addressing antimicrobial resistance (AMR). The CDC leads the U.S. public health response to AMR through its Antimicrobial Resistance (AR) Solutions Initiative, Lab Network and AR Isolate Bank (in coordination with FDA), which supports activities in all 50 state health departments, several local health departments, Puerto Rico, Guam and the U.S. Virgin Islands. Despite these efforts, most public health laboratories are not equipped with the trained personnel needed to translate AMR findings into rapid identification of emerging threats. Data modernization is needed for a systematic approach to detecting and tracking AMR.
Congress can improve public health data for AMR by providing robust and sustained funding for the CDC’s Antibiotic Resistance Surveillance and Laboratory Network, the National Healthcare Safety Network and the AMD program, which together coordinate AMR data collection and improve AMR surveillance.
The STAAR Act (), introduced in the previous Congress by Sen. Sherrod Brown (D-OH), contains provisions to strengthen monitoring capacity within intramural and extramural laboratories for stewardship and AMR emergence while making the data public facing. Passing this legislation would improve the flow of AMR data between the CDC, providers and state and local health departments.
6. How can Congress and CDC better leverage both disease-specific and disease-agnostic data collection strategies? What are the benefits of both approaches, when should they be used and how can we minimize potential silos between datasets?
Congress can improve public health data collection by permanently authorizing and providing sustainable funding for the National Wastewater Surveillance System (NWSS). This cutting edge, promising data collection tool was established to monitor wastewater for COVID-19 but, in time, has shown to have other important public health applications. The NWSS could be deployed to monitor spatial and temporal trends for a variety of health threats—from polio, to influenza, to AMR—but its future is uncertain, as the current network is funded through emergency supplemental funding.
ASM supports Section 105 of the HELP committee’s reauthorization of the Pandemic and All-Hazards Preparedness Act (S. 2333), which would authorize this system and allow it to provide continued value.
4. CDC’s Center for Forecasting and Outbreak Analytics intends to provide information to support timely decision-making and action. How can this approach be applied across CDC, and how can CDC’s data better inform the actions of other federal, state and local decision-makers?
ASM strongly supports the Center for Forecasting and Outbreak Analytics, which is central to the Moving Forward plan for CDC. This center coordinates closely with the AMD program given the cutting-edge technology, bioinformatics and epidemiology expertise it offers. AMD’s work has helped uncover previously unknown threats, helped pinpoint sources of outbreaks and improved understanding of disease transmission dynamics. Expanding this program could better support timely decision making and action.
Capacities similar to the Center for Forecasting and Outbreak Analytics could be used to perform risk-benefit analyses of proposed public health interventions. The incorporation of behavioral elements could improve the CDC’s models. For example, behavioral elements could be used to predict vaccine uptake and the effectiveness of other infection prevention and control measures.
Improving Upon What Works Well
2. How can CDC’s epidemiological, laboratory and other core public health and scientific work be encouraged further?
Support to maintain and expand laboratory capacity is paramount. This includes both human and financial resources. The cost of maintaining labs increases each year, from quality and safety initiatives to the cost of shipments and supplies, to recruiting and retaining specialized and highly trained staff. ASM urges Congress to devote the resources needed to bolster laboratory capacity, not only respond to public health emergencies, but also to address the real day-to-day challenges our labs face.
Another obstacle to maintaining and encouraging the CDC’s laboratory work and laboratory capacity across the country is the current shortage of medical laboratory scientists and infectious disease laboratory professionals. In 2016, the vacancy rate for medical laboratory scientists working in clinical microbiology laboratories was 6.25%, and the vacancies for supervisory positions was nearly 4%. By 2018-19, the vacancy rates had grown to 10.56% and nearly 7%, respectively. These shortages are expected to continue to grow, while demand for laboratory services increases. To combat these shortages, ASM recommends establishing federal loan forgiveness programs, including those that focus on laboratorians in public health, which include medical microbiologists and other medical laboratory scientists, and creating federal training grants for medical microbiologists.
We thank you for your leadership and appreciate your interest in strengthening CDC programs. Key public health programs at the CDC, such as the National Wastewater Surveillance System and the Advanced Molecular Detection program, require further attention from Congress to build on their successes. ASM and its members stand ready to assist you in this effort. If you have any questions, please contact Nicole Zimmerman, Senior Specialist, Federal Affairs at nzimmerman@asmusa.org.
Sincerely,
Allen Segal
Chief Advocacy Officer
Cc: Sen. Bernie Sanders (I-VT), Chairman, Senate Health, Education, Labor and Pensions Committee
