[Congressional Record Volume 146, Number 138 (Saturday, October 28, 2000)]
[Senate]
[Pages S11305-S11314]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
FIGHTING FOR FUNDAMENTAL FAIRNESS
Mr. REID. Mr. President, I rise today to attempt to put some
transparence on what is going on around here.
This summer, the Republicans very successfully convinced the American
people that their party was for estate tax relief and marriage penalty
relief and that the Democrats were not. Well, my friends, that is
simply not the case. The Democrats are for eliminating the estate tax
for small businesses and family farms valued at $8 million and for all
other estates worth $4 million. And, Mr. President, it is the
Democratic plan for marriage penalty relief that completely eliminates
the marriage penalty found in 65 provisions in the tax code.
So, isn't it a bit frightening that the Republicans have so
successfully twisted the debate so as to mislead the American people
into thinking that they are actually the party supportive of tax cuts.
Reality is, however, that they are the party of political rhetoric and
political maneuvering. If the Republicans really wanted to give the
American people estate tax relief and marriage penalty relief, they
could have--they had many, many opportunities for sending the President
real relief. Instead of giving the American people empty rhetoric--we
could be sitting here today with elimination of the estate tax and
marriage penalty tax relief for virtually all Americans.
Now, why do I bring all this up. Because it is happening over and
over again. The Republicans are misleading the American people on a
host of critical pieces of legislation, including: patients bill of
rights, prescription drug coverage, minimum wage increase, tax cuts,
health insurance coverage and education.
Instead of actually providing the American people with real relief--
this year--the Republicans prefer the politics.
I have heard from constituents who ask me--``If both Republicans and
Democrats want patients bill of rights, then why can't the Republicans
and Democrats just work together to get something done?'' That is an
excellent question. Why?
Why is it that we cannot just reach agreement? Is it that we are
missing
[[Page S11306]]
some magical force here in Washington to bring bipartisanship to all?
Unfortunately, the answer is that the Republicans want the rhetoric--
and the Democrats want real reform. So, until the Republicans stop
pandering and posturing and start sincerely and openly working
together, there can be no agreements. You see, the Republicans have a
more difficult time even working with each other--there is nothing
partisan or bipartisan about that. Yet they have misled the American
people to think that the Democrats--not the Republicans--are the ones
holding up the works and refusing to work in a bipartisan manner. Mr.
President, that is truly overstepping the bounds of the reality of what
is going on up here.
Our efforts to fight for fundamental fairness in health, education
and tax cuts, are being twisted into political pandering and posturing
by the Republicans. But all we are doing is fighting for the
fundamental fairness that the American people have fought for by
working hard every day of their lives.
Let me illustrate this by highlighting the differences between the
policies of the Republicans and the Democrats with respect to the bill
that we have before us.
The Democrats are fighting to ensure that we do as much as possible
to meet America's need for safe and modern schools.
Democrats solution--enact the bipartisan Rangel-Johnson proposal to
finance $25 billion in bonds to construct and modernize 6,000 schools.
Republican's bill--is thoroughly inadequate--it provides no
guaranteed funding for urgent school repairs, provides only $16 billion
in bonds, and does not include the important Davis-Bacon provision to
ensure that the construction workers who build and repair our nation's
schools receive a fair wage for their work.
Result of their plan--the arbitrage provision encourages delay in
urgently needed school construction and would disproportionately help
wealthy school districts.
The Democrats are fighting to ensure that we promote bipartisanship
in health care by coupling both the Republican and Democrat priorities
on health care and long-term care.
Democrats solution-- our FamilyCare proposal would expand coverage to
4 million uninsured parents at a cost of slightly over $3,000 per
person.
Republican's bill--provides additional coverage to one-seventh of the
people at $18,000 per person--that is one-seventh of the people at 6
times the cost. Their approach is inequitable, inefficient, and
counterproductive to health care policy.
Result of their plan--completely ignores a proposal to cover millions
of uninsured, working Americans and jeopardizes the insurance coverage
of those individuals currently receiving employer-based coverage. In
fact, on the Republican health deduction, the Joint Tax Committee
estimates that while over 26 million individuals would receive benefits
under the proposal, only 1.6 million individuals would be newly insured
as a result. In contrast, the Democrats in Congress and the Clinton-
Gore Administration plan would expand coverage to 5 million uninsured
Americans.
The Democrats are fighting to ensure that we help the families who
care for our nation's elderly.
Democrats solution--accept the Republicans deduction for long-term
care insurance in exchange for inclusion of a proposal to provide a
$3,000 tax credit for long-term care costs.
Republican's bill--provide a health care deduction for long-term care
costs.
Result of their plan--they provide half of the benefits of the long-
term care credit that the Democrats provide.
The Democrats are fighting to ensure that all Americans are insured.
Democrats solution--bipartisan policies for health insurance options
for children with disabilities, legal immigrant pregnant women and
children, and enrolling uninsured children in schools, needed payment
increases to hospitals, academic health centers, home health agencies
and other vulnerable providers.
Republican's bill--provides over one-third of the cost of their
medicare bill to the HMOs.
Result of their plan--there is no accountability to prevent excessive
payment increases to HMOs and failure to address the urgent health
needs of seniors, people with disabilities, and children.
The Democrats are fighting to ensure that we encourage medical
research and expand vaccine distribution to proactively approach
medicine.
Democrats solution--a bipartisan tax credit for vaccine research and
purchases for malaria, tuberculosis, HIV/AIDS and any infectious
disease that causes over 1 million deaths annually.
Republican's bill--nothing.
Result of their plan--this is a failure to address a problem of
serious ramifications. These diseases cause almost half of all deaths
worldwide of people under age 45, killing over 8 million children each
year and orphaning millions more.
The Democrats are fighting to ensure that low and middle income
individuals save and invest for their future.
Democrats solution--provide savings incentives to low and middle
income individuals through retirement savings accounts.
Republican's bill--they specifically dropped this provision from the
bipartisan Senate Finance Committee bill.
Result of their plan--a failure to address the lack of pension
coverage for 70 million people. I want to just add one point here.
Every year, through tax incentives, private pensions cost the fisc $76
billion. Yet 75 percent of American households in the 15 percent tax
bracket--that means income of about $30,000--receive little or no tax
incentive on their IRA or pension contribution.
The Democrats are fighting to ensure that we meet our current
obligations before we promise new programs for distressed communities.
Democrats solution--fully fund the currently existing empowerment
zones to spur economic development in distressed communities.
Republican's bill--create new renewal communities without meeting our
promise to the existing empowerment zone communities.
Result of their plan--irresponsible pandering to wealthy business
owners who will benefit from their new renewal communities at the
expense of low and middle income entrepreneurs.
The Democrats are fighting to ensure that we don't turn our backs on
those areas most in need.
Democrats solution--provide an economic activity credit to encourage
business investment in jobs for the residents of Puerto Rico.
Republican's bill--they specifically rejected this provision.
Result of their plan-- this equates to turning their backs on the
hard working people of Puerto Rico. Even while at an historical low of
about 10.1 percent, the unemployment rate in Puerto Rico continues to
remain well above that of any state; the per capita income in Puerto
Rico, which was $9,908 in FY 1999, is less than half that of any state;
and well over 50 percent of the labor force in Puerto Rico are within
$1.00 of the current minimum wage.
The Democrats are fighting to ensure that we encourage adoption of
special needs children from foster care programs.
Democrats solution--change a few words in the current tax code to
ensure that families who adopt children from foster care can benefit
from the same tax credit which is available to parents who adopt
international children.
Republican's bill--specifically ignored a more inclusive approach.
Result of their plan--the Republicans turned their backs on those
children with the greatest needs.
Let's look at some of those who do benefit under the Republican plan
for example--the Texas State Universities. Now, stay with me on this.
The Republicans--well I should say only about 4 or 5 Republicans, in
their closed door, secret meetings included a couple of interesting
rifle shots in their tax bill. The one, interestingly enough, would
provide a specific exception just for the Texas state universities,
that would make their interest on bonds nontaxable. The American people
are giving the Texas state universities a $4 million gift --while our
public elementary and high school students are learning in trailers.
The bottom line is that the Republicans want to help big business and
the HMOs. The Democrats reject this approach. The Democrats are
fighting for fundamental fairness for the American people--our
children, our elderly,
[[Page S11307]]
and all individuals of every race, color, and creed.
Mr. HATCH. Mr. President I rise again today to urge President Clinton
not to veto the Commerce, Justice, State appropriations bill that the
Senate passed yesterday.
President Clinton has threatened a veto because we did not include
his so-called Latino fairness act. But have included something much
better--the Legal Immigration Family Equity Act, the LIFE Act. This act
reunites families and restores due process to those who have played by
the rules. Our proposal does not pit one nationality against another,
nor does it pit one race against another. Our legislation provides
relief to immigrants from all countries. A veto of CJS would be a blow
against immigrant fairness.
But a veto would do far more than that. A veto would cut off funding
for some of our most important programs.
CJS appropriations allocates: $4.8 billion for the INS and an
additional $15.7 million for Border Patrol equipment upgrades, $3.3
billion for the FBI, and $221 million for training, equipment, and
research and development programs to combat domestic terrorism, $4.3
billion for the federal prison system; $1.3 billion for the Drug
Enforcement Administration; and $288 million for the Violence Against
Women Act program--legislation that I have strongly supported and that
provides assistance to battered women and children.
Actions have consequences. If President Clinton vetoes this bill,
he's putting the public's safety and well-being at risk both at home
and abroad. and he's doing this all in an effort to play wedge
politics. the President's veto threats ring especially hollow because
this appropriations bill provides many proposals to help immigrants.
The President himself has stated that he wants ``to keep families
together and to make our immigration policies more equitable.'' Well,
this is exactly what the LIFE Act does.
So, please, I ask Mr. Clinton, sign CJS appropriations so we can keep
all of these programs funded for the American people.
Mr. FRIST. Mr. President, I am pleased the Senate has passed, H.R.
2598, the Public Health Improvement Act of 2000, a bill which combines
a number of critical bills improving the health of our citizens.
Title I of this measure contains a bill which passed the Senate
Health, Education and Pensions Committee on June 14, 2000, the Public
Health Threats and Emergencies Act of 2000. This important legislation,
which I drafted with my colleague, Senator Kennedy, is the culmination
of three hearings and forums and a GAO report over the last two years
which demonstrated the need to improve our public health infrastructure
and address the growing threats of antimicrobial resistance and
bioterrorism.
The conclusion 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 basic equipment of a fax
machine or answering machine to assist in their work and improve
communications.
Besides improving our core public health capacity, this Act addresses
two specific problems faced by the nation: antimicrobial resistance and
bioterrorism.
The first, antimicrobial resistance is a growing public health
problem. As a heart and lung transplant surgeon, I know all too well
that the most common cause of death after the transplantation of a
heart or lung is not rejection, but infection. One hundred percent of
transplantation patients get infections following surgery. Infection is
the most common complication following surgery, the leading cause for
rehopitalization, and the most expensive aspect of treatment post-
transplantation. Antibiotics are a mainstay of treatment, yet we are
seeing increasingly resistant bacteria which are not killed by most
first-line antimicrobials.
The second issue addressed by this act, bioterrorism, poses a
significant threat to our country's strategic well-being. As a nation
we are presently more vulnerable to bioweapons than other more
traditional means of warfare. Bioweapons pose considerable challenges,
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, but also covert, weapons of
mass destruction known. Victims of a covert bioterrorist attack do not
necessarily develop symptoms upon exposure to the bioagent as the onset
may be delayed for days after the bioweapon is dispersed.
As a result, exposed individuals will likely show up in emergency
rooms, physician offices, or clinics with nondescript symptoms or ones
that mimic the common cold or flu. Physicians and other health care
providers will likely 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, then 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 suspected to contain anthrax. Thankfully, this was a hoax.
The Public Health Threats and Emergencies Act provides greater
resources and coordination to improve our public health infrastructure
and bolster our preparedness against antimicrobial resistance and
bioterrorism.
To strengthen public health infrastructure's ability to fulfill its
core functions and respond to emerging threats and emergencies, the
bill authorizes the establishment of voluntary performance goals for
public health systems, grants to public health agencies for assessments
and core capacity building, and funding to rebuild and remodel the
facilities of the Centers for Disease Control and Prevention, CDC.
To combat antimicrobial resistance, the bill authorizes a task force
to coordinate Federal programs related to antimicrobial resistance and
to improve public education on antimicrobial resistance; National
Institutes of Health (NIH) research into new therapeutics against and
improved diagnostics for resistant pathogens; and grants to detect,
monitor, and combat antimicrobial resistance.
To prevent and respond to bioterrorism, the bill authorizes: two
interdepartmental task forces to address the 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 improve the ability of public health agencies, hospitals, and health
care facilities to detect, diagnose, and respond to bioterrorism.
We must act now to improve our basic capacities to address all public
health threats, including antimicrobial resistance and bioterrorism.
This legislation provides State and local public health agencies the
necessary resources so that we better protect the health and well-being
of our Nation's citizens.
The Public Health Improvement Act also improves our nation's medical
research infrastructure through two bills that I co-authored: the
Clinical Research Enhancement Act and the Twenty-First Century Research
Laboratories Act.
As a physician, I am aware of the need to translate laboratory
discoveries into advances in patient care, but I was troubled by
numerous reports and analyses showing insufficient support for patient-
oriented research in the United States. The ``Clinical Research
Enhancement Act,'' which I also drafted with Senator Kennedy, addresses
this issue by establishing intramural and extramural clinical research
fellowship programs and a continuing
[[Page S11308]]
education clinical research training program at the NIH. In addition,
the bill provides grants for the establishment of general clinical
research centers, which provide the infrastructure for clinical
research, including clinical training and career enhancement.
The ``Twenty-First Century Research Laboratories Act,'' which I
drafted with Senator Harkin improves our research infrastructure that
is central to our continued leadership in medical research.
Unfortunately, many research facilities are outdated, and future
increases in federal funding for the NIH must include support for the
renovation and construction of extramural research facilities and the
purchase of state-of-the-art laboratory instrumentation. To renovate
biomedical and behavioral research facilities, the bill authorizes
grants or contracts to public and nonprofit private entities to expand,
remodel, renovate, or alter existing research facilities or construct
new research facilities, including centers of excellence. In addition,
it provides grants to public and non-profit private entities for the
purchase of high-end, state-of-the art laboratory instrumentation.
The ``Public Health Improvement Act'' also includes important public
health bills such as the ``Cardiac Arrest Survival Act,'' the ``Rural
Access to Emergency Devices Act,'' the ``Lupus Research Act,'' the
``Prostate Cancer Research and Protection Act,'' as well as important
critical pieces of legislation improving organ donation and
procurement.
The ``Cardiac Arrest Survival Act,'' which Senator Gorton introduced,
allows the Secretary of HHS to make recommendations with respect to
placing automated external defibrillators, AEDs, in federal building
and to expand liability protection to persons or organizations who use
AEDs. The ``Rural Access to Emergency Devices Act,'' which Senator
Collins introduced would improve access to AEDs in small communities
and rural areas to boost the survival rates of individuals in those
communities who suffer cardiac arrest. In many small and rural
communities limited budgets and the fact that so many rely on volunteer
organizations for emergency services can make acquisition and
appropriate training in the use of these life-saving devices
problematic. This legislation is intended to increase access to AEDs
and trained local responders for smaller towns and rural areas where
those first on the scene may not be paramedics or others who would
normally have AEDs. With more than 700 people dying of sudden cardiac
arrest each day, up to 30 percent of which could be saved through
immediate medical attention, including defibrillation and
cardiopulmonary resuscitation, it is my hope this provision will lead
to increased placement and use of this life saving equipment.
Senator Bennett introduced the Lupus Research Act, to require the
Director of the National Institute of Arthritis and Musculoskeletal and
Skin Diseases to expand and intensify research and related activities
of the Institute regarding lupus. Lupus is a disorder of the immune
system that affects between 1,400,000 and 2,000,000 Americans. Many
with the disease are either misdiagnosed or not diagnosed at all. Lupus
is often life threatening and is nine times more likely to affect women
than men. The symptoms of lupus make diagnosis difficult because they
are sporadic and imitate the symptoms of many other illnesses. If
diagnosed properly, the majority of lupus cases can be controlled with
proper treatment. This measure will increase research into this disease
so that it may be more effectively diagnosed and treated.
Title VI of the Public Health Improvement Act contains the Prostate
Cancer Research and Protection Act, which I introduced last year. Each
year an estimated 37,000 American men will die, and 179,300 will be
diagnosed with prostate cancer, the second leading cause of cancer-
related death in American men. Cancer of the prostate grows slowly,
without symptoms, and thus is often undetected until it's in its most
advanced and incurable stage. It is critical that men are aware of the
risk of prostate cancer and take steps to ensure early detection. The
``Prostate Cancer'' bill expands the authority of the CDC to carry out
activities related to prostate cancer screening and overall awareness
and surveillance of the disease. The bill also extends the authority of
the NIH to conduct basic and clinical research in combating prostate
cancer.
Finally, I would like to talk about provisions of great personal
significance to me relating to organ procurement and donation. Last
year, more than 21,000 lives were saved through transplantation in the
United States. However, the demand for transplants has more than
tripled in the past ten years, and 16 people die each day before they
can receive a transplant. As a transplant surgeon, I can't express
enough to my colleagues and the nation how important organ donation is.
That is why the ``Public Health Improvement Act'' includes a resolution
recognizing the need for increased organ and tissue donation and the
important role that families play in the process. The resolution
designates November 23, 2000, Thanksgiving Day, as a day to ``Give
Thanks, Give Life'' and to discuss organ and tissue donation with other
family members. It encourages families to use the time of Thanksgiving,
a time dedicated to spending time with one another, to discuss this
critical life-saving issue among themselves so that they may make
informed decisions should the occasion to donate arise. Thanksgiving is
a time to reflect on our blessings, and it represents the perfect
opportunity for family members to discuss this simple act that can give
life to those most in need.
The bill also includes the ``Organ Procurement Organization
Certification Act,'' which was drafted by Senators Collins and Dodd.
Organ Procurement Organizations, OPOs, approach families regarding
organ donation and arrange transportation of organs and transplant
surgery logistics. They must currently be recertified every two years
by the Health Care Financing Administration, HCFA, in order to qualify
for Medicare reimbursement. This bill requires HCFA to change the
standards for recertification to account for variation in the number of
potential donors in a given state and extends the current certification
cycle from two to four years.
Mr. President, I am pleased that the Senate has passed this bill,
which represents the work of many Senators which I have mentioned in my
remarks. I am thankful to all my colleagues for their support and
willingness to help improve the public health of this nation. I would
especially like to thank Senators Jeffords and Kennedy and
Representatives Tom Bliley, Michael Bilirakis, John Dingell and Sherrod
Brown, and their excellent staffs for all the hard work and dedication
that has gone into negotiating this package of bills. I would also like
to thank Mr. Bill Baird and Ms. Daphne Edwards of the Office of Senate
Legislative Counsel, for their tireless work and great expertise in
drafting this bill. I would like to thank my Staff Director of the
Public Health Subcommittee, Anne Phelps, and my Health Advisors Dave
Larson and Mary Sumpter Johnson for their work in making this bill
possible. Finally, I would like to thank the many groups who have
worked on the various provisions in this bill for their support, and I
look forward to enactment of this bill this year.
Mr. President, I ask unanimous consent to place in the record a
summary of the Public Health Improvement Act and letters of support for
the Public Health Threats and Emergencies Act, which is incorporated in
the Public Health Improvement Act.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The Public Health Improvement Act of 2000
TITLE I--Emerging Threats to Public Health
Most Americans live longer, healthier lives today than ever
before. However, the nation also faces grave new threats
that, if unmet, will imperil the extraordinary medical
progress made in recent decades. These emerging threats
include new or resurgent infectious diseases, dangerous
microbes resistant to antibiotics, and bioterrorist attacks.
The provision under this Title strengthens the nation's
capacity to detect and respond to these serious public health
threats by:
Improving the capacity of national, state, and local public
health agencies to detect and respond effectively to
infectious disease outbreaks and other public health
emergencies;
Enhancing the nation's ability to detect and control the
spread of disease-causing microbes that are resistant to
antibiotics; and
[[Page S11309]]
Upgrading the nation's preparedness for the public health
and medical consequences of bioterrorist attacks.
Improving the Capacity of Public Health Agencies to Combat
Disease Emergencies
Drug resistant diseases such as malaria and tuberculosis
continue to claim millions of lives across the world and will
pose an increasing danger to this country in years to come.
The recent outbreak of West Nile Fever in the Northeast is an
ominous warning of emerging infectious diseases. New plagues
like Ebola virus pose new threats to population around the
world, including the United States.
To respond effectively to these growing threats, we must
strengthen the capacity of our public health agencies to
detect, diagnose, and contain infectious disease outbreaks.
Many of these agencies lack the basic computer equipment to
share data electronically on disease outbreaks and cannot
perform simple lab tests to diagnose infections. Most
agencies don't have a complete assessment of their current
capacities and needs. To meet these challenges, Title I
establishes grant programs to allow state and local public
health agencies to:
Assess their current capacities and identify their areas of
greatest need.
Upgrade the ability of public health labs to identify
disease-causing microbes.
Improve and expand electronic communication networks.
Develop plans to respond to public health emergencies.
Train public health personnel.
Revitalizing Centers for Disease Control and Prevention
The mission of the federal Centers for Disease Control and
Prevention (CDC) is to prevent and control disease, injury,
and disability. However, most of CDC's laboratory facilities
are in a state of disrepair and require immediate
modernization. If nothing is done, these facilities may be
severely outmatched by undiscovered biological threats
encountered in the future. To better defend against and
combat the public health threats of the 21st century, this
bill authorizes funding to CDC for construction and
renovation of facilities.
Combating Antimicrobial Resistance
The widespread use of antibiotics beginning in the 1940's
provided--for the first time in history--effective treatments
for infectious diseases. These miracle drugs have saved
countless lives, but today they are increasingly prescribed
or used inappropriately. Antibiotics that once had the power
to cure dangerous infections are now often useless, because
microbes have become resistant to all but the newest and most
expensive drugs. Some ``superbugs'' are impervious to any
current pharmaceutical treatment.
Resistance to antibiotics takes a heavy toll on patients
across the nation. The World Health Organization (WHO)
estimates that 14,000 Americans per year, or one American
every 38 minutes, die from drug-resistant infections. The
financial burden of antibiotic resistance is also staggering.
WHO estimates that the United States spends $10 billion a
year treating antibiotic-resistant infections--and this
burden will grow heavier as more and more microbes become
resistant. To meet the grave and growing problem of
antimicrobial resistance, the provisions under Title I:
Directs HHS to conduct a nationwide campaign to educate
patients and doctors about the appropriate use of
antibiotics;
Authorizes HHS initiatives to monitor and contain the
spread of resistant microbes;
Authorizes grants for public health agencies to combat
antimicrobial resistance;
Establishes demonstration grants for hospitals and clinics
to promote the judicious use of antibiotics and to control
the spread of resistant infections.
Protecting the Public Health Against Bioterrorist Attacks
The Office of Emergency Preparedness estimates that 40
million Americans could die if a terrorist released smallpox
into the population. An Anthrax attack could kill 10 million
people. The nation must be prepared to resist these threats
as vigorously if they were an invading army. To enhance the
ability of the nation's public health agencies to respond to
acts of bioterrorism against the civilian population, the
provisions under Title I:
Establishes grants to train health care professional in
recognizing and treating illnesses caused by such attacks;
Improves coordination among federal agencies to develop
public health countermeasures against bioterrorism, such as
stockpiles of necessary drugs; and
Reauthorizes an existing provision that allows the
Secretary of HHS to protect the public health in the event of
a bioterrorist attack or other disease emergency.
TITLE II--CLINICAL RESEARCH ENHANCEMENT
Clinical research is needed to translate the discoveries
made in the laboratory into advances in patient care.
Numerous reports and analyses have proven that there is
insufficient support for patient-oriented research in the
United States. Title II will address these issues by:
Establishing intramural and extramural clinical research
fellowship programs and a continuing education clinical
research training program at NIH.
Providing statutory authority to the Director of the
National Center for Research Resources to award grants for
the establishment of general clinical research centers. These
centers provide the infrastructure for clinical research,
including clinical training and career enhancement. The
activities of the GCRCs will be expanded through the
increased use of telecommunications and telemedicine.
Establishing the Mentored Patient-Oriented Research Career
Development Awards. These grants support clinical
investigators in the early phases of their independent
careers by providing salary and other support for a period of
supervised study.
Establishing the Mid-Career Investigator Awards in Patient-
Oriented Research. These grants provide support for mid-
career level clinicians to allow them protected time to
devote to clinical research and to act as mentors for
beginning clinical investigators.
Establishing the Graduate Training in Patient-Oriented
Research Awards. These two-year grants provide stipend,
tuition, and institutional support for individuals in
advanced degree programs in clinical research.
Creating a clinical research educational loan repayment
program to encourage recruitment of new clinical
investigators.
TITLE III--Research Laboratory Infrastructure
The National Institutes of Health (NIH) is the principal
source of federal funding for medical research at research
institutions in the United States. The infrastructure of our
research institutions is central to our continued leadership
in medical research, but many research facilities are
outdated and inadequate. Future increases in federal funding
for the NIH must include increased support for the renovation
and construction of extramural research facilities and the
purchase of state-of-the-art laboratory instrumentation.
To renovate biomedical and behavioral research facilities,
Title III authorizes the Director of the National Center for
Research Resources (NCRR) at the NIH may make grants or
contracts to public and nonprofit private entities to expand,
remodel, renovate, or alter existing research facilities or
construct new research facilities, including centers of
excellence. In addition, the provision under this Title would
also provide grants to public and non-profit private entities
for the purchase of high-end, state-of-the art laboratory
instrumentation.
TITLE IV--Cardiac Arrest Survival
More than 700 people die each day from sudden cardiac
arrest, but immediate medical attention could save up to 30
percent of these victims through immediate medical response,
including defibrillation and cardiopulmonary resuscitation.
Title VI will increase public awareness about automated
external defibrillators and encourage their use.
Part A--Recommendations for Federal Buildings
Placement of AEDs in Federal Buildings
The Secretary of HHS shall make recommendations with
respect to placing automated external defibrillators (AEDs)
in federal buildings that include procedures for:
Implementing appropriate nationally recognized training
courses in performing CPR and in using AEDs;
Proper maintenance and testing of the devices, according to
manufacturer guidelines;
Ensuring direct involvement of a licensed medical
professional and coordination with EMS in the oversight of
training and notification when the devices are used; and
Ensuring that the local EMS agent is notified regarding the
location and type of device.
Extending Good Samaritan Protections
This legislation establishes Good Samaritan protection for
any person who provides emergency medical care through the
use of an AED unless the person engages in willful or wanton
misconduct, gross negligence, reckless misconduct or a
conscious, flagrant indifference to the rights or safety of
the victim. This legislation does not supersede any existing
or future law of any state.
Organizations that purchase for defibrillators are extended
the same Good Samaritan protection unless they are grossly
negligent or engaged in willful or wanton misconduct, if (1)
they have notified local emergency personnel regarding the
placement of the device; (2) the AED is properly maintained
and tested in accordance with the manufacturer's guidelines;
and (3) employees of the acquirer who are expected users
received proper training.
Part B--Rural Access to Emergency Devices
This legislation is intended to improve access to automated
external defibrillators (AEDs) in small communities and rural
areas to boost the survival rates of individuals in those
communities who suffer cardiac arrest. In many small and
rural communities limited budgets and the fact that so many
rely on volunteer organizations for emergency services can
make acquisition and appropriate training in the use of these
life-saving devices problematic. This legislation is intended
to increase access to AEDs and trained local responders for
smaller towns and rural areas where those first on the scene
may not be paramedics or others who would normally have AEDs.
Under this legislation, the Secretary of HHS, acting
through the Rural Health Outreach Office of the Health
Resources and Services Administration (HRSA), shall award
grants to community partnerships consisting of local
emergency responders, police and fire departments, hospitals
and
[[Page S11310]]
other community organizations to enable them to purchase AEDs
and to provide defibrillator and basic life support training
through the American Heart Association, the American Red
Cross, or other national recognized training courses. The
bill authorizes $25 million a year over three years for this
purpose.
TITLE V--Lupus Research and Care
Lupus is a disorder of the immune system that affects
between 1,400,000 and 2,000,000 Americans and many more with
the disease are either misdiagnosed or not diagnosed at all.
Lupus is often life threatening and is nine times more likely
to affect women than men. The symptoms of lupus make
diagnosis difficult because they are sporadic and imitate the
symptoms of many other illnesses. If diagnosed properly, the
majority of lupus cases can be controlled with proper
treatment.
Provisions under this Title would require the Director of
the National Institute of Arthritis and Musculoskeletal and
Skin Diseases to expand and intensify research and related
activities of the Institute regarding lupus. Requires the
Director to coordinate such activities with similar
activities conducted by other national research institutes
and agencies of NIH; and conduct or support research to
expand the understanding of the causes of, and to find a cure
for, lupus, including research to determine the reasons
underlying the elevated prevalence of the disease among
African-American and other women. The provisions also creates
grants for the establishment, operation, and coordination of
effective and cost-efficient systems for the delivery of
essential services to individuals with lupus and their
families.
TITLE VI--Prostate Cancer Research and Prevention
This year 37,000 American men will die, and 179,300 will be
diagnosed with prostate cancer, the second leading cause of
cancer-related death in American men. Cancer of the prostate
grows slowly, without symptoms, and thus is often undetected
until its most advanced and incurable stage. It is critical
that men are aware of the risk of prostate cancer and to take
steps to ensure early detection.
The provisions under this Title expands the authority of
the Centers for Disease Control and Prevention (CDC) to carry
out activities related to prostate cancer screening and
overall awareness and surveillance of the disease. The bill
also extends the authority of the National Institutes of
Health to conduct basic and clinical research in combating
prostate cancer.
TITLE VII--Organ Procurement and Donation
Last year, there were almost 22,000 transplants, nearly
double the roughly 13,000 transplants performed ten years
ago. Unfortunately, the demand for transplants has more than
tripled in the past ten years from 19,095 in 1989 to 72,255
in 1999.
Last year, 6,125 patients were removed from the OPTN
waiting list due to death, an increase of over 350% in the
last ten years. Moreover, since 1988, 38,574 patients have
died before they could receive a transplant, and the yearly
figures only continue to increase. OPOs are organizations
that approach families regarding organ donation and arrange
transportation of organs and transplant surgery logistics.
(OPOs are not responsible for the allocation of organs.) Each
state has one or two OPOs that cover non-overlapping
geographic regions. Currently, OPOs must be recertified every
two years by the Health Care Financing Administration (HCFA)
in order to qualify for Medicare reimbursement. Because
Medicare funds make up a large percentage of OPO budgets,
decertification essentially shuts down an OPO.
Requires HCFA to change the standards for recertification
to account for variation in the number of potential donors in
a given state, extends the current certification cycle from
two to four years, ensures rights of OPOs, and reinstates
certification for all OPOs who were decertified in April.
The bill also recognizes the need for increased organ and
tissue donation and the important role that families play in
the process--noting that designation as an organ donor on a
driver's license or similar instrument does not ensure
donation. The provision designates Thanksgiving as a day to
``Give Thanks, Give Life'', and encourages families to use
the time of Thanksgiving to discuss organ and tissue donation
to foster informed decisions among family members if the
occasion to donate arises.
TITLE VIII--Alzheimer's Clinical Research and Training
To address the devastating disease of Alzheimer's, the
provisions under this Title would authorize NIH to establish
a program to enhance clinical research relating to the
treatment of individuals with Alzheimer's disease. The
provisions would also provide support to clinicians for
research, study, and practice at centers of excellence in
Alzheimer's disease research and treatment.
TITLE IX--Sexually Transmitted Disease Clinical Research and Training
In an effort to develop treatment for sexually transmitted
diseases, the provisions under this Title would authorize NIH
to establish a program to enhance clinical research relating
to the treatment and care of individuals with sexually
transmitted diseases. The provisions would also provide
support to promising clinicians for research, study, and
practice at centers of excellence in sexually transmitted
disease research and treatment.
TITLE X--Miscellaneous Provisions
Technical amendment to the Children's Health Act of 2000
which corrects an inaccurate citation to a provision in the
Code of Federal Regulations.
____
September 21, 2000.
Re The Public Health Threats and Emergencies Act
U.S. Senate,
Washington, DC.
Dear Senator: Senators Bill Frist and Ted Kennedy have
joined in introducing a bipartisan bill that addresses a
pressing issue in public health. The organizations below join
in urging you to cosponsor S. 2731, ``The Public Health
Threats and Emergencies Act,'' and to support its prompt
passage.
Our nation faces grave new health threats in the 21st
century. New or resurgent infectious diseases, such as West
Nile virus, hantavirus, and Lyme disease, are on the upswing,
and the globalization of our economy makes the importation of
threatening new microorganisms highly likely. An increasing
number of microbes that cause serious disease have developed
resistance to existing antibiotics, so that formerly
treatable infections, such as staphylococcus and
tuberculosis, may rapidly become incurable. In addition, our
national security is directly threatened by biological
weapons, such as smallpox and anthrax, which could devastate
large populations if used for terrorism and mass destruction.
Our public health system, a collaboration among federal,
state and local governments, who must work closely with
private medical providers, bears the awesome responsibility
for protecting the population from these serious threats.
However, the public health system is not uniformly well
prepared to detect disease outbreaks rapidly or respond to
them effectively. Preparing our nation to address these
threats requires revitalizing public health agencies with
trained personnel, up-to-date equipment and technology, and
development of new systems to monitor and respond to disease.
The Public Health Threats and Emergencies Act authorizes
steps that are widely agreed to be essential to preparing for
new public health threats. It enjoys bipartisan support in
both the Senate and the House and the endorsement of leading
experts in public health and bioterrorism. Please co-sponsor
S. 2731 and enable the public health system to respond
effectively to deadly public health threats before they
strike on a widespread basis.
Sincerely,
American College of Preventive Medicine, American Lung
Association, American Public Health Association,
American Society for Microbiology, American Thoracic
Society, Association of American Medical Colleges,
Association for Professionals in Infection Control and
Epidemiology, Association of Public Health
Laboratories, Association of Schools of Public Health,
Association of State and Territorial Health Officials,
Council of State and Territorial Epidemiologists, Food
and Environment Program, Union of Concerned Scientists,
Infectious Disease Society of America, National
Association of Counties, National Association of County
and City Health Officials, National Association of
Local Boards of Health, National Association for Public
Health Statistics and Information Systems, National
Environmental Health Association, Partnership for
Prevention, Physicians for Social Responsibility,
Research! America.
____
Association of
American Medical Colleges,
Washington, DC, September 19, 2000.
Hon. Bill Frist,
U.S. Senate, Washington, DC.
Dear Senator Frist: The Association of American Medical
Colleges strongly supports the Public Health Threats and
Emergencies Act of 2000, S. 2731. The AAMC represents the
nation's 125 allopathic medical schools, nearly 400 major
teaching hospitals and health care systems, more than 87,000
faculty in 91 professional and scientific societies, and the
nation's 67,000 medical students and 102,000 residents.
This legislation is needed to strengthen the nation's
public health infrastructure and improve our preparedness at
a time when we are confronted by significant threats to the
health of the American people: new and reemerging infectious
diseases; increasing antimicrobial resistance, and the
growing menace of bioterrorism. We must take steps now to
restore and strengthen the capacity of our public health
system, which has been eroded by inadequate funding. This
legislation will provide the resources to revitalize our
ability to respond to these public health emergencies with
trained personnel, state-of-the-art equipment and technology,
and the development of new systems to monitor and combat
these deadly diseases. The bill also authorizes needed
funding to rebuild and remodel the facilities of the Centers
for Disease Control and Prevention. In addition, this bill
will coordinate federal research and education efforts, and
provide grants to improve the capacity of institutions to
detect and respond to antimicrobial resistance and
bioterrorism.
We commend you and Senator Kennedy for your leadership in
sponsoring this legislation
[[Page S11311]]
that addresses a critical set of issues affecting the health
and safety of the American people, and urge the Senate to
pass S. 2731 before the end of the current session.
Sincerely,
Jordan J. Cohen, M.D.
____
National Association of
County and City Health Officials,
Washington, DC, July 13, 2000.
Senator Bill Frist,
Subcommittee on Public Health, Health, Education, Labor, and
Pensions, Committee, U.S. Senate, Washington, DC.
Dear Senator Frist: The National Association of County and
City Health Officials (NACCHO) is very pleased to support S.
2731, the ``Public Health Threats and Emergencies Act'' that
you have introduced. This groundbreaking proposal provides a
vigorous and rational approach to improve our nation's public
health system and its preparedness to meet the public health
threats of the 21st century. You are doing a great service by
recognizing that strengthening the underlying infrastructure
of public health is essential to protecting the health of all
Americans.
NACCHO is the organization representing the almost 3000
local public health agencies--in cities, counties and towns--
that serve on the front lines in protecting and promoting the
nation's health. We are extraordinarily grateful for your
keen understanding of public health threats and your
commitment to addressing them skillfully and constructively.
NACCHO looks forward to working with you to ensure that the
promise of your legislation is fulfilled. Thank you for your
continuing foresight and leadership.
Sincerely,
Stephanie B.C. Bailey, MD, MSHSA,
President, NACCHO and Director of Health.
____
Association of Public Laboratories,
Washington, DC, August 3, 2000.
Re ``Public Health Threats and Emergencies Act'', S. 2731
Hon. William H. Frist,
U.S. Senate, Senate Dirksen Office Building, Washington, DC.
Hon. Edward M. Kennedy,
U.S. Senate, Senate Russell Office Building, Washington, DC.
Dear Senators Frist and Kennedy: The Association of Public
Health Laboratories (APHL) supports S. 2731 introduced June
14, 2000 to amend Title III of the Public Health Services Act
for enhancing the Nation's capacity to address public health
threats and emergencies. APHL is a professional association
organized to promote the role and contributions of public
health laboratories in support of the public health
objectives of disease prevention and health promotion.
Public health laboratories represent a first line of
defense in the rapid recognition and prevention of the spread
of communicable diseases. These public health laboratories
provide essential services for disease surveillance and
prevention as well as identification of new and re-emerging
infectious disease agents that threaten the public's health
and welfare. Besides the 56 State and Territorial Public
Health Laboratories, and the Federal (CDC) laboratories,
nearly 1,000 local health departments also provide some level
of direct public health laboratory services.
All sectors of the public health infrastructure (disease
control and prevention, maternal and child health,
environmental health, epidemiology, emergency preparedness
and response) are critically linked to the local, state and
federal public health laboratory ``system''. These public
health laboratories provide early warning signals of health
risks, compile data to solve outbreak investigations, and
identify causes of disease to aid in treatment and
prevention. This leadership, through science and through
service, promotes health and quality of life by preventing
and controlling disease, birth defects, disability and death
resulting from interactions between people and their
environment. Clearly, the nation's public health laboratories
play a vital role in disease prevention programs and are
central to the national public health infrastructure. The
loss of these laboratories, or the diminishment of their
abilities, will surely create a serious public health
crisis.
As new public health challenges arise, the effectiveness of
the national public health system's response will depend on
the efficacy of public health laboratories. It is evident
that the advent of new or re-emerging diseases and outbreaks
(including West Nile Fever Virus, Hantavirus infection, HIV/
AIDS, Legionellosis, Lyme Disease, antimicrobial-resistant
communicable disease agents, genetic disorders, E. coli
O157:H7 infections, environmental exposures and potential
bioterrorism activities) presents a tremendous challenge to
the public health system, and particularly to public health
laboratories. Facing these challenges will require critical
development or enhancement of the functions,
responsibilities, staffing and capability of these
laboratories.
The public health laboratory must maintain expertise and
flexibility to investigate disease outbreaks; conduct special
disease surveillance activities; determine immunity levels
for a variety of vaccine preventable diseases; and to provide
laboratory support as part of the state's disaster
preparedness plan for response to emergencies. This includes
ensuring that a well trained and equipped cadre of personnel
are available to quickly respond to public health emergencies
and on-going laboratory surveillance activities at the local,
state and federal levels.
APHL also supports the revitalization of laboratories
within the Centers for Disease Control and Prevention (CDC)
as an important component of this bill as these laboratories
have been, and will remain, a critical partner with state and
local laboratories in disease prevention and diagnosis.
We applaud the proactive stance taken through this bill to
evaluate and enhance the public health laboratories
infrastructure to protect the health and welfare of our
nation's population and look forward to working with you on
this effort. Please fell free to contact APHL's executive
director, Scott J. Becker, at 202-822-5227 as needed.
Sincerely,
Ronald L. Cada, DrPH,
President, APHL.
____
National Foundation for
Infectious Diseases,
Bethesda, MD, August 2, 2000.
Hon. William Frist,
U.S. Senate, Dirksen Building,
Washington, DC.
Dear Senator Frist: The National Foundation for Infectious
Diseases (NFID) is a national, not-for-profit organization
whose mission is professional and public education about, and
support of research into the causes, treatments, and
prevention of infectious diseases. I am writing on behalf of
the NFID Board of Directors and Board of Trustees to endorse
S. 2731, the Public Health Threats and Emergencies Act of
2000. This bill, introduced by you and Senator Kennedy, seeks
to strengthen the public health infrastructure in the United
States by improving surveillance, recognition, treatment,
control, and prevention of infectious diseases. The bill
specifically, and importantly, singles out antimicrobial
resistance and bioterrorist threats, and outlines programs to
address these growing public health concerns.
As you are aware, infectious diseases now are the third
most common cause of death in the United States. National and
global infectious diseases threats continually emerge,
highlighted most recently by the epidemic of West Nile Virus
in New York City last summer. However, one need look no
farther than the devastating human immunodeficiency virus
pandemic to recognize the vulnerability of human populations
to emergent microbial pathogens. The alarming rise in
antimicrobial resistance and the possibility of bioterrorist
attacks upon the civilian population have increasingly
captured the attention of public health officials,
clinicians, legislative officials, and the general public.
It is within the context of these concerns that the NFID
wholeheartedly supports the efforts taken by you and Senator
Kennedy. Building the capacity to respond to natural and
intentional infectious diseases threats will require
substantial funding and your commitment to increase the
needed support is to be lauded.
The NFID is pleased to work with you to accomplish your
goals and would be happy to continue to be involved as S.
2731 moves forward. If I can be of assistance in the future,
please do not hesitate to call me at (301) 656-0003 X 13 or
fax at (301) 907-0878.
Sincerely yours,
William J. Martone, M.D.,
Senior Executive Director.
____
American Society for Microbiology,
Washington, DC, July 5, 2000.
Hon. William Frist,
U.S. Senate, Dirksen Building,
Washington, DC.
Dear Senator Frist: The American Society for Microbiology
(ASM), which represents over 42,000 microbiologists and
infectious disease experts, is writing to endorse S. 2731,
the Public Health Threats and Emergencies Act of 2000.
The ASM applauds the initiative which you and Senator
Kennedy have taken to respond to emerging public health
threats, particularly the alarming trend toward antimicrobial
resistance among pathogenic microorganisms. Your commitment
to significantly strengthening the public health system to
respond to the potential threat of bioterrorism is very
reassuring for the country and the microbiological community.
The Society especially commends your efforts in drafting
legislation to increase needed support for the public health
needs of the nation. Public Health Agency plans to address
antimicrobial resistance and improve the public health
infrastructure urgently require additional funding to be
successful.
The ASM is pleased to work with you towards achieving this
goal. The ASM would like to continue to be involved in the
process as S. 2731 moves forward. Please do not hesitate to
call on the ASM at anytime. We stand ready to be of
assistance to you and your staff.
Sincerely,
Gail H. Cassell, Ph.D.,
Chair, Public and Scientific Affairs Board.
____
American Society of Tropical
Medicine and Hygiene,
Boston, MA, August 8, 2000.
Hon. William Frist,
U.S. Senate, Russell Senate Office Building, Washington, DC.
Dear Senator Frist: The American Society of Tropical
Medicine and Hygiene commends you and your colleague Senator
Edward Kennedy for introducing S. 2731, ``The Public Health
Threats and Emergencies Act
[[Page S11312]]
of 2000,'' legislation that will bolster the public health
infrastructure and the national response to new and re-
emerging health threats.
The American Society of Tropical Medicine and Hygiene is a
professional society of 3,500 researchers and practitioners
dedicated to the prevention and treatment of infectious and
tropical infectious diseases. The collective expertise of the
Society is in the areas of basic molecular science, medicine,
vector control, epidemiology, and public health.
The Society believes a strong federal commitment to
domestic and international research, prevention and treatment
activities targeted towards infectious and tropical
infectious disease, whether naturally occurring or resulting
from a deliberate terrorist act, is absolutely critical to
protecting our nation's health and national security
interests. S. 2731 represents an important step in protecting
the public from the most serious health and security threats
of the 21st Century--infectious disease, antimicrobial
resistance, and bioterrorism--by providing resources and the
leadership mechanism across federal agencies to launch a
comprehensive, coordinated attack against these killers.
The American Society of Tropical Medicine and Hygiene
strongly supports S. 2731 and looks forward to working with
you to advance this initiative and pursue additional
prevention strategies to control these health threats from
exacting a greater burden on domestic and global health.
Thank you for your ongoing efforts to address these
critical public health issues.
Sincerely,
Dyann F. Wirth, Ph.D.,
Past President.
____
SmithKline Beecham,
Philadelphia, PA, June 20, 2000.
Hon. William Frist,
U.S. Senate,
Washington, DC.
Hon. Edward M. Kennedy,
U.S. Senate,
Washington, DC.
Dear Senators Frist and Kennedy: I am writing on behalf of
SmithKline Beecham to commend you upon introduction of your
legislation, ``The Public Health Threats and Emergencies
Act'', designed to address the threat of antibiotic
resistance, public health emergencies and bioterrorist
attacks. As emphasized this week in a new report by the World
Health Organization, resistance to antibiotics is increasing
rapidly, threatening to recreate the preantibiotic era when
bacterial infections killed and maimed routinely.
While antibiotics are a crucial tool to fighting disease,
it is important that they be prescribed judiciously. To this
end, SmithKline Beecham has worked in partnership with
medical and public health organizations, such as the U.S.
Centers for Disease Control and Prevention, in an effort to
ensure that antibiotics are prescribed appropriately, and
that attention is paid to prescribing antibiotics that are
most effective against the most prevalent disease-causing
bacteria. We note that your bill furthers this type of
activity by encouraging federal agencies and professional
organizations and societies to develop and implement
educational programs fostering public awareness of the threat
of resistance and the prudent use of antibiotics.
America must do its part to help preserve the effectiveness
of our current pharmaceutical arsenal against infection and
our country must quickly develop an effective strategy
against this growing public health threat. The Public Health
Threats and Emergencies Act is a major step toward
accomplishing this important goal. For our part, SmithKline
Beecham is committed to investing heavily in state of the art
approaches to new antibiotic discovery in order to have the
best possible chance of combating antibiotic resistance. We
feel that more needs to be done to foster research and
development of new lines of defense against resistance
microbes.
We look forward to working with you on this important
issue. I thank you for the opportunity to comment on your
bill, and applaud you for your initiative.
Sincerely,
Jean-Pierre Garnier, Ph.D.
Chief Executive Officer.
Mr. KENNEDY. Mr. President, the Public Health Improvement Act of 2000
will bring far-reaching benefits to the health of millions of
Americans. I commend my colleagues, Senator Jim Jeffords and Senator
Bill Frist, for their leadership in bringing this important measure to
the Senate floor today. The leadership of our colleagues in the House
was also essential in developing this groundbreaking bill, and I thank
Representatives Tom Bliley, John Dingell, Michael Bilirakis, and
Sherrod Brown for their dedication and skillful work in bringing this
legislation forward.
The Act will help the nation meet many of the health challenges we
face at the beginning of the 21st century. Few of these are more grave
than the ominous threat of attack with a biological weapon. Like the
lethal mushroom cloud of a nuclear bomb, a haze of anthrax spores
released by a terrorist over one of our major cities could bring death
and disease to millions of Americans. Chilling revelations from the
former Soviet Union and other nations have revealed extensive and
sophisticated programs to use deadly microbes as weapons of mass
destruction. Just this week, we heard alarming news from Uganda about
the deadly outbreak of Ebola fever. Yet viruses like Ebola were a
subject of research in bioweapons programs whose aim was to make these
viruses even deadlier and more contagious.
Senator Frist and I have held numerous hearings in the Public Health
Subcommittee on these public health threats. Witness after witness
testified that the best way to defend the nation against these deadly
biological weapons threats is to strengthen the ability of public
health agencies to respond at the local, state and national levels.
Given the importance of these agencies in safeguarding the health of
the nation, we were appalled to hear that many public health agencies
are underfunded, ill-equipped and poorly prepared to respond to these
modern disease threats. In this electronic era, when we can send an e-
mail message from Cape Town to Cape Cod in the blink of an eye, our
nation's public health agencies often lack equipment as basic as a fax
machine. At a time when scientists have deciphered the entire DNA
sequence of the human genetic code, many of the nation's public health
laboratories cannot conduct simple genetic tests to identify deadly
microbes rapidly and accurately. Yet, in a disease emergency, swift
action can keep a local outbreak from becoming a national epidemic. A
few lost hours can mean thousands more lost lives.
To counter the threat of infectious disease outbreaks--whether
naturally occurring or resulting from bioterrorist attacks--we must
strengthen our public health defenses. Expert testimony provided to our
committee showed how much work needs to be done. We must begin by
defining and assessing the capacities that public health agencies need
to fight infectious diseases. Our bill authorizes grants to these
agencies to enable them to assess their ability to respond effectively
to infectious disease threats.
Once assessments have been completed, state and local public health
agencies will become eligible to receive grants to strengthen their
capacity to fight infectious disease threats. While only a few states
that have already completed capacity assessments will be eligible for
these grants in the first year of this program, more and more states
will become eligible in the years to come.
Strengthening the nation's public health agencies will also assist in
countering the threats posed by microbes that have become resistant to
antibiotics. Not long ago, doctors were confident that most microbes
could be easily treated with antibiotics. In recent years, however,
this confidence has been shaken by the rise of deadly infections that
cannot be cured by antibiotics. The World Health Organization estimates
that 14,000 Americans die every year from drug-resistant infections,
and that fighting these infections costs the United States $10 billion
per year. These figures are distressing, and they are sure to become
even more alarming in the future, as the number of resistant infections
increases.
We must clearly do more to halt that upward spiral. If we act now to
contain the spread of antibiotic resistance, we can buy enough time for
new antibiotics to be developed that provide additional defenses
against microbes that are becoming increasingly resistant to the
current generation of drugs. This legislation supports efforts to use
existing drugs more carefully, monitor drug-resistant infections more
diligently, and conduct research to find the next generation of
antimicrobial treatments.
The existing interagency task force on antimicrobial resistance has
made a good start in tackling these problems. This group has carefully
brought together federal agencies with special responsibilities in
areas related to antimicrobial resistance, and has sought the advice of
experts in formulating its Action Plan. Our legislation provides
statutory authorization for this task force to continue its essential
work. The activities already underway or planned by the task force will
do much
[[Page S11313]]
to invigorate federal efforts to fight antimicrobial resistance, and
our committee will watch carefully to make sure that these promising
plans are translated into effective action.
The Food and Drug Administration has a special responsibility to
protect the public from the growing threat of drug-resistant microbes
in our nation's food supply. Numerous scientific studies have provided
compelling evidence that there is a link between the overuse of
antibiotics in food animals and the alarming increase in drug-resistant
microbes found in meat and poultry. The FDA deserves credit for
carefully gathering information about the risk of using antibiotics in
food animals. The agency now has an opportunity to act decisively on
this information, by setting regulatory thresholds for the presence of
drug-resistant microbes in food at levels which will protect the public
health. Both consumers and producers will benefit if the nation can be
assured that its food supply is safe and uncontaminated. I am sure that
many members of our committee and our colleagues in Congress will pay
close attention to the decisions that the FDA makes on this important
issue in the months to come.
Countering emerging public health threats is only one part of this
important legislation. The Act also includes important provisions to
strengthen clinical research. These provisions, which the Senate
approved last November as the Clinical Research Enhancement Act, will
begin to reverse the alarming decline in the number of health
professionals who conduct research directly related to the needs of
patients. These provisions will also provide clinical researchers with
the facilities they need to conduct their important work.
Numerous expert reports and analyses have proven that support for
patient-oriented research is inadequate in the United States. Too
often, talented health professionals are deterred from careers in
clinical research because of inadequate grant funding or the extreme
financial pressure of high educational debt. In addition, there are too
few clinical research centers which conduct high quality patient-
oriented research. The Act addresses these deficiencies by authorizing
grants for clinical researchers throughout their careers, by providing
relief from the education debt burden that keeps many health
professionals from pursuing careers in clinical research, and by
authorizing grants to establish general clinical research centers.
This legislation is not intended to single out any individual area of
medical research for special study or emphasis. Instead, it provides
broad support for clinical research so that clinical researchers can
pursue whichever avenues of medical research have the greatest medical
need or offer the most promising opportunities. In introducing and
passing this legislation, it is our strong view that awards under the
Act should be granted to investigators who show the greatest promise
and who are conducting research of the greatest scientific or health
value, regardless of the specific diseases or conditions they may be
studying.
The Clinical Research Enhancement Act will bear fruit now and in the
coming years as new medical advances move more rapidly from the
laboratory of the researcher to the bedside of the patient. The skill
and dedication of the nation's clinical researchers deserve this
support, and it is long overdue.
The Act will also revitalize the nation's biomedical research
facilities. Continued progress in medicine depends on modern and well-
maintained research facilities--yet the nation's basic biomedical
research facilities are in an alarming state of disrepair. To restore
and rebuild the nation's biomedical research infrastructure, the Act
incorporates the provisions originally passed in the Senate last year
as the Twenty-First Century Research Laboratories Act. I commend
Senator Harkin for his leadership on these needed provisions. I also
commend our colleague, Representative Michael Bilirakis, for
introducing and championing this legislation in the House.
Earlier this year, the National Science Foundation conducted a
comprehensive study of the nation's research facilities. The shocking
facts uncovered by the analysis demonstrate the need for this important
legislation. Over 60 percent of the universities and research
institutions studied by the NSF had inadequate laboratory space in the
biomedical sciences. The NSF found that 5 percent of the laboratory
space at the nation's research institutions is in such poor condition
that it needs immediate replacement. An additional 18 percent--or 4.6
million square feet of lab space--needs major repairs and renovations.
Funding for such construction has not kept pace with the significant
budget increases provided to the NIH in recent years. As a result, 54
percent of all research institutions have had to defer needed
construction for research and development due to insufficient funding,
resulting in a backlog of more than $2.1 billion in deferred
construction.
Funding from state, local and institutional sources can meet a
significant proportion of this shortfall. But federal resources are
needed too, to revitalize the nation's biomedical research
laboratories. Under this legislation, NIH will be authorized to provide
merit-based grants for construction or revitalization of essential
laboratory facilities.
The Act also authorizes grants to institutions to purchase the
sophisticated scientific instruments that are increasingly required to
conduct top quality biomedical research. As scientists learn more and
more about the fundamental processes of life, advances in research rely
increasingly on complex and expensive scientific instruments. In a
matter of moments, an advanced DNA sequencer can find out vital
information about the genes that affect health and disease. New
microscopes and imaging devices can provide snapshots inside the body
or within a single cell.
The Federation of American Societies for Experimental Biology
recently released a detailed survey about the needs of the nation's
biomedical research institutions for scientific equipment. Over 80
percent of NIH grant recipients believed that shared scientific
equipment and core facilities are essential to their research--but more
than half felt that NIH's grant support is inadequate for purchases of
this needed equipment. Future progress in medicine will increasingly
depend on sophisticated and expensive equipment. Congress has a
responsibility to accelerate this progress by providing adequate
federal support for equipment.
The Act also includes the House-passed Lupus Research and Care
Amendments of 2000. These provisions authorize new resources for lupus
research and new programs for treating this cruel disease. Lupus
disproportionately affects women, and it affects African-American women
in particular. Patients with lupus suffer a debilitating variety of
symptoms that include inflammation of the joints, kidney failure,
painful skin rashes, neurological impairments and many other painful
conditions. While lupus is rarely fatal, it can often result in a
lifetime of pain or disability for persons with the disease. There is
no known cure for lupus, but the Act will advance our understanding of
this disease, and provide assistance to persons who suffer from its
consequences.
The Act will also improve the treatment and detection of prostate
cancer, by incorporating the provisions of the Prostate Cancer Research
and Prevention Act that was passed by the Senate last November. Too
often, men with prostate cancer go untreated because they fail to take
advantage of screening procedures that detect the early symptoms of
this deadly disease. Early detection is the key to surviving prostate
cancer, and these provisions will assist the efforts of the Department
of Health and Human Services to promote widespread screening for
this disease.
The Act also reflects the nation's commitment to improving the
treatment and understanding of Alzheimer's disease and sexually
transmitted diseases, by authorizing fellowships for clinical
scientists conducting research in these areas. Large numbers of
Americans today have friends or relatives who suffer from the
terrifying loss of mental abilities brought on by Alzheimer's disease.
We have made a significant investment in basic research, and we must
ensure that the new treatments produced by research are brought rapidly
to patients suffering from this disease. I commend my colleague from
Massachusetts, Representative Ed Markey, for introducing the
Alzheimer's Clinical Research and
[[Page S11314]]
Training Awards Act of 2000, which has been incorporated into this Act.
This measure authorizes clinical research awards to health
professionals for research, study and practice at centers of excellence
for Alzheimer's disease research and treatment. The Act includes a
similar provision to increase support for health professionals engaged
in clinical research on sexually transmitted diseases, which will
improve the understanding and treatment of these disorders.
Taken together, the provisions of the Public Health Improvement Act
of 2000 will improve the lives of millions of Americans and help
safeguard the nation's health in the years ahead. This significant
legislation will help revitalize the capacity of the nation's public
health agencies to respond effectively to public health emergencies,
such as infectious disease outbreaks or bioterrorist attacks. It will
help bridge the gap between discoveries made in the laboratory and
improvements in patient care by providing new support for talented
health professional to pursue careers in patient-oriented clinical
research. This legislation will help rebuild the nation's laboratory
infrastructure, which is in an alarming state of decay and disrepair.
The Act also gives new emphasis to research into the causes and
treatment of lupus, prostate cancer, Alzheimer's disease and sexually
transmitted diseases. The Public Health Improvement Act of 2000 can
help lay a firm foundation for more effective public health in a wide
variety of areas, and I urge my colleagues to approve this much needed
legislation.
amending section 319
Mr. FRIST. Mr. President, the Public Health Improvement Act of 2000
incorporates provisions that I originally introduced with my colleague,
Senator Kennedy, as the Public Health Threats and Emergencies Act. The
Act reauthorizes and amends Section 319 of the Public Health Service
Act. This Section reauthorizes the ``Public Health Emergency Fund,''
from which the Secretary of Health and Human Services may expend funds
in the event of a public health emergency. The Public Health Emergency
Fund is a separate and distinct fund from the existing Public Health
and Social Services Emergency Fund, which is now used to fund other
programs within the Department of Health and Human Services. It is our
intent that the provisions of Section 319 of the Public Health Service
Act apply to the Public Health Emergency Fund, and not to the Public
Health and Social Services Emergency Fund.
Since public health emergencies may present unanticipated costs, the
sponsors of the Act did not specify a dollar amount in authorizing
appropriations for the Public Health Emergency Fund. However, we
believe that a fund should exist from which expenditures can be made in
the event of a public health emergency and appropriations made
accordingly, so that monies need not be diverted from existing programs
when emergencies arise, as is often now the case.
Mr. KENNEDY. I thank my colleague, Senator Frist, for his thoughtful
remarks regarding the Public Health Threats and Emergencies Act, and I
agree with them strongly.
weapons of mass destruction
Mr. SESSIONS. Mr. President, I would like to engage the
distinguished Senator from Tennessee in a brief colloquy to clarify
language in the Public Health Improvement Act of 2000 as it pertains to
public health countermeasures to a bio-terrorist attack.
I commend my colleague for bringing such an important measure to the
Senate floor. His legislation addresses several weaknesses that persist
today in the pre-crisis and consequence management phases of an attack
by a terrorist using a weapon of mass destruction, WMD. Since the end
of the cold war, our nation has strived to address how we might cope
with an event the likes of which we have never seen on our soil; an
event that could easily produce thousands of civilian casualties. To
this end the government has taken some steps to train responders,
provide them needed equipment, and in rare cases created exercises to
test systems and response capabilities. The nation is making strides,
and government is spending billions on all sorts of related programs.
Yet, I think we remain adrift and ill-prepared to address both the
cause and effect of a WMD event, particularly one involving a
biological weapon.
American's Public Health system is second to none. It has the
inherent capacity to thoroughly plan, properly train, and expertly
execute tasks associated with a crisis. My colleague's experience in
the field of medicine takes the need for planning and training for a
bio-terrorist event to the next level by requiring the establishment of
two interagency working groups. Each is designed to bring the expertise
resident in the government today forward in a constructive manner which
will allow agencies to set in motion processes that will result in
increased planning, preparedness and most importantly response.
One of the failures of WMD programs found elsewhere in the nation and
elsewhere in the government is the unnecessary proliferation of new
bureaucracies created to manage new programs, grants, and training
programs at the expense of producing qualified graduates. Therefore, I
believe in this instance that it is extremely important to use existing
Public Health Service training facilities, particularly those with WMD
training programs in place whenever practical to respond to the
training needs of medical professionals outlined in this legislation.
Does the Senator from Tennessee agree that these PHS facilities, which
already have the infrastructure in place to implement weapons of mass
destruction training and related activities, should be considered as an
eligible applicant of any grants or new training initiatives initiated
by the Secretary?
Mr. FRIST. The Senator from Alabama is correct. Using current
facilities and training programs would provide our health care
professionals the most efficient way of training as many medical
personnel as possible in the shortest amount of time.
Mr. SESSIONS. Mr. President, I would like to thank my colleague for
his hard work on this issue. I, too, look forward to working with my
friend from Tennessee and other colleagues on this important
issues.
____________________