[Congressional Record Volume 146, Number 74 (Wednesday, June 14, 2000)]
[Senate]
[Pages S5115-S5117]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST for himself and Mr. Kennedy):
  S. 2731. 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; to the Committee on Health, Education and Pensions.


           Public Health Threats and Emergencies Act of 2000

  Mr. FRIST. Mr. President. I am pleased today to introduce the 
``Public

[[Page S5116]]

Health Threats and Emergencies Act of 2000'' with my colleague, 
Senator, Kennedy, to improve our public health infrastructure and to 
address the growing threats of antimicrobial resistance and 
bioterrorism.
  Over the last two years, we have held three hearings and forums on 
these topics, and I also commissioned a GAO report on antimicrobial 
resistance. The outcome of all this research is clear; we need to 
improve our public health infrastructure to be able to respond in a 
timely and effective manner to these and other threats.
  For too long, we have not provided adequate funding to maintain and 
improve the core capacities of our nation's public health 
infrastructure. As the GAO report found, many State and local public 
health agencies lack even the most basic equipment such as FAX machines 
or answering machines to assist their workload and improve 
communications.
  We face a myriad of public health threats everyday, and besides 
improving our core public health capacity, this act aim addresses two 
problems in particular: antimicrobial resistance and bioterrorism.
  Antimicrobial resistance is a pressing pubic health problem. As a 
heart and lung transplant surgeon, I know all too well that the most 
common cause of death after transplantation of a heart or lung is not 
rejection, but infection. One hundred percent of transplantation 
patients contract infections following surgery. Infection is the most 
common complication following surgery, the leading cause for 
rehospitalization, and the most expensive aspect of treatment post-
transplantation. Antibiotics are a mainstay of treatment, yet we are 
increasingly seeing resistant bacteria which are not killed by most 
first-line antimicrobials.
  In fact, the New England Journal of Medicine has reported that 
certain Staphylocci, which are a common cause of post-surgical and 
hospital acquired infections, are showing intermediate resistance to 
vancomycin, an antibiotic of the last resort. Just recently in mid-
April, the FDA approved the first entirely new type antibiotic in 35 
years.
  How did we reach this point? For most of human history, infections 
were the scourge of man's existence causing debilitating disease and 
often death. Antibiotics, when initially discovered more than 50 years 
ago, were heralded as miracle drugs and quickly became our most lethal 
weapon in the crusade against disease-causing bacteria. Antibiotics 
were widely dispensed and, in the 1970's premature optimism lead us to 
declare the war on infections won.
  Unfortunately, we discovered that bacteria are cagey, tenacious 
organisms that swiftly developed resistance to antibiotics and adapted 
to drug-rich environments. In addition, the art of medicine evolved, 
creating new opportunities for bacteria to cause infection from 
invasive procedures using catheters to organ transplant recipients who 
are treated with immunosuppressive agents to prevent rejection. As a 
result, we are both seeing more invasive, life-threatening infections 
that require concurrent treatment with several antibiotics to control 
and infections that were on the decline, such as Tuberculosis, re-
emerging in an antimicrobial resistant form.
  While infections have plagued man's existence for most of human 
history, throughout civilization, bioweapons have been strategically 
deployed during critical military battles. For example, in 1344, the 
Mongols hurled corpses infected with bubonic plague over the city walls 
of Caffa (now Feodossia, Ukraine). During World War I, the Germans 
hoped to gain an advantage by infecting their enemies horses and 
livestock with anthrax.
  Bioterrorism is a significant threat to our country. As a nation we 
are presently more vulnerable to bioweapons than other more traditional 
means of warfare. Bioweapons pose considerable challenges that are 
different from those of standard terrorist devices, including chemical 
weapons.
  The mere term ``bioweapon'' invokes visions of immense human pain and 
suffering and mass casualties. Pound for pound, ounce for ounce, 
bioagents represent one of the most lethal weapons of mass destruction 
known. Moreover, victims of a covert bioterrorist attack do not 
necessarily develop symptoms upon exposure to the bioagent. Development 
of symptoms may be delayed days long after the bioweapon is dispersed.
  As a result, exposed individuals will most likely show up in 
emergency rooms, physician offices, or clinics, with nondescript 
symptoms or ones that mimic the common cold or flu. In all likelihood, 
physicians and other health care providers will not attribute these 
symptoms to a bioweapon. If the bioagent is communicable, such as small 
pox, many more people may be infected in the interim, including our 
health care workers. As Stephanie Bailey, the Director of Health for 
Metropolitan Nashville and Davidson County pointed out in our hearing 
on bioterrorism, ``many localities are on their own for the first 24 to 
48 hours after an attack before Federal assistance can arrive and be 
operational. This is the critical time for preventing mass 
casualties.''
  If experts are correct in their belief that a major bioterrorist 
attack is a virtual certainty, that it is no longer a question of 
``if'' but rather ``when.'' In fact, my home town of Nashville last 
year joined an ever-increasing number of cities to receive and respond 
to a package that was suspected of containing anthrax. Thankfully, this 
was a hoax.
  To address these concerns about our public health infrastructure and 
improve our preparedness for the threats of antimicrobial resistance 
and bioterrorism, I have joined with Senator Kennedy to provide greater 
resources and coordination to address these issues.
  The Public Health Threats and Emergencies Act, which we introduce 
today, will provide needed guidance, resources, and coordination to 
increase the core capacities of the nation's public health 
infrastructure. This Act will also improve the coordination and 
increase the resources available to address the threats of bioterrorism 
and antimicrobial resistance.
  Strengthening capacities to ensure that the public health 
infrastructure is adequate to respond to carry out core functions and 
respond to emerging threats and emergencies, the Public Health Threats 
and Emergencies Act authorizes: the establishment of voluntary 
performance goals for public health systems; grants to public health 
agencies to conduct assessments and build core capacities to achieve 
these goals; and funding to rebuild and remodel the facilities of the 
Center for Disease Control and Prevention.
  To strengthen public health capacities to combat antimicrobial 
resistance, the Act authorizes: a task force to coordinate Federal 
programs related to antimicrobial resistance and to improve public 
education on antimicrobial resistance; the National Institutes of 
Health (NIH) to support research into the development of new 
therapeutics against and improved diagnostics for resistant pathogens; 
and grants for activities to improve specific capacities to detect, 
monitor, and combat antimicrobial resistance.
  To strengthen public health capacities to prevent and respond to 
bioterrorism, the Act authorizes: two interdepartmental task forces to 
address joint issues of research needs and the public health and 
medical consequences of bioterrorism; NIH and CDC research on the 
epidemiology of bioweapons and the development of new vaccines or 
therapeutics for bioweapons; and grants to public health agencies and 
hospitals and care facilities to detect, diagnose, and respond to 
bioterrorism.
  Mr. President, this Act is necessary. We must take steps now to 
improve our basic capacities to address all public health threats, 
including antimicrobial resistance and bioterrorism. I am hopeful this 
legislation provides State and local public health agencies the 
resources to improve their abilities so that we better protect the 
health and well-being of our Nation's citizens.
  I want to thank Senator Kennedy for joining me in this effort and for 
the work of his staff. I would also like to thank Dr. Stephanie Bailey, 
the Director of Health for Metropolitan Nashville and Davidson County 
for her assistance and input on this important piece of legislation.
  Mr. KENNEDY. Mr. President, several months ago, my distinguished 
colleague, Senator Bill Frist, and I began to develop legislation 
needed to enhance the nation's protections

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against the triple threat to health posed by new and resurgent 
infectious diseases, by ``superbugs'' resistant to antibiotics, and by 
terrorist attacks with biological weapons. Today, Senator Frist and I 
are introducing the Public Health Threats and Emergencies Act of 2000. 
I commend Senator Frist for his leadership and commitment on this 
important legislation.
  The bill that we are introducing today will provide the nation with 
additional weapons to win the battle against the deadly perils of 
infectious disease, antimicrobial resistance and bioterrorism. The 
Public Health Threats and Emergencies Act of 2000 will revitalize the 
nation's ability to monitor and fight outbreaks of infectious disease, 
control the spread of germs resistant to antibiotics, and protect the 
nation more effectively against bioterrorism.
  Today we face a world where deadly contagious diseases that erupt in 
one part of the world can be transported across the globe with the 
speed of a jet aircraft. The recent outbreak of West Nile Fever in the 
New York area is an ominous warning of future dangers. Diseases such as 
cholera, typhoid and pneumonia that we have fought for generations 
still claim millions of lives across the world and will pose increasing 
dangers to this country in years to come. New plagues like Ebola virus, 
Lassa Fever and others now unknown to science may one day invade our 
shores.
  Less exotic, but also deadly, are the simpler infections that for 
almost a century we have been able to treat with antibiotics, but that 
are now becoming resistant even to our most advanced medicines. Drugs 
that once had the power to cure dangerous infections are now often 
useless--because ``superbugs`' have now become resistant to all but the 
most powerful and expensive medications. Strains of tuberculosis that 
are resistant to antimicrobial drugs are prevalent around the world, 
and are a growing danger in our inner cities and among the homeless. If 
action is not urgently taken, we may soon return to the days when a 
simple case of food poisoning could prove deadly and a mere cut could 
become severely infected and cost a limb.
  The growing financial burden of antimicrobial resistance on the 
health care system is staggering. Treating a patient with TB usually 
costs $12,000. But when a patient has drug-resistant TB, that figure 
soars to $180,000. The National Foundation for Infectious Diseases 
estimates that the total cost of antimicrobial resistance to the U.S. 
health care system is as high as $4 billion every year--and this figure 
will only rise as resistant infections become more common.
  But the most potentially deadly of these threats is bioterrorism. We 
are a nation at risk. Biological weapons are the massive new threats of 
the twenty-first century. The Office of Emergency Preparedness 
estimates that 40 million Americans could die if a terrorist released 
smallpox into the American population. Anthrax could kill 10 million. 
Other deadly pathogens known to have been developed in biological 
warfare labs around the world could kill millions.
  Our proposal will strengthen the nation's public health agencies, 
which provide the first line of defense against bioterrorism and many 
other threats to the public health. Our legislation authorizes the 
Secretary of Health and Human Services to respond swiftly and 
effectively to a public health emergency, and provides the Secretary 
with needed resources to mount a strong defense against whatever danger 
imperils the nation's health.
  The bill calls upon the Secretary of Health and Human Services to 
establish a national monitoring plan for dangerous infections resistant 
to antibiotics, and to work closely with state and local public health 
agencies to ensure that this peril is contained.
  It is also essential to educate patients and medical providers in the 
appropriate use of antibiotics. Too often, patients demand antibiotics 
and doctors provide them for illnesses which do not require and do not 
respond to these drugs. Our legislation calls upon the federal 
government to lead a national campaign to educate patients and health 
providers in the appropriate use of antibiotics.
  The threat of bioterrorism demands particular attention, because of 
its potential for massive death and destruction. Currently, dozens of 
federal agencies share responsibility for domestic preparedness against 
bioterrorist attacks. This bill will enhance the nation's preparedness 
by improving coordination among federal agencies responsible for all 
aspects of a bioterrorist attack. Better coordination will allow us to 
develop the public health countermeasures needed to defend against 
bioterrorism, such as stockpiles of essential supplies and effective 
disaster planning.
  Since the infectious organisms likely to be used in a bioterrorist 
attack are rarely encountered in normal medical practice, many doctors 
or laboratory specialists are likely to be unable to diagnose persons 
with these diseases rapidly and accurately. Recognizing a bioterrorist 
attack quickly is a major part of containing it. This bill will improve 
the preparedness of public health institutions, health providers, and 
emergency personnel to detect, diagnose, and respond to bioterrorist 
attacks through improved training and public education.
  One of the highest duties of Congress is to protect the nation 
against all threats, foreign and domestic. Deadly infectious diseases, 
new ``superbugs'' resistant to antibiotics, and bioterrorism clearly 
menace the nation. We must resist these threats as vigorously as we 
would fight an invading army. the Frist-Kennedy bill is intended to 
provide the weapons we need to win this battle.

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