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WASHINGTON -- Preparing for the next pandemic was high on senators' minds Wednesday during a on the CDC's budget request for fiscal year 2022 -- but it wasn't the only thing.

"Addressing health infrastructure in rural areas is a serious concern," Sen. Cindy Hyde-Smith (R-Miss.) said during the hearing held by the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. "There is no entity within the CDC tasked specifically with this work, and that's concerning to me. I believe establishing a new Office of Rural Health within the CDC would be an important way to support rural communities through the end of this pandemic and to prepare for any other future public health crisis ... How strongly do you support establishing an official Office of Rural Health within the CDC, and how can we work together to get this done?"

CDC Director Rochelle Walensky, MD, did not answer directly. "Part of the deep need for investment in a public health infrastructure is to develop a workforce that looks like the community that is from these communities, that knows how to access and reach these communities, which is exactly one of the challenges that has occurred during this pandemic," she said. "We also know that there are other ways outside of COVID that we totally learned from COVID, such as telehealth," which should be expanded.

Proposal for a $1.6 Billion Increase

In her opening statement, Walensky listed several of the spending priorities for her agency's $8.7 billion discretionary budget request for FY2022, an increase of $1.6 billion over the previous year. "The increase focuses on four critical areas: building public health infrastructure, reducing health disparities, using public health approaches to reduce violence, and defeating diseases and epidemics," she stated.

In particular, the fiscal year 2022 request "makes initial investments to continue public health data modernization, build the public health workforce, enhance global health security and strengthen our immunization infrastructure," she continued. "In addition, we are requesting funds to help states and communities be climate ready and prepared to confront new health risks, such as those associated with vector-borne diseases. The fiscal year 2022 budget request also makes specific investments in programs that work to improve health equity, such as maternal mortality review committees." And the proposed increases "will address public health problems that have been exacerbated by this pandemic, such as opioids, injury and violence, HIV and sexually transmitted diseases," she added.

The general tenor of the proposed budget pleased Sen. Patty Murray (D-Wash.), the subcommittee's chairman. "I always say a budget is a reflection of your values and priorities, and I think Americans can breathe a sigh of relief knowing this budget shows they now have a President who values science and public health," she said in her opening remarks. "After years of underinvestment in CDC -- and attempted cuts to CDC by President Trump -- this budget request is such a breath of fresh air ... These investments will help us finish strong when it comes to this pandemic, prepare for the next one, and make progress on other public health challenges."

Murray asked Walensky what in particular needs to be done to shore up the public health infrastructure. "We've had challenges with our public health workforce," Walensky said. "We were down 56,000 jobs just in the last decade; we need to train and upskill that workforce in addition to bolster that workforce, over the years ahead ... We need to do data modernization -- when I spoke early on in my tenure to state and local health officials, I was hearing about faxes of [COVID] test results...and then manual data entry of those results." In addition, she said, "we need to build our public health labs. We didn't have the capacity to to do genomic sequencing in all of these labs; we've had to scale that up."

"Partisan" Increases Questioned

Sen. Roy Blunt (R-Mo.), the committee's ranking member, gave the request a more mixed review. "I want to recognize the tireless efforts of the CDC staff working across the country during the pandemic," he said. "There are really several areas of alignment where we can work together -- for example, addressing the needs of the hard-hit public health infrastructure and responding to the opioid crisis ... along with other mental health and behavioral health challenges." However, the proposal "also includes what I believe are excessive areas of increases in areas that are extremely partisan," Blunt said. "I hope we can set those issues aside and invest in areas of common ground that benefit all Americans."

Sen. Jack Reed (D-R.I.) asked about the CDC's efforts in the area of suicide prevention. "This is such a challenging area," Walensky said. "Suicide was one of several issues that we really needed to tackle before the pandemic and we saw during the pandemic that these have only gotten worse." Walensky said funds are needed to gather "surveillance data -- we need to understand how much this is a challenge, how many people are presenting to the emergency room, and we need toolkits to deliver to states and to physician organizations so that they are empowered as to how to prevent it."

Reed also pushed for more funds to address lead exposure, noting that screening children for lead poisoning dropped last year due to the pandemic. President Biden "is going after lead pipes which I applaud... but in older communities like mine, the issue isn't lead pipes, it's housing and lead paint -- a whole series of issues."

Walensky agreed. "We know we've missed lead toxicity that we need to make up for."

Mask Guidance at Issue

Some senators wanted to discuss issues other than the budget request. "Could you in 1 minute summarize for me what the recommendations are today from your agency about wearing masks?" asked Sen. John Kennedy (R-La.). Walensky responded that "for an individual who is fully vaccinated and not immunocompromised, they are able to safely unmask, with certain exceptions in travel corridors and indoor settings ... inside and outside."

Kennedy also asked what Walensky thought the origin of the virus was. "This has been studied by the WHO [World Health Organization] -- " Walensky said, but Kennedy interrupted her. "No, ma'am, I'm asking your opinion," he said. "I don't believe I've seen enough individual data for me to be able to comment on that," she said. Kennedy then asked what the possibilities were. "Most coronaviruses that we know of that have impacted the population -- SARS CoV1, MERS -- generally come from an animal origin ... and certainly a lab-based origin is one possibility," she stated.

Sen. Mike Braun (R-Ind.) asked whether it was necessary for governors to keep mask mandates in place. "One of the things that's really key in this is to recognize that we're not a homogeneous country, that there are some areas that some counties that still have less than 20% of people vaccinated," said Walensky. "The decisions about whether to [remove] a mask mandate has to be made at the local level, has to be made at the community level -- there are still some communities who are suffering." She noted that African Americans lost 2.9 years of life expectancy last year compared to white Americans losing 0.8 years of life, so these decisions "need to be made at the local and community level for exactly that reason."

Braun asked whether it wouldn't be better for more mandates to be lifted for vaccinated people as an incentive for others to get the vaccine. "I think it would be really amazing if our new guidance got more people vaccinated ... but my whole agency does not make CDC guidance based on what it will help people do," she replied. "We have to do it based on the diseases out there and the access to vaccines, and based on the science that has emerged."

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