Common use of Impact Clause in Contracts

Impact. The response systems and infrastructure that states require to respond to public health emergencies would not exist in most instances without PHEP funding. According to CDC’s evaluations, PHEP awardees have improved capacity in nearly all high priority public health preparedness capabilities in the past few years. And the National Health Security Preparedness Index has found that public health preparedness domains trended upward between 2013-2017.3 The largest investments focused on public health surveillance and epidemiological investigation, laboratory testing, community preparedness and recovery, and medical countermeasures and mitigation. In order to help awardees address gaps, CDC works with the jurisdiction on technical assistance plans, including consultation across CDC. Nearly 2,700 state, local, territorial and federal preparedness and response employees across the country are funded in large part or entirely by the PHEP program.4 Federal funding is crucial to maintaining state, local and territorial public health preparedness capacity. Every fluctuation in funding – such as the 2016 redirection of $44 million from PHEP for the federal 1 “Widespread Person-to-Person Outbreaks of Hepatitis A Across the United States.” In Centers for Disease Control and Prevention. xxxxx://xxx.xxx.xxx/hepatitis/outbreaks/2017March-HepatitisA.htm 2 S Xxxxxxxxx, X Xxxxxxxxx, X Xxxxxxxx, and X Xxxxxxxx. “The Great Flood of 2019: A Complete Picture of a Slow-Motion Disaster.” The New York Times, September 11, 2019. xxxxx://xxx.xxxxxxx.xxx/interactive/2019/09/11/us/midwestflooding.html 3 FY2021 CDC Congressional Justification. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional- justification.pdf 4 FY2021 CDC CJ. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional-justification.pdf Xxxx response – has major impacts on workforce, training, and readiness.5 These cuts cannot be backfilled with short-term funding after an event. An efficient and effective state and local workforce response relies heavily on predictable, ongoing funding support for a network of local expertise, relationships and trust that is carefully built over time through shared responses, training and exercises. Some examples of recent accomplishments of the PHEP program include: • Hepatitis A Outbreaks: Several states experienced hepatitis A outbreaks from 2016-2019, often among people experiencing homelessness or substance misuse.6 In Michigan, PHEP-funded health department staff worked with communicable disease and immunization program staff to decrease the time to report new cases, interview those affected, and provide information to the public. Thanks to coordination made possible through PHEP, Michigan administered 300,000 doses of hepatitis A vaccine, and new cases have declined each month since December 2017. • Hurricanes: During Hurricane Xxxxxxxx, state and local health department personnel staffed emergency operations centers, ensured safety of shelters, and prevented disease outbreaks. They also coordinated the transport of medical supplies and organized mosquito control efforts. In addition, states from across the country deployed 169 public health nurses to North Carolina to provide staffing support to places like Brunswick County, which had been isolated by flooding. The nurses provided medical and public health support for thousands of evacuees.7 • 2019 Floods: The winter of 2018-2019 was the wettest winter on record in the U.S. A series of record floods occurred in the Mississippi River Tributary basins, including the Ohio, Missouri and Arkansas rivers. The health risks associated with flooding include drowning, sewage contamination, waterborne diseases, food and water safety, mold, and mosquito-borne diseases. In Arkansas, the Department of Health prioritized immunizing first responders and people who would be temporarily living in shelters, ensuring access to healthcare for anyone displaced by the floods, insect control, communications, and monitoring for possible chemical releases or other contaminants in the Arkansas River and in water systems and private xxxxx. The state and local health departments worked with healthcare to evacuate a hospital and long-term care facility.8 Recommendation: TFAH recommends $824 million for the Public Health Emergency Preparedness Cooperative Agreements in FY21, the levels authorized in 2006. Emergency responses are increasing, despite funding eroding by about one-third since FY2002. This level of funding would: • Help restore capacity at health departments impacted by budget cuts and address gaps identified in the PHEP capabilities operational readiness review process, in areas such as risk communications and medical countermeasures distribution. • Build the Laboratory Response Network (LRN) and CDC and public health expertise and capacity for radiological and nuclear events. There is currently no public health laboratory capacity outside of CDC for this kind of testing and only limited throughput at CDC’s lab. • Advance biological and chemical laboratory capacity in states to keep up with current technologies and threats. • Support career epidemiology field officers (CEFO) in additional states, who are highly trained personnel who can help jurisdictions build their disease surveillance and response capability. • Conduct anthrax, pandemic influenza, continuity of operations (COOP), and administrative preparedness exercises. 5 xxxxx://xxx.xxxxxx.xxx/uploads/downloadable-resources/Impact-of-the-Redirection-of-PHEP-Funding-to-Support-Xxxx- Response.pdf 6 CDC, 2018. xxxxx://xxx.xxx.xxx/cpr/readiness/stories/MIHepA.htm 7 FY2021 CDC Congressional Justification. HHS. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC- congressional-justification.pdf

Impact. The response systems systems, personnel, and infrastructure that states require to respond to public health emergencies like COVID-19 would not exist in most instances states without PHEP funding. According to CDC’s evaluations, Since 2002 the PHEP awardees have improved capacity in nearly all high priority program has saved lives by building and maintaining a nationwide public health preparedness capabilities in the past few yearsemergency management system that enables communities to prepare and rapidly respond to public health threats. And the The National Health Security Preparedness Index has found that public health preparedness domains trended upward between 2013-2017.3 2019.4 The largest investments focused on public health surveillance and epidemiological investigation, laboratory testing, community preparedness and recovery, and medical countermeasures and mitigation. In order to help awardees address gaps, CDC works with the jurisdiction on technical assistance plans, including consultation across CDC. Nearly 2,700 Over 2600 state, local, territorial and federal preparedness and response employees across the country are funded wholly or in large part or entirely by the PHEP program.4 Federal funding is crucial to maintaining state, local 1 Public Health Emergency Preparedness (PHEP) Cooperative Agreement. In Centers for Disease Control and territorial public health preparedness capacityPrevention. Every fluctuation in funding – such as the 2016 redirection of $44 million from PHEP for the federal 1 xxxxx://xxx.xxx.xxx/cpr/readiness/phep.htm 2 Id. 3 “Widespread Person-to-Person Outbreaks of Hepatitis A Across the United States.” In Centers for Disease Control and Prevention. xxxxx://xxx.xxx.xxx/hepatitis/outbreaks/2017March-HepatitisA.htm 2 S Xxxxxxxxx4 National Health Security Preparedness Index 2020 Release Key Findings. NHSPI. xxxxx://xxxxx.xxx/wp- content/uploads/2020/06/NHSPI_2020_Key_Findings.pdf part by CDC’s PHEP program.4 Federal funding is crucial to maintaining state, X Xxxxxxxxxlocal and territorial public health preparedness capacity. Cuts to public health funding from the past two decades have meant that health agencies have been less equipped to sustain the expert workforce and invest in modern data and laboratory technologies that would have made the nation more resilient to COVID-19. While emergency response funding is critical for a major emergency, X Xxxxxxxx, and X Xxxxxxxx. “The Great Flood of 2019: A Complete Picture of a Slow-Motion Disaster.” The New York Times, September 11, 2019. xxxxx://xxx.xxxxxxx.xxx/interactive/2019/09/11/us/midwestflooding.html 3 FY2021 CDC Congressional Justification. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional- justification.pdf 4 FY2021 CDC CJ. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional-justification.pdf Xxxx response – has major impacts on workforce, training, and readiness.5 These cuts cannot be backfilled with short-term funding after an eventsupplements do not allow for sustained preparedness and response infrastructure. An efficient and effective state and local workforce response relies heavily on predictable, ongoing funding support for a network of local expertise, relationships and trust that is carefully built over time through shared responses, training and exercises. Some examples of recent accomplishments of the PHEP program include: • Hepatitis A Outbreaks: Several states experienced hepatitis A outbreaks from 2016-2019In September 2021, often among people experiencing homelessness or substance misuse.6 In Michiganthe Delaware Department of Health and Social Services (DHSS) used PHEP funding in response to significant property damage as a result of Hurricane Xxx in Wilmington. This funding allowed the DHHS to implement a massive care plan that included support for evacuees, PHEP-funded health department including activating community shelters and opening the state’s disaster recovery center. This center supported 375 impacted residents, representing 200 households, while also connecting them to multiple agency and community partners. The DHSS staff worked with communicable disease and immunization program staff canvassed seven city blocks to decrease the time to report new casesaddress immediate issues, interview those affectedsuch as food, safety, shelter, and provide information to the public. Thanks to coordination made possible through PHEP, Michigan administered 300,000 doses of hepatitis A vaccine, and new cases have declined each month since December 2017. • Hurricanes: During Hurricane Xxxxxxxx, state and local behavioral health department personnel staffed emergency operations centers, ensured safety of shelters, and prevented disease outbreaks. They also coordinated the transport of medical supplies and organized mosquito control efforts. In addition, states from across the country deployed 169 public health nurses to North Carolina to provide staffing support to places like Brunswick County, which had been isolated by flooding. The nurses provided medical and public health support for thousands of evacuees.7 • 2019 Floods: The winter of 2018-2019 was the wettest winter on record in the U.S. A series of record floods occurred in the Mississippi River Tributary basins, including the Ohio, Missouri and Arkansas riversneeds. The health risks associated with flooding include drowning, sewage contamination, waterborne diseases, food and water safety, mold, and mosquito-borne diseases. In Arkansas, the Department of Health prioritized immunizing first responders and people who would be temporarily living in shelters, ensuring access to healthcare for anyone displaced by the floods, insect control, communications, and monitoring for possible chemical releases or other contaminants in the Arkansas River and in water systems and private xxxxx. The state and local health departments department also worked with healthcare other state agencies to locate alternative housing for residents who had to evacuate their homes and were fearful of going to community shelters due to risk of COVID-19. • Shoshone-Paiute tribes used PHEP funds to purchase and convert a hospital 45-foot van trailer with electrical capabilities into a mobile command center (MCC) in response to public health emergencies in Idaho such as winter storms, power outages, landslides and the COVID-19 outbreak in 2020. Considering long-term care facility.8 sustainability factors such as the reservation’s remote, rural location and the area’s inclement winter weather, they allocated their remaining PHEP funds for MCC supplies, including insulated storage containers to safeguard equipment susceptible to winter damage when not in use. • Maryland continues to use PHEP funding and relationships with other federal partners to improve security at state warehouses containing necessary COVID-19 medical countermeasures. Recommendation: TFAH recommends $824 million for the Public Health Emergency Preparedness Cooperative Agreements in FY21FY23, the levels authorized in 2006. Emergency responses are increasing, despite funding eroding by about one-third since FY2002. This level of funding would: • Strengthen the nation’s readiness to protect the public from future dangers caused by catastrophic emergencies such as a pandemic as well as smaller regional emergencies. • Help restore capacity at health departments impacted by budget cuts and address gaps identified in the PHEP capabilities operational readiness review process, in areas such as risk communications and medical countermeasures distribution. • Modernize data systems to enhance surveillance systems, data management, and sharing and analysis of disease trends. • Build the Laboratory Response Network (LRN) and CDC and public health expertise and capacity for radiological and nuclear events. There is currently no public health laboratory capacity outside of CDC for this kind of testing and only limited throughput at CDC’s lab. • Advance biological and chemical laboratory capacity in states to keep up with current technologies and threats. • Support career epidemiology field officers (CEFO) in additional states, who are highly trained personnel who can help jurisdictions build their disease surveillance and response capability. • Conduct anthrax, pandemic influenza, continuity of operations (COOP), and administrative preparedness exercises. 5 xxxxx://xxx.xxxxxx.xxx/uploads/downloadable-resources/Impact-of-the-Redirection-of-PHEP-Funding-to-Support-Xxxx- Response.pdf 6 CDC, 2018. xxxxx://xxx.xxx.xxx/cpr/readiness/stories/MIHepA.htm 7 FY2021 CDC Congressional Justification. HHS. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC- congressional-justification.pdf.

Impact. The response systems systems, personnel, and infrastructure that states require to respond to public health emergencies like COVID-19 would not exist in most instances states without PHEP funding. According to CDC’s evaluations, Since 2002 the PHEP awardees have improved capacity in nearly all high priority program has saved lives by building and maintaining a nationwide public health preparedness capabilities in the past few yearsemergency management system that enables communities to prepare and rapidly respond to public health threats. And the The National Health Security Preparedness Index has found that public health preparedness domains trended upward between 2013-2017.3 2019.3 The largest investments focused on public health surveillance and epidemiological investigation, laboratory testing, community preparedness and recovery, and medical countermeasures and mitigation. In order to help awardees address gaps, CDC works with the jurisdiction on technical assistance plans, including consultation across CDC. Nearly 2,700 Over 2600 state, local, territorial and federal preparedness and response employees across the country are funded wholly or in large part or entirely by the PHEP program.4 Federal funding is crucial to maintaining state, local 1 Public Health Emergency Preparedness (PHEP) Cooperative Agreement. In Centers for Disease Control and territorial public health preparedness capacityPrevention. Every fluctuation in funding – such as the 2016 redirection of $44 million from PHEP for the federal 1 xxxxx://xxx.xxx.xxx/cpr/readiness/phep.htm 2 “Widespread Person-to-Person Outbreaks of Hepatitis A Across the United States.” In Centers for Disease Control and Prevention. xxxxx://xxx.xxx.xxx/hepatitis/outbreaks/2017March-HepatitisA.htm 2 S Xxxxxxxxx3 National Health Security Preparedness Index 2020 Release Key Findings. NHSPI. xxxxx://xxxxx.xxx/wp- content/uploads/2020/06/NHSPI_2020_Key_Findings.pdf part by CDC’s PHEP program.4 Federal funding is crucial to maintaining state, X Xxxxxxxxxlocal and territorial public health preparedness capacity. Cuts to public health funding from the past two decades have meant that health agencies have been less equipped to sustain the expert workforce and invest in modern data and laboratory technologies that would have made the nation more resilient to COVID-19. While emergency response funding is critical for a major emergency, X Xxxxxxxx, and X Xxxxxxxx. “The Great Flood of 2019: A Complete Picture of a Slow-Motion Disaster.” The New York Times, September 11, 2019. xxxxx://xxx.xxxxxxx.xxx/interactive/2019/09/11/us/midwestflooding.html 3 FY2021 CDC Congressional Justification. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional- justification.pdf 4 FY2021 CDC CJ. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional-justification.pdf Xxxx response – has major impacts on workforce, training, and readiness.5 These cuts cannot be backfilled with short-term funding after an eventsupplements do not allow for sustained preparedness and response infrastructure. An efficient and effective state and local workforce response relies heavily on predictable, ongoing funding support for a network of local expertise, relationships and trust that is carefully built over time through shared responses, training and exercises. Some examples of recent accomplishments of the PHEP program include: • Hepatitis A Outbreaks: Several states experienced hepatitis A outbreaks from 2016-2019The Minnesota Department of Health (MDH) used PHEP funding to develop two mobile/computer apps that can be used to help quickly distribute medication to the public in emergency situations, often among people experiencing homelessness or substance misuse.6 In Michigansuch as a mass anthrax exposure and an influenza pandemic. The two apps, PHEP-funded called POD (Point of Dispensing) PreCheck and POD Locator, were developed to guide citizens through a treatment screening process and will allow the state health department staff worked to quickly and accurately distribute medical countermeasure information, like POD locations, to residents. • In Rhode Island, public health officials drew on medical countermeasure protocols developed with communicable disease and immunization program staff PHEP funding, to decrease the time to report new casessuccessfully receive, interview those affectedstage, and provide information to store all assets the public. Thanks to coordination made possible through PHEP, Michigan administered 300,000 doses of hepatitis A vaccine, and new cases have declined each month since December 2017state received from the Strategic National Stockpile for the COVID-19 response. • Hurricanes: During Hurricane Xxxxxxxx, Technical assistance provided by PHEP subject matter experts has improved the ability of multiple state and local health department personnel staffed emergency operations centers, ensured safety of shelters, and prevented disease outbreaks. They also coordinated the transport of jurisdictions to properly store medical supplies and organized mosquito control efforts. In addition, states from across the country deployed 169 public health nurses to North Carolina to provide staffing support to places like Brunswick County, which had been isolated by flooding. The nurses provided medical and public health support for thousands of evacuees.7 • 2019 Floods: The winter of 2018-2019 was the wettest winter on record in the U.S. A series of record floods occurred in the Mississippi River Tributary basinscountermeasures, including the Ohio, Missouri and Arkansas riversthose requiring strict cold chain management. The health risks associated with flooding include drowning, sewage contamination, waterborne diseases, food and water safety, mold, and mosquito-borne diseases. In Arkansas, the Department of Health prioritized immunizing first responders and people who would be temporarily living in shelters, ensuring access to healthcare for anyone displaced by the floods, insect control, communications, and monitoring for possible chemical releases or other contaminants in the Arkansas River and in water systems and private xxxxx. The state and local health departments worked with healthcare to evacuate a hospital and long-term care facility.8 Recommendation: TFAH recommends $824 million for the Public Health Emergency Preparedness Cooperative Agreements in FY21FY22, the levels authorized in 2006. Emergency responses are increasing, despite funding eroding by about one-third since FY2002. This level of funding would: • Strengthen the nation’s readiness to protect the public from future dangers caused by catastrophic emergencies like a pandemic as well as smaller regional emergencies. • Help restore capacity at health departments impacted by budget cuts and address gaps identified in the PHEP capabilities operational readiness review process, in areas such as risk communications and medical countermeasures distribution. • Modernize data systems to enhance surveillance systems, data management, and sharing and analysis of disease trends. • Build the Laboratory Response Network (LRN) and CDC and public health expertise and capacity for radiological and nuclear events. There is currently no public health laboratory capacity outside of CDC for this kind of testing and only limited throughput at CDC’s lab. • Advance biological and chemical laboratory capacity in states to keep up with current technologies and threats. • Support career epidemiology field officers (CEFO) in additional states, who are highly trained personnel who can help jurisdictions build their disease surveillance and response capability. • Conduct anthrax, pandemic influenza, continuity of operations (COOP), and administrative preparedness exercises. 5 xxxxx://xxx.xxxxxx.xxx/uploads/downloadable-resources/Impact-of-the-Redirection-of-PHEP-Funding-to-Support-Xxxx- Response.pdf 6 CDC, 2018. xxxxx://xxx.xxx.xxx/cpr/readiness/stories/MIHepA.htm 7 FY2021 CDC Congressional Justification. HHS. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC- congressional-justification.pdf.

Impact. The response systems and infrastructure that states require to respond to public health emergencies would not exist in most instances without PHEP funding. According to CDC’s evaluations, PHEP awardees have improved capacity in nearly all high priority public health preparedness capabilities in the past few years. And the National Health Security Preparedness Index has found that public health preparedness domains trended upward between 2013-2017.3 The largest investments focused on public health surveillance and epidemiological investigation, laboratory testing, community preparedness and recoverypreparedness, information sharing, and medical countermeasures and mitigationemergency operations coordination. In order to help awardees address gaps, CDC works with the jurisdiction on technical assistance plans, including consultation across CDC. Nearly 2,700 state, local, territorial CDC has also established a Capacity Building Branch to design systematic approaches and federal preparedness and response employees across the country are funded in large part or entirely by the PHEP program.4 solutions to address commonly occurring gaps that require more broad capacity-building assistance. Federal funding is crucial to maintaining state, local and territorial public health preparedness capacity. Every fluctuation Even small fluctuations in funding – such as the 2016 redirection of $44 million from PHEP for the federal 1 “Widespread Person-to-Person Outbreaks of Hepatitis A Across the United States.” In Centers for Disease Control and Prevention. xxxxx://xxx.xxx.xxx/hepatitis/outbreaks/2017March-HepatitisA.htm 2 S Xxxxxxxxx, X Xxxxxxxxx, X Xxxxxxxx, and X Xxxxxxxx. “The Great Flood of 2019: A Complete Picture of a Slow-Motion Disaster.” The New York Times, September 11, 2019. xxxxx://xxx.xxxxxxx.xxx/interactive/2019/09/11/us/midwestflooding.html 3 FY2021 CDC Congressional Justification. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional- justification.pdf 4 FY2021 CDC CJ. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC-congressional-justification.pdf Xxxx response – has have major impacts on workforce, training, and readiness.5 readiness.3 These cuts cannot be backfilled with short-term funding after an event. An efficient and effective state and local workforce 1 NOAA, Billion-Dollar Weather and Climate Disasters: Overview. xxxxx://xxx.xxxx.xxxx.xxx/billions/. 2 HHS, FY 2017 CDC Justification of Estimates for Appropriations Committees. xxxx://xxx.xxx.xxx/budget/documents/fy2017/fy-2017-cdc-congressional-justification.pdf 3 xxxxx://xxx.xxxxxx.xxx/uploads/downloadable-resources/Impact-of-the-Redirection-of-PHEP-Funding-to-Support-Xxxx- Response.pdf response in particular relies heavily on predictablereliable, ongoing funding support for a network of local expertise, relationships and trust that is carefully built over time through shared responses, training and exercises. It can be rapidly degraded but it cannot be rapidly created or brought in through sporadic, ad hoc investments when a crisis strikes. Source: Centers for Disease Control and Prevention, 2017 Some examples of recent accomplishments of the PHEP program include: • Hepatitis A Outbreaks: Several states experienced hepatitis A outbreaks from 2016-2019, often among people experiencing homelessness or substance misuse.6 In Michigan, PHEP-funded health department staff worked with communicable disease and immunization program staff to decrease the time to report new cases, interview those affected, and provide information to the public. Thanks to coordination made possible through PHEP, Michigan administered 300,000 doses of hepatitis A vaccine, and new cases have declined each month since December 2017. • Hurricanes: During Hurricane Xxxxxxxx, state and local health department personnel staffed emergency operations centers, ensured safety of shelters, and prevented disease outbreaks. They also coordinated the transport of medical supplies and organized mosquito control efforts. In addition, states from across the country deployed 169 public health nurses to North Carolina to provide staffing support to places like Brunswick County, which had been isolated by flooding. The nurses provided medical and public health support for thousands of evacuees.7 • 2019 Floods: The winter of 2018-2019 was the wettest winter on record in the U.S. A series of record floods occurred in the Mississippi River Tributary basins, including the Ohio, Missouri and Arkansas rivers. The health risks associated with flooding include drowning, sewage contamination, waterborne diseases, food and water safety, mold, and mosquito-borne diseases. In Arkansas, the Department of Health prioritized immunizing first responders and people who would be temporarily living in shelters, ensuring access to healthcare for anyone displaced by the floods, insect control, communications, and monitoring for possible chemical releases or other contaminants in the Arkansas River and in water systems and private xxxxx. The state and local health departments worked with healthcare to evacuate a hospital and long-term care facility.8 Recommendation: TFAH recommends $824 million for the Public Health Emergency Preparedness Cooperative Agreements in FY21, the levels authorized in 2006. Emergency responses are increasing, despite funding eroding by about one-third since FY2002. This level of funding would: • Help restore capacity at health departments impacted by budget cuts and address gaps identified in the PHEP capabilities operational readiness review process, in areas such as risk communications and medical countermeasures distribution. • Build the Laboratory Response Network (LRN) and CDC and public health expertise and capacity for radiological and nuclear events. There is currently no public health laboratory capacity outside of CDC for this kind of testing and only limited throughput at CDC’s lab. • Advance biological and chemical laboratory capacity in states to keep up with current technologies and threats. • Support career epidemiology field officers (CEFO) in additional states, who are highly trained personnel who can help jurisdictions build their disease surveillance and response capability. • Conduct anthrax, pandemic influenza, continuity of operations (COOP), and administrative preparedness exercises. 5 xxxxx://xxx.xxxxxx.xxx/uploads/downloadable-resources/Impact-of-the-Redirection-of-PHEP-Funding-to-Support-Xxxx- Response.pdf 6 CDC, 2018. xxxxx://xxx.xxx.xxx/cpr/readiness/stories/MIHepA.htm 7 FY2021 CDC Congressional Justification. HHS. xxxxx://xxx.xxx.xxx/budget/documents/fy2021/FY-2021-CDC- congressional-justification.pdf: