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Adam Bradley
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1 November 9, 2010 The Honorable Daniel Inouye The Honorable Thad Cochran Chairman Ranking Member U.S. Senate U.S. Senate Washington, DC Washington, DC The Honorable David Obey The Honorable Jerry Lewis Chairman Ranking Member U.S. House of Representatives U.S. House of Representatives Washington, DC Washington, DC Dear Senators Inouye and Cochran and Representatives Obey and Lewis: On behalf of the undersigned organizations we are writing to urge you to increase funding for viral hepatitis prevention by $3.8 million in the FY2011 Labor-HHS- Education Appropriations bill. Hepatitis B and C affect nearly six million Americans, the vast majority of whom do not know they are infected, and can lead to chronic liver disease, cirrhosis, liver cancer and liver failure that claim 15,000 lives each year. We appreciate the Committee s past support for the viral hepatitis program at the Centers for Disease Control and Prevention (CDC), which currently receives $19.3 million and was once as high as $25 million. The House FY2011 Labor-HHS-Education Appropriations bill provides a $3.8 million increase to CDC s viral hepatitis program, bringing its total budget to $23.1 million, whereas the Senate companion bill provides the President s request of $1.8 million. As you go through the Labor-HHS-Education Appropriations bill, it is vital that you ensure the small House increase of $3.8 million remain for viral hepatitis prevention. The size of CDC s Division of Viral Hepatitis (DVH) budget undermines recent progress and future efforts to manage the domestic hepatitis epidemics. States and cities continue to receive an average funding award of $90,000. This can only provide for a single staff position and is not sufficient for the provision of core prevention services. As requested by Congress, DVH estimates in its professional judgment (PJ)

2 budget that it would need at least $300 million or 16 times its current budget to forge a robust response. Funding must go to support hepatitis B and C education, counseling, testing and referral, at-risk adult vaccination of hepatitis A and B, and establishing a surveillance system for chronic hepatitis B and C. This investment would provide better data to guide the use of the limited resources available. It is absolutely essential that we respond aggressively to address the rising health care costs and death rates caused by viral hepatitis in the United States. This is particularly urgent due to the rising incidence rate among disproportionately impacted populations. In 2007 alone, the CDC estimated that 43,000 Americans were newly infected with hepatitis B and 17,000 with hepatitis C. Unfortunately, it is believed that these estimates of hepatitis B and C infections are just the tip of the iceberg, since we lack sufficient data in the absence of an adequate surveillance system. Sixty-five percent of people living with hepatitis B and over seventy-five percent of people living with hepatitis C are unaware that they are infected. Further, the baby boomer population currently accounts for two out of every three cases of chronic hepatitis C. As these Americans continue to age, they are likely to develop complications from hepatitis C and require expensive medical interventions such as liver transplants. It is also estimated that this epidemic will increase costs by billions of dollars to private insurers and public systems of health such as Medicare and Medicaid, and account for additional billions lost due to decreased American workforce productivity from the millions of workers suffering from chronic hepatitis B and C. Two recent legislative authorizations provided the federal government with a unique opportunity to regain lost ground in its response to the prevention and control of viral hepatitis. The first missed opportunity occurred when viral hepatitis did not receive any of the $650 million in prevention and wellness funding authorized under the American Recovery and Reinvestment Act of Unlike other infectious diseases such as HIV, it also did not receive any of the $500 million of the Prevention and Public Health funding neither established in the Affordable Care Act in FY2010 nor is it slated to receive any of the $750 million in FY2011. Further, the CDC s Section 317 Vaccine Program s Adult Hepatitis B Vaccination Initiative, which helped expand hepatitis B vaccine to at-risk adults with a funding high of $20 million, has recently been discontinued leading to immediate reduction of the availability of this critical, costsaving prevention tool for individuals at risk. In addition, healthcare providers are neither aware of nor screening for viral hepatitis and are not readily delivering hepatitis A and B vaccines to adults at highest risk. Finally, we believe the reforms under the Affordable Care Act are not a panacea and will not provide adequate relief for viral hepatitis due to scant investment in the public health infrastructure needed to provide core prevention and care services to people at highest risk.

3 With the 2010 release of the Institute of Medicine (IOM) report, Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C, the federal government has the opportunity to improve its response by implementing the IOM s evidence-based recommendations. The report attributes the lack of adequate financial resources as the primary cause of the profound ignorance among the American public and our health providers, the large disparate impact of hepatitis on certain populations such as Asian Americans and African Americans, and the current unnecessarily high morbidity and mortality associated with viral hepatitis. On the heels of this report, the Assistant Secretary for Health (ASH), Dr. Howard Koh, has convened an interagency working group on viral hepatitis, which is poised to release a national action plan this fall. The implementation of this action plan, which closely mirrors the IOM recommendations, must be adequately funded to enable collaboration with key stakeholders, including state and local health departments, professional organizations, health care organizations, and community-based organizations to effectively reduce the morbidity and mortality related to chronic viral hepatitis. The viral hepatitis community welcomes the opportunity to work with you and your staff on this important issue. Please contact Colin Schwartz with the Hepatitis Appropriations Partnership (HAP) at or cschwartz@nastad.org if you have any questions or need additional information. Sincerely, AIDS Alabama, Birmingham, AL AIDS Foundation of Chicago, Chicago, IL American Association for the Study of Liver Diseases, Alexandria, VA American Association of Occupational Health Nurses, Pensacola, FL American Liver Foundation, New York, NY American Social Health Association, Washington, DC Asian & Pacific Islander American Health Forum, San Francisco, CA and Washington, DC Asian Center Southeast Michigan, Southfield, MI Asian Health Coalition, Chicago, IL Asian Liver Center at Stanford University, Palo Alto, CA Asian Pacific AIDS Intervention Team, Southern CA, CA Asian Pacific HealthCare Venture, Los Angeles, CA Asian Pacific Liver Center at St. Vincent Medical Center, Los Angeles, CA Asian Services In Action, Inc., Cleveland, OH AsianWeek Foundation, San Francisco, CA Aspirations, Baton Rouge, LA Association of Asian Pacific Community Health Organizations, Oakland, CA Bartz-Altadonna Community Health Center, Lancaster, CA Caring Ambassadors Program, Inc., Oregon City, OR

4 Cascade AIDS Project, Portland, OR Center for Health Justice, Los Angeles, CA Chicago Recovery Alliance, Chicago, IL Children's Hospital & Research Center Oakland, Oakland, CA Community Access National Network, Washington, DC Community HealthNet, Gary, IN Community HIV/AIDS Mobilization Project (CHAMP), New York, NY Community HIV/Hepatitis Advocates of Iowa Network, Des Moines, IA Digestive Disease National Coalition, Washington, DC Downtown Manhattan HCV Support Group, Manhattan, NY Greene County Combined Health District, Xenia, OH Guam Communications Network, Long Beach, CA H.E.A.L.S of the South, Tallahassee, FL Harm Reduction Coalition, New York, NY Hep B Free San Francisco, San Francisco, CA Hep C Connection, Denver, CO Hepatitis B Coalition of WA (WithinReach), Seattle, WA Hepatitis B Foundation, Doylestown, PA Hepatitis B Initiative DC, Washington, DC Hepatitis C Association, Scotch Plain, NJ Hepatitis C Task Force for Los Angeles County, Los Angeles, CA Hepatitis Education Project, Seattle, WA Hepatitis Foundation International, Silver Spring, MD Hepatitis Support Network of Hawaii, Honolulu, HI HIV Medicine Association, Arlington, VA HIVictorious, Inc., Madison, WI Homeless Health Care Los Angeles, Los Angeles, CA Hope for Hepatitis C, Frederick, MD Immunization Action Coalition, St. Paul, MN Infectious Diseases Society of America (IDSA), Arlington, VA Japanese American Citizens League, Washington, DC Lao American Community Services, Chicago, IL Lao Assistance Center of Minnesota, Minneapolis, MN Laotian American National Alliance (LANA), Washington, DC LiverHope, Minnetonka, MN Local Area Support For Hepatitis, Inc., Redding, CA Los Angeles County Perinatal Hepatitis B Prevention Unit, Los Angeles, CA Maryland Hepatitis Coalition, Baltimore, MD Maryland Partnership for Prevention, Inc., Owings Mills, MD Midwest Asian Health Association (MAHA), Chicago, IL Mo Hepatitis C Alliance, Columbia, MO National Alliance of State and Territorial AIDS Directors (NASTAD), Washington, DC National Asian American Pacific Islander Mental Health Association, Denver, CO

5 National Association of State Alcohol and Drug Abuse Directors (NASADAD), Washington, DC National Task Force on Hepatitis B: Focus on Asian and Pacific Islander Americans, Palo Alto, CA National Viral Hepatitis Roundtable, CA Native Hawaiian and Pacific Islander Alliance (NHPIA), Gardena, CA New York Harm Reduction Educators' Inc, Bronx, NY New York Harm Reduction Educators, Inc., Bronx, NY New York Hepatitis B Coalition, New York, NY North Shore Health Project, Gloucester, MA NYU B Free Center of Excellence for the Elimination of Hepatitis B Disparities (CEED), New York, NY OCA National Center, Washington, DC O'Connor Hospital HCV & HBV Support Group, Delhi, NY Ohio Asian American Health Coalition, Columbus, OH OraSure Technologies, Inc., Bethlehem, PA Pacific Islander Health Partnership, Garden Grove, CA Project Inform, San Francisco, CA Public Health Management Corporation, Philadelphia, PA Samoan National Nurses Association, Long Beach, CA San Francisco AIDS Foundation, San Francisco, CA Sexuality Information and Education Council of the U.S. (SIECUS), Washington, DC Spears Foundation For Hepatitis C, Franklin, TN Status C Unknown, Medford, NY STOPHepC, Pelzer, SC The AIDS Institute, Washington, DC The American Academy of HIV Medicine, Washington, DC The Catalyst Foundation, Lancaster, CA The National Association of People with AIDS (NAPWA), New York, NY Tibotec Therapeutics, Titusville, NJ Treatment Action Group, New York, NY United Cambodian Community, Long Beach, CA Upstate New York Hepatitis Awareness Project, Delancey, NY Vietnamese Community Health at University of California, Los Angeles, CA Washington Heights CORNER Project, New York, NY cc: The Hepatitis Appropriations Partnership (HAP) is a national coalition based in Washington, DC and includes community-based organizations, public health and provider associations, national hepatitis and HIV organizations, and diagnostic, pharmaceutical and biotechnology companies from all over the country. HAP works with policy makers and public health officials to increase federal support for hepatitis prevention, testing, education, research and treatment. For more information, please contact Colin Schwartz at or cschwartz@nastad.org.

Dear Speaker Ryan, Minority Leader Pelosi, Chairman Frelinghuysen, and Ranking Member Lowey:

February 23, 2018 Dear Speaker Ryan, Minority Leader Pelosi, Chairman Frelinghuysen, and Ranking Member Lowey: On behalf of the undersigned organizations we write to urge you to include an increase of