[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2731 Reported in Senate (RS)]






                                                       Calendar No. 952
106th CONGRESS
  2d Session
                                S. 2731

                          [Report No. 106-505]

  To amend title III of the Public Health Service Act to enhance the 
  Nation's capacity to address public health threats and emergencies.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 14, 2000

 Mr. Frist (for himself, Mr. Kennedy, Mr. Jeffords, Ms. Mikulski, Mr. 
    Cleland, Mr. Cochran, Mr. Lieberman, Mr. Kerry, and Mr. Durbin) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

            October 18 (legislative day, September 22), 2000

               Reported by Mr. Jeffords, with amendments
  [Omit the part struck through and insert the part printed in italic]

_______________________________________________________________________

                                 A BILL


 
  To amend title III of the Public Health Service Act to enhance the 
  Nation's capacity to address public health threats and emergencies.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Public Health Threats and 
Emergencies Act''.

SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by striking section 319 and inserting the 
following:

``SEC. 319. PUBLIC HEALTH EMERGENCIES.

    ``(a) Emergencies.--If the Secretary determines, after consultation 
with the Director of the Centers for Disease Control and Prevention and 
other public health officials as may be necessary, that--
            ``(1) a disease or disorder presents a public health 
        emergency; or
            ``(2) a public health emergency, including significant 
        outbreaks of infectious diseases or bioterrorist attacks, 
        otherwise exists,
the Secretary may take such action as may be appropriate to respond to 
the public health emergency, including making grants and entering into 
contracts and conducting and supporting investigations into the cause, 
treatment, or prevention of a disease or disorder as described in 
paragraphs (1) and (2).
    ``(b) Public Health Emergency Fund.--
            ``(1) In general.--There is established in the Treasury a 
        fund to be designated as the `Public Health Emergency Fund' to 
        be made available to the Secretary without fiscal year 
        limitation to carry out subsection (a) only if a public health 
        emergency has been declared by the Secretary under such 
        subsection. There is authorized to be appropriated to the Fund 
        such sums as may be necessary.
            ``(2) Report.--Not later than 90 days after the end of each 
        fiscal year, the Secretary shall prepare and submit to the 
        Committee on Health, Education, Labor, and Pensions of the 
        Senate and the Committee on Commerce of the House of 
        Representatives a report describing--
                    ``(A) the expenditures made from the Public Health 
                Emergency Fund in such fiscal year; and
                    ``(B) each public health emergency for which the 
                expenditures were made and the activities undertaken 
                with respect to each emergency which was conducted or 
                supported by expenditures from the Fund.
    ``(c) Supplement Not Supplant.--Funds appropriated under this 
section shall be used to supplement and not supplant other Federal, 
State, and local public funds provided for activities under this 
section.

``SEC. 319A. NATIONAL NEEDS TO COMBAT THREATS TO PUBLIC HEALTH.

    ``(a) Capacities.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of this section, the Secretary, and such 
        Administrators, Directors, or Commissioners, as may be 
        appropriate, and in collaboration with State and local health 
        officials, shall establish reasonable capacities that are 
        appropriate for national, State, and local public health 
        systems and the personnel or work forces of such systems. Such 
        capacities shall be revised every 10 years, or more frequently 
        as the Secretary determines to be necessary.
            ``(2) Basis.--The capacities established under paragraph 
        (1) shall improve, enhance or expand the capacity of national, 
        state and local public health agencies to detect and respond 
        effectively to significant public health threats, including 
        major outbreaks of infectious disease, pathogens resistant to 
        antimicrobial agents and acts of bioterrorism. Such capacities 
        may include the capacity to--
                    ``(A) recognize the clinical signs and 
                epidemiological characteristic of significant outbreaks 
                of infectious disease;
                    ``(B) identify disease-causing pathogens rapidly 
                and accurately;
                    ``(C) develop and implement plans to provide 
                medical care for persons infected with disease-causing 
                agents and to provide preventive care as needed for 
                individuals likely to be exposed to disease-causing 
                agents;
                    ``(D) communicate information relevant to 
                significant public health threats rapidly to local, 
                State and national health agencies; or
                    ``(E) develop or implement policies to prevent the 
                spread of infectious disease or antimicrobial 
                resistance.
<DELETED>    ``(b) Report.--Not later than 1 year after the date of 
enactment of this section, and every 10 years thereafter, the Secretary 
shall prepare and submit to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on Commerce of the House 
of Representatives a report describing the capacities established 
pursuant to subsection (a).</DELETED>
    ``<DELETED>(c)</DELETED> (b) Supplement Not Supplant.--Funds 
appropriated under this section shall be used to supplement and not 
supplant other Federal, State, and local public funds provided for 
activities under this section.
    ``<DELETED>(d)</DELETED> (c) Technical Assistance.--The Secretary 
shall provide technical assistance to the States to assist such States 
in fulfilling the requirements of this section.
    ``<DELETED>(e)</DELETED> (d) Authorization of Appropriations.--
There <DELETED>is</DELETED> are authorized to be appropriated to carry 
out this section such sums as may be necessary for each of the fiscal 
years 2001 through 2006.

``SEC. 319B. ASSESSMENT OF PUBLIC HEALTH NEEDS.

    ``(a) Program Authorized.--Not later than 1 year after the date of 
enactment of this section and every 10 years thereafter, the Secretary 
shall award grants to States to perform, in collaboration with local 
public health agencies, an evaluation to determine the extent to which 
the States or local public health agencies can achieve the capacities 
applicable to State and local public health agencies described in 
subsection (a) of section 319A. The Secretary shall provide technical 
assistance to States in addition to awarding such grants.
    ``(b) Procedure.--
            ``(1) In general.--A State may contract with an outside 
        entity to perform the evaluation described in subsection (a).
            ``(2) Methods.--To the extent practicable, the evaluation 
        described in subsection (a) shall be completed by using 
        <DELETED>commonly accepted methods</DELETED> methods, to be 
        developed by the Secretary in collaboration with State and 
        local health officials, that facilitate the comparison of 
        evaluations conducted by a State to those conducted by other 
        States receiving funds under this section.
    ``(c) Report by State.--Not later than 1 year after the date on 
which a State receives a grant under this subsection, such State shall 
prepare and submit to the Secretary a report describing the results of 
the evaluation described in subsection (a) with respect to such State.
    ``(d) Supplement Not Supplant.--Funds appropriated under this 
section shall be used to supplement and not supplant other Federal, 
State, and local public funds provided for activities under this 
section.
    ``<DELETED>(E)</DELETED> (e) Authorization of Appropriations.--
There <DELETED>is</DELETED> are authorized to be appropriated to carry 
out this section such sums as may be necessary for each of the fiscal 
years 2002 and 2003.

``SEC. 319C. GRANTS TO IMPROVE STATE AND LOCAL PUBLIC HEALTH AGENCIES.

    ``(a) Program Authorized.--The Secretary shall award competitive 
grants to eligible entities to address core public health capacity 
needs using the capacities developed under section 319A, with a 
particular focus on building capacity to identify, detect, monitor, and 
respond to threats to the public health.
    ``(b) Eligible Entities.--A State or political subdivision of a 
State, or a consortium of 2 or more States or political subdivisions of 
States, that has completed an evaluation under section 319B(a), or an 
evaluation that is substantially equivalent as determined by the 
Secretary under section 319B(a), shall be eligible for grants under 
subsection <DELETED>(b)</DELETED> (a).
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
subsection <DELETED>(b)</DELETED> (a), may use funds received under 
such grant to--
            ``(1) train public health personnel;
            ``(2) develop, enhance, coordinate, or improve 
        participation in an electronic network by which disease 
        detection and public health related information can be rapidly 
        shared among national, regional, State, and local public health 
        agencies and health care providers;
            ``(3) develop a plan for responding to public health 
        emergencies, including significant outbreaks of infectious 
        diseases or bioterrorism attacks, which is coordinated with the 
        capacities of applicable national, State, <DELETED>and local 
        national</DELETED> local, and national health agencies; and
            ``(4) enhance laboratory capacity and facilities.
<DELETED>    ``(d) Report.--Not later than 1 year after the date of 
enactment of this section and annually thereafter, the Secretary shall 
prepare and submit to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on Commerce of the House of 
Representatives a report that describes the activities carried out 
under this section.</DELETED>
    ``(d) Report.--No later than January 1, 2005, the Secretary shall 
prepare and submit to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on Commerce of the House of 
Representatives a report that describes the activities carried out 
under sections 319A, 319B, and 319C.
    ``(e) Supplement Not Supplant.--Funds appropriated under this 
section shall be used to supplement and not supplant other Federal, 
State, and local public funds provided for activities under this 
section.
    ``(f) Authorization of Appropriations.--There <DELETED>is</DELETED> 
are authorized to be appropriated to carry out this section such sums 
as may be necessary for each of the fiscal years 2001 through 2006.

``SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    ``(a) Findings.--Congress finds that the Centers for Disease 
Control and Prevention have an essential role in defending against and 
combatting public health threats of the twenty-first century and 
requires secure and modern facilities that are sufficient to enable 
such Centers to conduct this important mission.
    ``(b) Authorization of Appropriations.--For the purposes of 
achieving the mission of the Centers for Disease Control and Prevention 
described in subsection (a), for constructing new facilities and 
renovating existing facilities of such Centers, including laboratories, 
laboratory support buildings, health communication facilities, office 
buildings and other facilities and infrastructure, for better 
conducting the capacities described in section 319A, and for supporting 
related public health activities, there are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2001 through 2010.

``SEC. 319E. COMBATING ANTIMICROBIAL RESISTANCE.

    ``(a) Task Force.--
            ``(1) In general.--The Secretary shall establish an 
        Antimicrobial Resistance Task Force to <DELETED>coordinate</DELETED> 
        provide advice and recommendations to the Secretary on Federal 
        programs relating to antimicrobial resistance. The Secretary 
        may appoint or select a committee, or other organization in 
        existence as of the date of enactment of this section, to serve 
        as such a task force, if such committee, or other organization 
        meets the requirements of this section.
            ``(2) Members of task force.--The task force described in 
        paragraph (1) shall be composed of representatives from such 
        Federal agencies, public health constituencies, manufacturers, 
medical professional societies and others as determined to be necessary 
by the Secretary, to <DELETED>develop and implement</DELETED> provide 
advice and recommendations regarding a comprehensive strategic plan to 
address the public health threat of antimicrobial resistance.
            ``(3) Agenda.--
                    ``(A) In general.--The task force described in 
                paragraph (1) shall consider factors the Secretary 
                considers appropriate, including--
                            ``(i) public health factors contributing to 
                        increasing antimicrobial resistance;
                            ``(ii) public health needs to detect and 
                        monitor antimicrobial resistance;
                            ``(iii) detection, prevention, and control 
                        strategies for resistant pathogens;
                            ``(iv) the need for improved information 
                        and data collection;
                            ``(v) the assessment of the risk imposed by 
                        pathogens presenting a threat to the public 
                        health; and
                            ``(vi) any other issues which the Secretary 
                        determines are relevant to antimicrobial 
                        resistance.
                    ``(B) Detection and control.--The Secretary, in 
                consultation with the task force described in paragraph 
                (1) and State and local public health officials, 
                shall--
                            ``(i) develop, improve, coordinate or 
                        enhance participation in a surveillance plan to 
                        detect and monitor emerging antimicrobial 
                        resistance; and
                            ``(ii) develop, improve, coordinate or 
                        enhance participation in an integrated 
                        information system to assimilate, analyze, and 
                        exchange antimicrobial resistance data between 
                        public health departments.
            ``(4) Meetings.--The task force described under paragraph 
        (1) shall convene not less than twice a year, or more 
        frequently as the Secretary determines to be appropriate.
    ``(b) Research and Development of New Antimicrobial Drugs and 
Diagnostics.--The Director of the National <DELETED>Institute</DELETED> 
Institutes of Health and the Director of the <DELETED>Center</DELETED> 
Centers for Disease Control and Prevention, <DELETED>in collaboration 
with members</DELETED> consistent with the recommendations of the task 
force established under subsection (a), shall conduct and support 
research, investigations, experiments, demonstrations, and studies in 
the health sciences that are related to--
            ``(1) the development of new therapeutics, including 
        vaccines and antimicrobials, against resistant pathogens;
            ``(2) the development or testing of medical diagnostics to 
        detect pathogens resistant to antimicrobials;
            ``(3) the epidemiology, mechanisms, and pathogenesis of 
        antimicrobial resistance;
            ``(4) the sequencing of the genomes of priority pathogens 
        as determined by the Director of the National Institutes of 
        Health in consultation with the task force established under 
        subsection (a); and
            ``(5) other relevant research areas.
    ``(c) Education of Medical and Public Health Personnel.--The 
Secretary, after consultation with the Surgeon General, the Director of 
the Centers for Disease Control and Prevention, the <DELETED>Director 
of</DELETED> Administrator of the Health Resources and Services 
Administration, the Director of the Agency for Healthcare Research and 
Quality, members of the task force described in subsection (a), and 
professional organizations and societies, shall--
            ``(1) develop and implement educational programs to 
        increase the awareness of the general public with respect to 
        the public health threat of antimicrobial resistance and the 
        appropriate use of antibiotics;
            ``(2) develop and implement educational programs to 
        instruct health care professionals in the prudent use of 
        antibiotics; and
            ``(3) develop and implement programs to train laboratory 
        personnel in the recognition or identification of resistance in 
        pathogens.
    ``(d) Grants.--
            ``(1) In general.--The Secretary shall award competitive 
        grants to eligible entities to enable such entities to increase 
        the capacity to detect, monitor, and combat antimicrobial 
        resistance.
            ``(2) Eligible entities.--Eligible entities for grants 
        under paragraph (1) shall be State or local public health 
        agencies.
            ``(3) Use of funds.--An eligible entity receiving a grant 
        under paragraph (1) shall use funds from such grant for 
        activities that are consistent with the factors identified by 
        the task force under subsection (a)(3), which may include 
        activities that--
                    ``(A) provide training to enable such entity to 
                identify patterns of resistance rapidly and accurately;
                    ``(B) develop, improve, coordinate or enhance 
                participation in information systems by which data on 
                resistant infections can be shared rapidly among 
                relevant national, State, and local health agencies and 
                health care providers; and
                    ``(C) develop and implement policies to control the 
                spread of antimicrobial resistance.
    ``(e) Grants for Demonstration Programs.--
            ``(1) In general.--The Secretary shall award competitive 
        grants to eligible entities to establish demonstration programs 
        to promote judicious use of antimicrobial drugs or control the 
        spread of antimicrobial-resistant pathogens.
            ``(2) Eligible entities.--Eligible entities for grants 
        under paragraph (1) may include hospitals, clinics, 
        institutions of long-term care, <DELETED>or professional 
        medical societies</DELETED> professional medical societies, or 
        other public or private nonprofit entities.
            ``(3) Technical assistance.--The Secretary shall provide 
        appropriate technical assistance to eligible entities that 
        receive grants under paragraph (1).
    ``(f) Supplement Not Supplant.--Funds appropriated under this 
section shall be used to supplement and not supplant other Federal, 
State, and local public funds provided for activities under this 
section.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of the fiscal years 2001 through 2006.

``SEC. 319F. PUBLIC HEALTH COUNTERMEASURES TO A BIOTERRORIST ATTACK.

    ``(a) Working Group on Preparedness for Acts of Bioterrorism.--The 
Secretary, in coordination with the Secretary of Defense, shall 
establish a joint interdepartmental working group on preparedness and 
readiness for the medical and public health effects of a bioterrorist 
attack on the civilian population. Such joint working group shall--
            ``(1) coordinate research on pathogens likely to be used in 
        a bioterrorist attack on the civilian population as well as 
        therapies to treat such pathogens;
            ``(2) coordinate research and development into equipment to 
        detect pathogens likely to be used in a bioterrorist attack on 
        the civilian population and protect against infection from such 
        pathogens;
            ``(3) develop shared standards for equipment to detect and 
        to protect against infection from pathogens likely to be used 
        in a bioterrorist attack on the civilian population; and
            ``(4) coordinate the development, maintenance, and 
        procedures for the release of, strategic reserves of vaccines, 
        drugs, and medical supplies which may be needed rapidly after a 
        bioterrorist attack upon the civilian population.
    ``(b) Working Group on the Public Health and Medical Consequences 
of Bioterrorism.--
            ``(1) In general.--The Secretary, in collaboration with the 
        Director of the Federal Emergency Management Agency and the 
        Attorney General, shall establish a joint interdepartmental 
        working group to address the public health and medical 
        consequences of a bioterrorist attack on the civilian 
        population.
            ``(2) Functions.--Such working group shall--
                    ``(A) assess the priorities for and enhance the 
                preparedness of public health institutions, providers 
                of medical care, and other emergency service personnel 
                to detect, diagnose, and respond to a bioterrorist 
                attack; and
                    ``(B) in the recognition that medical and public 
                health professionals are likely to provide much of the 
                first response to such an attack, develop, coordinate, 
                enhance, and assure the quality of joint planning and 
                training programs that address the public health and 
                medical consequences of a bioterrorist attack on the 
                civilian population between--
                            ``(i) local firefighters, ambulance 
                        personnel, police and public security officers, 
                        or other emergency response personnel; and
                            ``(ii) hospitals, primary care facilities, 
                        <DELETED>or</DELETED> and public health 
                        agencies.
            ``(3) Working group membership.--In establishing such 
        working group, the Secretary shall act through the Director of 
        the Office of Emergency Preparedness and the Director of the 
        Centers for Disease Control and Prevention.
            ``(4) Coordination.--The Secretary shall ensure 
        coordination and communication between the working groups 
        established in this subsection and subsection (a).
    ``(c) Grants.--
            ``(1) In general.--The Secretary, in coordination with the 
        working group established under subsection (b), <DELETED>shall 
        award grants on a competitive basis to</DELETED> shall, on a 
        competitive basis and following scientific or technical review, 
        award grants to or enter into cooperative agreements with 
        eligible entities to enable such entities to increase their 
        capacity to detect, diagnose, and respond to acts of 
        bioterrorism upon the civilian population.
            ``(2) Eligibility.--To be an eligible entity under this 
        subsection, such entity must be a State, political subdivision 
        of a State, a consortium of 2 or more States or political 
        subdivisions of States, or a hospital, clinic, or primary care 
        facility.
            ``(3) Use of funds.--An entity that receives a grant under 
        this subsection shall use such funds for activities that are 
        consistent with the priorities identified by the working group 
        under subsection (b), including--
                    ``(A) training health care professionals and public 
                health personnel to enhance the ability of such 
                personnel to recognize the symptoms and epidemiological 
                characteristics of exposure to a potential bioweapon;
                    ``(B) addressing rapid and accurate identification 
                of potential bioweapons;
                    ``(C) coordinating medical care for individuals 
                exposed to bioweapons; and
                    ``(D) facilitating and coordinating rapid 
                communication of data generated from a bioterrorist 
                attack between national, State, and local health 
                agencies.
            ``(4) Coordination.--The Secretary, in awarding grants 
        under this subsection, shall--
                    ``(A) notify the Director of the Office of Justice 
                Programs, and the Director of the National Domestic 
                Preparedness Office annually as to the amount and 
                status of grants awarded under this subsection; and
                    ``(B) coordinate grants awarded under this 
                subsection with grants awarded by the Office of 
                Emergency Preparedness and the Centers for Disease 
                Control and Prevention for the purpose of improving the 
                capacity of health care providers and public health 
                agencies to respond to bioterrorist attacks on the 
                civilian population.
            ``(5) Activities.--An entity that receives a grant under 
        this subsection shall, to the greatest extent practicable, 
        coordinate activities carried out with such funds with the 
        activities of a local Metropolitan Medical Response System.
    ``(d) Federal Assistance.--The Secretary shall ensure that the 
Department of Health and Human Services is able to provide such 
assistance as may be needed to State and local health agencies to 
enable such agencies to respond effectively to bioterrorist attacks.
    ``(e) Education.--The Secretary, in collaboration with members of 
the working group described in subsection (b), and professional 
organizations and societies, shall--
            ``(1) develop and implement educational programs to 
        instruct public health officials, medical professionals, and 
        other personnel working in health care facilities in the 
        recognition and care of victims of a bioterrorist attack; and
            ``(2) develop and implement programs to train laboratory 
        personnel in the recognition and identification of a potential 
        bioweapon.
    ``(f) Future Resource Development.--The Director of National 
Institutes of Health and the Director of the Centers for Disease 
Control and Prevention shall consult with the working group described 
in subsection (a), to develop priorities for and conduct research, 
investigations, experiments, demonstrations, and studies in the health 
sciences related to--
            ``(1) the epidemiology and pathogenesis of potential 
        bioweapons;
            ``(2) the development of new vaccines or other therapeutics 
        against pathogens likely to be used in a bioterrorist attack;
            ``(3) the development of medical diagnostics to detect 
        potential bioweapons; and
            ``(4) other relevant research areas.
<DELETED>    ``(g) Report.--Not later than 180 days after the date of 
enactment of this section, and annually, on June 30 of each year 
thereafter, the Secretary shall prepare and submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate, the Committee on 
Commerce of the House of Representatives, the Committee on Armed 
Services of the Senate, the Committee on Armed Services of the House of 
Representatives, and other congressional committees as may be 
appropriate, a report that--</DELETED>
        <DELETED>    ``(1) details the activities carried out by the 
        working groups under subsections (a) and (b) during the fiscal 
        year preceding the date on which the report is submitted and 
        describing such activities to be undertaken by Federal agencies 
        to combat bioterrorism in the subsequent year;</DELETED>
        <DELETED>    ``(2) describes the programs carried out under 
        subsection (c); and</DELETED>
        <DELETED>    ``(3) describes activities carried out by the 
        Secretary under subsections (d) and (e).</DELETED>
    ``<DELETED>(h)</DELETED> (g) General Accounting Office Report.--Not 
later than 180 days after the date of enactment of this section, the 
Comptroller General shall submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on Commerce of the 
House of Representatives a report that describes--
            ``(1) Federal activities primarily related to research on, 
        preparedness for, and the management of the public health and 
        medical consequences of a bioterrorist attack against the 
        civilian population;
            ``(2) the coordination of the activities described in 
        paragraph (1);
            ``(3) the amount of Federal funds authorized or 
        appropriated for the activities described in paragraph (1); and
            ``(4) the effectiveness of such efforts in preparing 
        national, State, and local authorities to address the public 
        health and medical consequences of a potential bioterrorist 
        attack against the civilian population.
    ``<DELETED>(i)</DELETED> (h) Supplement Not Supplant.--Funds 
appropriated under this section shall be used to supplement and not 
supplant other Federal, State, and local public funds provided for 
activities under this section.
    ``<DELETED>(j)</DELETED> (i) Authorization of Appropriations.--
There <DELETED>is</DELETED> are authorized to be appropriated to carry 
out this section such sums as may be necessary for each of the fiscal 
years 2001 through 2006.''.




                                                       Calendar No. 952

106th CONGRESS

  2d Session

                                S. 2731

                          [Report No. 106-505]

_______________________________________________________________________

                                 A BILL

  To amend title III of the Public Health Service Act to enhance the 
  Nation's capacity to address public health threats and emergencies.

_______________________________________________________________________

            October 18 (legislative day, September 22), 2000

                        Reported with amendments