FY 2024 Budget Request for the Centers for Disease Control and Prevention

CDC’s surveillance systems are crucial for understanding and preventing the causes of disease, injury, and death that affect all Americans.  These systems, and a dedicated workforce in every jurisdiction that operates them, help identify contaminants in food, water, soil, and air; infectious disease outbreaks in hospitals; the drivers of maternal and newborn mortality and how to address them; and whether antimicrobial resistance has reduced options for treatment of bacterial and fungal infections. To have a U.S. public health system that is quickly responsive to changes in health and can rapidly analyze and communicate the latest data, the nation must continue to invest in public health surveillance.

CDC’s Data Modernization Initiative

The Data Modernization Initiative (DMI) is a multi-year effort to make core public health data and surveillance infrastructure current with today’s technology and build the systems for the future. Thanks to investments to date, the country is in a vastly different position for recognizing and responding to health threats than it was before the pandemic. The value of these gains—to gather, analyze, and share information for communities’ use in decision making—cannot be overstated. DMI investments improved the efficiency of nearly every surveillance tool in use by state and counties around the country. Further investment in FY 2024 with annual resources as requested in the Budget will continue to enhance health security for every American and anticipate future public health data needs.

Americans are already benefitting from investments in data modernization, including through DMI and other efforts across numerous CDC programs. CDC will continue to improve public health with FY 2024 requested increases, including each of the following:

• Speeding up transmission of digital laboratory reports through the Electronic Laboratory Reporting (ELR) from laboratories to state and local public health departments, healthcare systems, and CDC.
• Increasing connectivity for public health departments to communicate with the National Notifiable Diseases Surveillance System.
• Advancing real-time syndromic surveillance using de-identified data from participating emergency departments.
• Advancing real-time, automated case reporting to health departments using electronic Case Reporting (eCR), including expanding use of eCRs from rural health clinics.
• Enabling earlier and more robust information about deaths in the United States by increasing interoperability of systems pulling data for the National Vital Statistics System.
• Bringing state-of-the art analytic and predictive capacity to Americans through the Center for Forecasting and Outbreak Analytics at CDC.
• Protecting patient safety through CDC’s National Healthcare Safety Network.
• Reducing maternal deaths using information from Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET).
• Advancing U.S. capacity for gathering and analyzing data by integrating federal, state, and local government and hospital system data through the Ready Response Enterprise Data Integration platform (formerly HHS Protect).

This funding, paired with a modernized data authority requested in the budget will support public health agencies at the federal, state, and local levels to share quality and timely data, while reducing burden on providers.

Emerging Infectious Diseases and Quarantine

As the world sees an increase in newly emerging pathogens and responses become increasingly complex, CDC requests an increase in funding for Emerging Infectious Diseases to allow funds to be used for novel pathogens for which a funding line does not yet exist.  CDC is a global leader in studying and responding to emerging pathogens due to its groundbreaking research and state-of-the-art laboratories, public health expertise, and collaborative networks with state, local, and tribal health departments that quickly identify and characterize emerging pathogens and allow for coordination of multistate investigations and responses. Increased funding for Emerging Infectious Diseases will provide resources needed to harness these unique capabilities in the face of uncertainty.

The requested increase for quarantine activities will be used to scale-up migration systems that protect against future international outbreaks and pandemics. CDC will sustain investments made with COVID-19 supplemental funds to support innovative solutions that focus on a modernized and flexible traveler management program aimed to engage with travelers before, during, and after travel.

Antimicrobial Resistance

Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. Resistant infections can be difficult, and sometimes impossible, to treat. Antimicrobial resistance is an urgent public health threat. With increased funding requested in the budget, CDC will expand state and local capacity to detect and prevent emerging and existing threats through strengthened antibiotic stewardship data collection and quality improvement efforts, improve data sets addressing health equity and disparities, and expand the Global Antimicrobial Resistance Laboratory and Response Network. Investments will provide support to implement and achieve the goals under the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), 2020-2025.

Vaccine-preventable Diseases

Vaccines continue to be one of our most effective tools to protect health. For example, during the 2021-2022 flu season, flu vaccination prevented 1.8 million flu-related illnesses, one million medical visits, 22,000 hospitalizations, and nearly 1,000 deaths in the United States. Recent reductions in vaccine coverage and confidence across the world create vulnerabilities to health security at home and abroad. The budget includes significant investments to support the immunization infrastructure throughout the United States. This includes modernizing immunization information systems, implementing new strategies for vaccine equity, building vaccine confidence, expanding the scientific evidence base, and enhancing support in human papilloma virus (HPV) vaccination efforts, which aligns with the Biden-Harris Administration’s Cancer Moonshot initiative.

The budget also proposes an expansion of the Vaccines for Children program to include all children under age 19 enrolled in the Children’s Health Insurance Program, and as I mentioned earlier, a complementary system for adults—the Vaccines for Adults program—to begin to expand access to vaccines recommended by the ACIP at no cost for uninsured adults.

The budget also includes an increase for the Global Immunization program to achieve priority goals including shifting children out of zero-dose status, increasing life-course vaccination, preventing and mitigating large outbreaks, which can cross borders, and working toward essential service targets globally.

CDC works collaboratively with state, tribal, local, and territorial health departments to bring science and interventions to all communities. Working at the community level promotes healthy living, helps prevent injury and chronic diseases, and brings the greatest health benefits to the greatest number of people in need, while investing in local communities and addressing the drivers of health disparities seen in this country. Greater engagement of enduring community institutions such as faith-based organizations, civic groups, and others have been instrumental in embedding health promotion and disease prevention as community values.

Protecting Americans from Environmental Health Threats

CDC’s budget request for Environmental Health Activities within the National Center for Environmental Health will support expanded laboratory and health investigation efforts under the Cancer Moonshot Initiative and provide additional funding to health departments to address environmental hazards and health. CDC programs funded under the Environmental Health Activities budget line support core environmental health programs, workforce capacity, and research that protect Americans from emerging and everyday environmental health threats wherever they live. CDC and the Agency for Toxic Substances and Disease Registry employees work with state officials in assessing how environmental exposures affect health, such as evaluating Hawaii’s drinking water and analyzing chemical exposures in the aftermath of the train derailment in East Palestine, Ohio.

These programs are critical for ensuring environmental public health practitioners at state, tribal, local, and territorial health departments have the resources, tools, and evidence-based guidance to detect, prevent, and control environmental public health hazards, including threats from wildfires, hurricanes, or other extreme weather events.

CDC’s Childhood Lead Poisoning Prevention program focuses on primary prevention of lead exposure as well as detection, early intervention, and support for those children already demonstrating elevated blood lead levels. The requested funding increase in the budget will enable CDC to add another 38 grants for a total of 110 grants nationwide. Data from CDC’s nationally representative National Health and Nutrition Examination Survey (NHANES) show that children’s mean blood lead levels are going down over time, and continued support for this program would allow resources and strategies to be directed

Advancing Efforts to Address Cancer Prevention and Control

The experience of cancer —getting a cancer diagnosis, surviving cancer, or losing someone to cancer — has touched virtually every American family. The Biden-Harris Administration’s Cancer Moonshot initiative seeks to cut the death rate from cancer by at least 50 percent over the next 25 years and improve the experience of people and their families living with and surviving cancer. The funding requested in the budget builds on investments CDC has made in a comprehensive, coordinated cancer prevention and control portfolio for more than 30 years. Funded programs will demonstrate how proven strategies advance health equity, such as Patient Navigator programs, and build community capacity in cancer prevention and control. Outcomes include improving the provision of clinical preventive services, facilitating planning among partners to promote evidence-based strategies in communities, and improving cancer surveillance. The FY 2024 budget increases support for cancer prevention and control programs across CDC, in addition to tobacco prevention, HPV prevention, and analysis of cancer clusters related to environmental concerns.

The Built Environment and Food Security

The characteristics of places and resources where people live, learn, work, and play have an enormous impact on the likelihood of achieving healthy outcomes. CDC has funded projects in jurisdictions to develop one-year accelerator plans addressing key aspects of CDC’s priority social determinants of health (SDOH): the built environment, food security, clinical-community linkages, social connectedness, tobacco-free policies, and healthcare access and quality. Funds requested in the FY 2024 budget for CDC’s SDOH program will be used to implement and evaluate action plans and to build the evidence base for interventions through applied research, data collection, and surveillance.

In support of the White House National Strategy on Hunger, Nutrition, and Health, the FY 2024 Budget includes funding to expand the State Physical Activity and Nutrition (SPAN) program to all 50 states, the District of Columbia, and 14 territories. The SPAN program works with jurisdictions to implement evidence-based strategies to reduce chronic diseases by improving physical activity and nutrition. Through this program, the Active People, Healthy Nation initiative makes physical activity safe and accessible for all by implementing state and community-level policies and activities that connect pedestrian, bicycle, or transit opportunities to everyday destinations.

Mental health is an important part of overall health at every stage of life, from childhood and adolescence through adulthood, and includes our emotional, psychological, and social well-being. CDC promotes and supports efforts to improve mental health, especially among youth and adolescents, and prevents violence in communities.

Protecting Children

In the FY 2024 Budget, CDC requests an increase in funding to expand the number of states implementing strategies that have been proven to reduce adverse childhood experiences (ACEs) and promote positive ones. Through the Essentials for Childhood: Preventing Adversity through Data to Action program, CDC will increase investments in surveillance and research activities for the prevention of ACEs.

CDC’s Healthy Schools Program plays a unique role in bringing together the education and public health sectors to support physical education, physical activity and healthy nutrition, management of disabilities and chronic conditions, emotional well-being, and healthy and supportive school environments. In FY 2024, CDC plans to use its increase in funding as requested in the budget to implement the Healthy Schools program in all states.

In addition, the budget includes additional funds to promote adolescent mental health through CDC’s What Works in Schools program. The program works to strengthen schools’ prevention activities. Using data from multiple large-scale surveys of school-aged children and adolescents, CDC developed guidance and curricula that have substantially reduced risk behaviors, experience of violence, substance use, and poor mental health among students. Increased funding as requested in the budget will be used to expand support for up to 75 of the nation’s largest local education agencies to implement these proven practices and focus specifically on school connectedness in the wake of COVID-19.

Preventing Violence

Violence is a serious and growing problem in the United States affecting people in all stages of life. CDC is the nation’s leading authority on violence and injury prevention. The FY 2024 Budget would create a Community Violence Intervention (CVI) program within CDC that would support community-based organizations in implementing proven public health strategies that reduce violence. With CVI resources requested in the FY 2024 President’s Budget, CDC will fund cities and communities demonstrating the greatest need for intervention and programming to stem the tide of community violence. Research, surveillance, and program evaluation efforts will be prioritized to emphasize those interventions and populations where evidence strongly suggests that public health approaches will reduce the burden of community violence.

Once again, we are reminded of the terrible toll that firearm injuries take on our young people. Injuries are the most common cause of death among children, adolescents, and young adults between one and 24 years of age in the United States. For more than 60 years, motor vehicle crashes were the leading cause of injury-related death among this age group. However, beginning in 2017, firearm-related injuries surpassed motor vehicle crashes as the leading cause of death from injury.¹ CDC will continue to fund research to identify the most effective ways to prevent firearm- related injuries and deaths. As requested in the budget, CDC plans to use increased funding for firearm injury and mortality prevention research to provide additional funding opportunities to support R01 research grants that improve understanding of firearm injury; inform the development of innovative and promising prevention strategies; and rigorously evaluate the effectiveness of strategies to keep individuals, families, schools, and communities safe from firearm-related injuries, deaths, and crime. CDC will fund additional research grants to support new investigators and will focus on improving collection and dissemination of timely data on firearm-related deaths, nonfatal firearm injuries, and behavioral issues related to firearms such as safe storage. This will include the expansion of the Firearm Injury Surveillance Through Emergency Rooms (FASTER) program to as many states as possible.

In the FY 2024 Budget, CDC requests an increase to build and enhance the primary prevention capacity of state, territorial, and tribal sexual assault coalitions for rape prevention. This will complement work funded through existing rape prevention funding opportunities.

In the FY 2024 Budget, CDC requests additional funding for the National Violent Death Reporting System (NVDRS) to implement and maintain the system, monitor and report data, and use data to inform prevention efforts to save lives. CDC will continue to increase the use of NVDRS data by characterizing manner of death and identifying key populations at risk for violence for further study.

In the FY 2024 Budget, CDC also requests an increase for expanding the reach of the Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) program, which aims to decrease risk factors in communities that may lead to intimate partner violence and to increase protective factors that prevent it.

Preventing Overdose

The opioid epidemic has shattered families, claimed lives, and ravaged communities across the nation—and the COVID-19 pandemic has only deepened this crisis. Addressing the current overdose epidemic remains a priority for CDC. The Biden-Harris Administration’s strategy brings together surveillance, prevention, treatment, recovery, law enforcement, interdiction, and source-country efforts to address the continuum of challenges facing this country due to drug use. CDC’s unique role in preventing overdose stems from its ability to gather data on the circumstances surrounding overdose deaths, which states use to spot trends and understand risk factors leading to these deaths.

CDC’s budget request for Opioid Overdose Prevention and Surveillance funding will support integration of state and local prevention and response efforts, provide support for providers and health systems prevention (including use of prescription drug monitoring programs as a clinical decision support tool), enhance partnerships with public safety and first responders, establish and improve linkages to medications for opioid use disorder and other supportive services through harm reduction activities, and empower individuals to make informed choices. These activities support multiple initiatives included in the Office of National Drug Control Policy (ONDCP) Policy Priorities and the National Drug Control Strategy.²