The American Society for Microbiology (ASM), representing over 42,000 researchers and clinicians, recognizes with appreciation Congress' historically strong support of medical research funded by the National Institutes of Health (NIH), which is critical to improving the health and well-being of all Americans. The ASM particularly commends the leadership of Chairman Porter and the members of the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies for providing a $17.8 billion appropriation for NIH in fiscal year 2000. This investment in basic and clinical research will lead to further advances in disease diagnosis, treatment and prevention.
As an organization knowledgeable about public health threats, the ASM recommends that Congress increase the proposed FY 2001 budget request for NIH to provide additional resources for basic and clinical research to address an increasingly complex set of scientific and medical challenges. The ASM endorses a $2.7 billion increase (15 percent) which would bring the NIH budget to $20.5 billion in FY 2001. During the past two years, Congress has increased the NIH budget by 15 percent each year, steps toward the goal of doubling the NIH budget by 2003 (The ASM is a member of the Ad Hoc Group for Medical Research and endorses the Ad Hoc Group's recommendation for NIH funding for FY 2001.
One of the NIH's highest priorities is the funding of medical research through research project grants, which generate new scientific knowledge and opportunities. Under the proposed FY 2001 budget, the NIH estimates that it would support 7,641 new and competing grants, a disturbing 1300 fewer grants than awarded in the current fiscal year. In addition, noncompeting and competing grants would be allowed only a 2 and 2.1 percent inflation increase, respectively, well below the 3 percent normally allowed and certainly well below general inflation rates.
Public Health Needs
There is no doubt that public health has benefited, not only in the United States but around the world, from bipartisan support for scientific research. The U.S. public expects and deserves, real advances in medicine and science. Through research funding, the NIH consistently contributes to our national health and to a real return on the public's financial investment. Advances from NIH supported research in the past year alone include the identification of a gene in salmonella bacteria linked to pathogenicity and present in many other disease-causing bacteria, suggesting innovative approaches to antibiotics and vaccines. NIH supported scientists also demonstrated that an inexpensive and simple treatment regimen with the antiretroviral drug nevirapine can reduce transmission of the HIV virus from mother to infant. These and other impressive successes must continue in the fight against infectious and chronic diseases and other threats to public health.
Infectious diseases remain the third largest cause of death in the United States, and a number one killer worldwide. Globally, acute respiratory infection is the leading infectious killer, responsible for 3.5 million deaths in 1998. Pneumonia and influenza are the leading infectious killers in the United States, ranked 5th in preliminary data for 1998. In an age of medical miracles, stubborn infectious diseases such as malaria persist, new infectious diseases such as hantavirus are emerging and old infectious diseases such as tuberculosis (TB) are reemerging. One-third of the world's population has latent TB and multi-drug resistant TB cases have been reported from 45 states over a 5 year period. The disease is the 8th leading cause of death worldwide, and on the rise in this country. Another "old" disease, malaria, is undergoing a global resurgence, with 275 million cases annually resulting in an estimated 1.1 million deaths. In the United States, an estimated 271,000 people are living with HIV infection, while the hepatitis C virus (a cause of cirrhosis and liver cancer) has infected almost 4 million and kills about 9,000 annually. In the United States, the rate of new HIV/AIDS infections is 40,000 per year, and over 420,000 people with AIDS have died as of June 20, 1999. The HIV/AIDS epidemic will soon become the worst epidemic of infectious diseases in recorded history, with over 16 million people estimated to have already died from AIDS at the end of 1999 and 33.6 million living with HIV/AIDS worldwide. Vaccines against both viruses are desperately needed.
As a nation, global health should be a high priority, for humanitarian reasons and because of our own vulnerability. For example, over 60 cases of West Nile virus encephalitis were detected in New York last year, the first documented cases in the Western Hemisphere of a virus restricted to Africa, West Asia and the Middle East.
Within the NIH, the National Institute of Allergy and Infectious Diseases (NIAID), has responded aggressively and effectively to microbial threats. The NIAID is the third largest component of the NIH due to the emergence of HIV/AIDS in the early 1980s and the realization that infectious diseases will continue to emerge unpredictably and at times explosively. It is clear that despite the defeat of diseases like smallpox, the dangers of infectious diseases are far from eliminated. One of the most significant threats to public health continues unabated, namely our inability to treat some infectious diseases because of antibiotic resistance. Antibiotic resistance is emerging for almost one-third of hospital acquired pathogens, as well as for many community acquired pathogens. Newly discovered pathogens, reemerging more virulent pathogens, with their sobering potential as bioterrorist weapons, mean that our struggle against infectious diseases is far from over and must be intensified.
The ASM recommends that NIH funding be increased to expand support for research to unlock the basic mechanisms of disease, for antimicrobial resistance, vaccine research, the infectious etiology of chronic diseases, emerging infectious diseases, hepatitis C, Lyme disease, opportunistic infections including tuberculosis, AIDS-related research, and microbial gene sequencing research. This intimidating list of microbial targets represents some of the most serious threats to public health, but also offers exciting possibilities for scientific advancement.
Scientific Progress and Opportunities
As we enter the 21st century, scientific opportunities are greater than ever, thanks to historic advances in basic and clinical research over recent years. These opportunities promise future benefits through new knowledge, new treatments, and new prevention strategies. We have witnessed the power of basic research to enhance public health manifested, for example, as effective hepatitis B vaccines or the development of rapid diagnostic tests for specific pathogenic microorganisms. We enter the century with new research capabilities, with more sophisticated laboratory tools and with a scientific workforce that is increasingly interdisciplinary in its attitudes and abilities.
Remarkable opportunities await researchers as a result of DNA and computer technologies developed in the latter part of the 20th century. ASM concurs with the NIAID's strategic plan statement that "DNA technologies are profoundly altering the health research landscape... [and] revolutionizing approaches to understanding pathogenesis, microbial physiology, and epidemiology of infectious diseases; radically advancing the understanding of immune activation and regulation; uncovering the genetic bases of disease susceptibility; and accelerating the development of new diagnostic, treatment and intervention strategies." This suggests stunning returns on public investment in basic research through the NIH. Add to these possibilities those provided by computer modeling, robotics and x-ray crystallography, and our future defenses against infectious diseases will likely look quite different than those of the past century.
Nature of And Requirements of Today's Research
New technologies will be a trademark of research in the 21st century, but they will not be the only agent of change reshaping our scientific approach to fighting both old and new diseases. The NIH will support the skilled personnel and the knowledge base necessary to adapt to these changes.
Much of the research landscape has changed over the past century, and will continue to change. Undoubtedly, scientific research will become even more expensive. Our increasing dependence on highly sophisticated technologies, such as advanced computers, functional imaging, and gene chips, increases the cost of doing research. The growing use of genetically modified animals and more elaborate animal facilities adds significant cost, as does the obvious need for more clinical research and clinicians participating in multi-institution studies. Scientific advances are cumulative and research is a multi-year process that may not produce a satisfactory product for a long period of time. Long-term funding for research and its underpinning infrastructure remains a necessary part of assuring scientific and medical advances.
Among the factors reshaping how we will do research is the absolute necessity for burgeoning databases, innovative computer usage, and information sharing within highly complex research projects. The NIH is responding to this new world of information with informatics projects, input from the National Library of Medicine, and interdisciplinary efforts in the fields of biology, computer science, and mathematics. In FY 2001, the NIH plans to provide the infrastructure to train the next generation of interdisciplinary scientists, to develop new means for storing, managing, and accessing vast data collections, and to enhance basic research in biomedical computing. To accomplish these new approaches to research, resources must be sufficient to train scientists in interdisciplinary fields and to encourage cooperative efforts among specialists.
Research in the 21st century must also adapt to significant changes in patient populations. Since the beginning of 20th century, life expectancy at birth in the United States has increased from fewer than 50 years to more than 76 years. As a result, future research will focus more than ever on enhancing the quality of human life. By the middle of this new century, the number of Americans over 65 will more than double and the number over age 85 will increase five-fold, making diseases of the aged a higher priority for researchers. An example is our growing awareness that microorganisms play more of a role in chronic disease than previously thought, an area now being investigated by the NIH. A virus has been found in spinal cords of victims of the neuromuscular disease known as Lou Gehrig's disease. Other chronic diseases with a possible microbial etiology include peptic ulcers, arthritis, cardiovascular disease, conditions affecting the lungs, and some types of cancer.
Women and minorities in the United States and around the world also bear a disproportionate burden of many infectious diseases, including AIDS, sexually transmitted disease, auto immune diseases and end stage renal disease. The NIH supports research to improve the health status of patients affiliated with these diseases.
Triumph over diseases that assault human health is not the only reward from research. The financial benefits of research are significant, through both economic stimulus and cost-savings. Approximately 82 percent of the funds appropriated to the NIH flows into research labs across the nation, supporting the work of more than 50,000 researchers affiliated with some 2,000 hospitals, universities, and other research institutions. Federally supported research offers obvious benefits to the biotechnology and pharmaceutical industries, which utilize discoveries from basic research and in return receive increased revenues and a steady input of opportunities for new-product development. In 1999, more than 153,000 highly skilled workers were employed by U.S. biotech companies, generating an impressive $19 billion in annual revenues.
The American public, however, is the greatest recipient of scientific and medical advances. Surveys consistently show that citizens support increased funding for medical research, in recognition of the importance of public health and of research as the foundation underlying success against disease. Through efforts by the NIAID there are clear examples of direct benefits from basic research: the identification of infectious agents for several human diseases, including Lyme disease, bronchopneumonia, hemorrhagic fevers, and diarrheal illness; and the genomic sequencing of the cause of syphilis, Treponema palllidum, and of E. coli strain K 12 and Chlamydia trachomatis, of a chromosome of the malaria parasite Plasmodium falciparum, and of Mycobacterium tuberculosis. As a result of these laboratory discoveries, we will develop more specific and more effective diagnostic, treatment and prevention strategies. The dividends from public investment in a vigorous and well-funded research enterprise are not merely hypothetical, but very real improvements in public health and the national economy.
The ASM appreciates the opportunity to submit written testimony to support increased funding for the NIH in fiscal year 2001 appropriation.