(RFP) to address specific factors related to infectious disease emergence.

CENTERS FOR DISEASE CONTROL

The majority of research and training supported by the CDC in the area of infectious diseases is conducted by the National Center for Infectious Diseases (NCID). The CDC does not maintain formal overseas laboratories, but it does support a number of foreign field stations that carry out infectious disease research and training. These initiatives are collaborative efforts with the host country (see Table 3-2 in the earlier section on Recognition).

The CDC is home to more than 40 WHO collaborating centers, more than half of which are housed in the NCID. In addition, the CDC has nearly 50 employees stationed in foreign countries, many of whom are involved in activities related to infectious disease. In fiscal 1990, the agency mounted 25 international emergency responses, 10 of which were related to infectious disease outbreaks. Agency research personnel were sent to, among other locations, Brazil (Brazilian purpuric fever), Bolivia (yellow fever), Netherlands (filovirus in monkeys), and Uganda (meningitis). In fiscal 1991, CDC personnel were instrumental in investigations of the cholera epidemic in Latin America (ASM News, 1992).

From the mid-1960s to early-1970s, the CDC administered an extramural program that awarded grants to academia and other institutions for research in infectious disease prevention and control. This program, discontinued in 1973 by the CDC as a result of tight funding (the legislation for this program then lapsed), supported up to 102 separate research projects and varied from a high of approximately $3.9 million in fiscal year 1969 to a low of $1.7 million in its final year. Examples of areas in which support was provided included the evaluation of immunization techniques and the resulting effects on the immunity of populations, the development and evaluation of laboratory diagnostic tests, field studies on the epidemiology and control of specific diseases, and defining health hazards related to pesticide use. The committee concludes that the now defunct program filled a need for support in a critical area of research.

The committee recommends increased research on surveillance methods and applied control methods, on the costs and benefits of prevention, control, and treatment of infectious disease, and on the development and evaluation of diagnostic tests for infectious diseases. Reinstating and expanding (both in size and scope) the extramural grant program at the Centers for Disease Control, which ceased in 1973, would be one important step in this direction. Similarly, the FDA extramural grant



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