[Congressional Record Volume 155, Number 73 (Wednesday, May 13, 2009)]
[Senate]
[Pages S5437-S5439]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 1028. A bill to amend the Public Health Service Act to improve the 
Nation's surveillance and reporting for diseases and conditions, and 
for other purposes; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. BINGAMAN. Mr. President, I am introducing legislation today 
entitled the Strengthening America's Public Health System Act of 2009.
  The ongoing swine flu pandemic makes clear the necessity for a robust 
public health system in the U.S. This legislation is designed to 
strengthen epidemiology and laboratory capacity in State and local 
health departments and, correspondingly, national surveillance and 
reporting of infectious diseases and other conditions of public health 
importance.
  Currently, many parts of the local-state-federal disease surveillance 
system are fragmented and paper-based, and have not fully benefited 
from new technologies that could improve the completeness and 
timeliness of reporting. A 2007 survey found that 20 states are 
manually reporting diagnostic findings, albeit with a web interface, 
and 16 are completely paper-based. Only 2 State public health 
laboratories have bidirectional data flow and can both send and receive 
laboratory messages, the gold standard for disease reporting. The 
potential for new pathogen discovery, rapid electronic exchange of 
public health information, national bacterial and viral databases for 
DNA ``fingerprinting'' of infectious disease organisms has not been 
fully realized. My legislation focuses on improving electronic disease 
surveillance and reporting so that all state and local health 
departments and public health laboratories can readily and seamlessly 
receive, monitor, and report infectious diseases and other urgent 
conditions of public health importance. The bill also authorizes a 
process for determining a list of nationally notifiable diseases and 
conditions and, creates a national committee to evaluate best practices 
in public health surveillance.
  The Strengthening America's Public Health System Act calls for the 
expansion of resources, renewed focus and mission, and new areas of 
special emphasis for several existing programs within the Centers for 
Disease Control and Prevention, CDC. These programs support public 
health capacity to identify and monitor the occurrence of infectious 
diseases and other conditions of public health importance; detect new 
and emerging infectious disease threats, including laboratory capacity 
to detect antimicrobial resistant infections; identify and respond to 
disease outbreaks; and hire and train necessary professional staff.
  The outbreak of swine flu that originated in Mexico highlights the 
need for cooperation between the U.S. and Mexico in the surveillance, 
reporting and control of infectious diseases that cross the border. 
Clear standards, however, have not yet been established for what 
information should be shared and how the sharing should take place. My 
legislation tasks the CDC to finalize and adopt the ``Guidelines for 
U.S.-Mexico Coordination on Epidemiological Events of Mutual Interest'' 
so that we have a clear mechanism in place for communication with 
public health officials in Mexico.
  This important legislation has been endorsed by the: American 
Association of Public Health Veterinarians, American Public Health 
Association, American Society for Microbiology, Association for 
Professionals in Infection Control & Epidemiology, Association of 
Public Health Laboratories, Association of Schools of Public Health, 
Association of State and Territorial Health Officials, Center for 
Infectious Disease Research and Policy, Council of State and 
Territorial Epidemiologists, Infectious Diseases Society of America, 
National Association of County and City Health Officials, National 
Alliance of State and Territorial AIDS Directors, National Association 
of State Public Health Veterinarians, National Public Health 
Information Coalition, Society for Healthcare Epidemiology of America, 
and Trust for America's Health.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1028

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Strengthening America's 
     Public Health System Act''.

     SEC. 2. PURPOSES.

       The purpose of the programs authorized under this Act is to 
     strengthen public health surveillance systems and disease 
     reporting by--
       (1) delineating existing grant mechanisms at the Centers 
     for Disease Control and Prevention designed to enhance 
     disease surveillance and reporting by improving and 
     modernizing capacity at the State and local level--
       (A) to identify and monitor the occurrence of infectious 
     diseases and other conditions of public health importance;
       (B) to detect new and emerging infectious disease threats; 
     and
       (C) to identify and respond to disease outbreaks;
       (2) expanding eligibility for grantees;
       (3) increasing funding to ensure all States and 
     jurisdictions have appropriate surveillance and reporting 
     capacity and can provide comprehensive electronic reporting, 
     including laboratory reporting;
       (4) delineating existing applied epidemiology, laboratory 
     science, and informatics fellowship programs designed to 
     reduce documented workforce shortages for these essential 
     public health professionals at the State and local level and 
     increasing funding for these programs;
       (5) expanding the Epidemic Intelligence Service;
       (6) delineating a refined process for establishing a list 
     of nationally notifiable diseases and conditions;
       (7) improving binational surveillance of diseases in the 
     United States and Mexico border region, including developing 
     improved standards and protocols for binational epidemiology, 
     surveillance, laboratory analyses, and control of infectious 
     diseases between the two nations; and
       (8) establishing a forum to permit review and 
     identification of best surveillance practices with a 
     particular focus on improving coordination of animal-human 
     disease surveillance.

     SEC. 3. STRENGTHENING PUBLIC HEALTH SURVEILLANCE SYSTEMS.

       Title XXVIII of the Public Health Service Act (42 U.S.C. 
     300hh et seq.) is amended by adding at the end the following:

     ``Subtitle C--Strengthening Public Health Surveillance Systems

     ``SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.

       ``(a) In General.--Subject to the availability of 
     appropriations, the Secretary, acting through the Director of 
     the Centers for Disease Control and Prevention, shall 
     establish an Epidemiology and Laboratory Capacity Grant 
     Program to award grants to eligible entities to assist public 
     health agencies in improving surveillance for, and response 
     to, infectious diseases and other conditions of public health 
     importance by--

[[Page S5438]]

       ``(1) strengthening epidemiologic capacity;
       ``(2) enhancing laboratory practice;
       ``(3) improving information systems; and
       ``(4) developing and implementing prevention and control 
     strategies.
       ``(b) Eligible Entities.--In this section, the term 
     `eligible entity' means an entity that--
       ``(1) is--
       ``(A) a State health department;
       ``(B) a local health department that meets such criteria as 
     the Director of the Centers for Diseases Control and 
     Prevention determines for purposes of this section;
       ``(C) a tribal jurisdiction that meets such criteria as the 
     Director of the Centers for Disease Control and Prevention 
     determines for purposes of this section; or
       ``(D) a partnership established for purposes of this 
     section between one or more eligible entities described in 
     subparagraph (A), (B), or (C) and an academic center; and
       ``(2) submits to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(c) Use of Funds.--
       ``(1) In general.--An eligible entity shall use amounts 
     received under a grant under this section for core functions 
     described in this subsection including--
       ``(A) building public health capacity to identify and 
     monitor the occurrence of infectious diseases and other 
     conditions of public health importance;
       ``(B) detecting new and emerging infectious disease 
     threats, including laboratory capacity to detect 
     antimicrobial resistant infections;
       ``(C) identifying and responding to disease outbreaks;
       ``(D) hiring necessary staff;
       ``(E) conducting needed staff training and educational 
     development; and
       ``(F) other activities that improve surveillance as 
     determined by the Director of the Centers for Disease Control 
     and Prevention.
       ``(2) Development and maintenance of information 
     exchange.--
       ``(A) National standards.--Not later than 180 days after 
     the date of the enactment of this subtitle, the Secretary, 
     acting through the Director of the Centers for Disease 
     Control and Prevention, and in consultation with the National 
     Coordinator for Health Information Technology, shall issue 
     guidelines for public health entities that--
       ``(i) are designed to ensure that all State and local 
     health departments and public health laboratories have access 
     to information systems to receive, monitor, and report 
     infectious diseases and other urgent conditions of public 
     health importance; and
       ``(ii) are consistent with standards and recommendations 
     for health information technology by the National Coordinator 
     for Health Information Technology, and by the American Health 
     Information Community (AHIC) and its successors.
       ``(B) Secure information systems.--An eligible entity shall 
     use amounts received through a grant under this section to 
     ensure that the entity has access to a web-based, secure 
     information system that complies with the guidelines 
     developed under subparagraph (A). Such a system shall be 
     designed--
       ``(i) to receive automated case reports of State and 
     national reportable conditions from clinical systems and 
     health care offices that use electronic health records and 
     from clinical and public health laboratories, and to submit 
     reports of nationally reportable conditions to the Director 
     of the Centers for Disease Control and Prevention;
       ``(ii) to receive and analyze, within 24 hours, de-
     identified electronic clinical data for situational awareness 
     and to forward such reports immediately to the Centers for 
     Disease Control and Prevention at the time of receipt;
       ``(iii) to manage, link, and process different types of 
     data, including information on newly reported cases, exposed 
     contacts, laboratory results, number of people vaccinated or 
     given prophylactic medications, adverse events monitoring and 
     follow-up, in an integrated outbreak management system;
       ``(iv) to geocode analyze, display, report, and map, using 
     Geographic Information System technology, accumulated data 
     and to share data with other local health departments, State 
     health departments, and the Centers for Disease Control and 
     Prevention;
       ``(v) to receive, manage, and disseminate alerts, 
     protocols, and other information, including Health Alert 
     Network and Epi-X information, as appropriate, for public 
     health workers, health care providers, and public health 
     partners in emergency response within each health 
     department's jurisdiction and to automate the exchange and 
     cascading of such information with external partners using 
     national standards;
       ``(vi) to have information technology security and critical 
     infrastructure protection as appropriate to protect public 
     health information;
       ``(vii) to have the technical infrastructure needed to 
     ensure availability, backup, and disaster recovery of data, 
     application services, and communications systems during 
     natural disasters such as floods, tornados, hurricanes, and 
     power outages; and
       ``(viii) to provide for other capabilities as the Secretary 
     determines appropriate.
       ``(C) Laboratory systems.--An eligible entity shall use 
     amounts received under a grant under this section to ensure 
     that State or local public health laboratories are utilizing 
     web-based, secure systems that are in compliance with the 
     guidelines developed by the Secretary under subparagraph (A) 
     and that--
       ``(i) are fully integrated laboratory information systems;
       ``(ii) provide for the reporting of electronic test results 
     to the appropriate local and State health departments using 
     currently existing national format and coding standards;
       ``(iii) have information technology security and critical 
     infrastructure protection to protect public health 
     information (as determined by the Secretary);
       ``(iv) have the technical infrastructure needed to ensure 
     availability, backup, and disaster recovery of data, 
     application services, and communications systems during 
     natural disasters including floods, tornadoes, hurricanes, 
     and power outages; and
       ``(v) address other capabilities as the Secretary 
     determines appropriate.
       ``(D) Other uses.--In addition to the activities described 
     in subparagraphs (B) and (C), an eligible entity (including 
     the entity's public health laboratory) may use amounts 
     received under a grant under this section for systems 
     development and maintenance, hiring necessary staff, and 
     staff technical training. Grantees under this section may 
     elect to develop their own systems or use federally developed 
     systems in carrying out activities under this paragraph.
       ``(d) Priority.--In allocating funds under subsection 
     (f)(2) for activities under subsection (c)(2)(B) (relating to 
     secure information systems), the Secretary shall give 
     priority to eligible entities that demonstrate need.
       ``(e) Reports.--Not later than September 30, 2011, and each 
     September 30 thereafter, the Secretary shall submit to 
     Congress an annual report on the activities carried out under 
     this section by recipients of assistance under this section.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $190,000,000 for each of fiscal years 2010 through 2013, of 
     which--
       ``(1) not less than $95,000,000 shall be made available 
     each such fiscal year for activities under subsection (c)(1);
       ``(2) not less than $60,000,000 shall be made available 
     each such fiscal year for activities under subsection 
     (c)(2)(B); and
       ``(3) not less than $32,000,000 shall be made available 
     each such fiscal year for activities under subsection 
     (c)(2)(C).

     ``SEC. 2822. FELLOWSHIP TRAINING IN APPLIED PUBLIC HEALTH 
                   EPIDEMIOLOGY, PUBLIC HEALTH LABORATORY SCIENCE, 
                   PUBLIC HEALTH INFORMATICS, AND EXPANSION OF THE 
                   EPIDEMIC INTELLIGENCE SERVICE.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may carry out activities to address documented workforce 
     shortages in State and local health departments in the 
     critical areas of applied public health epidemiology and 
     public health laboratory science and informatics and may 
     expand the Epidemic Intelligence Service.
       ``(b) Specific Uses.--In carrying out subsection (a), the 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention, shall provide for the 
     expansion of existing fellowship programs operated through 
     the Centers for Disease Control and Prevention in a manner 
     that is designed to alleviate shortages of the type described 
     in subsection (a).
       ``(c) Other Programs.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may provide for the expansion of other applied epidemiology 
     training programs that meet objectives similar to the 
     objectives of the programs described in subsection (b).
       ``(d) Work Obligation.--Participation in fellowship 
     training programs under this section shall be deemed to be 
     service for purposes of satisfying work obligations 
     stipulated in contracts under section 338I(j).
       ``(e) General Support.--Amounts may be used from grants 
     awarded under this section to expand the Public Health 
     Informatics Fellowship Program at the Centers for Disease 
     Control and Prevention to better support all public health 
     systems at all levels of government.
       ``(f) Authorizations of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $39,500,000 for each of fiscal years 2010 through 2013, of 
     which--
       ``(1) $5,000,000 shall be made available in each such 
     fiscal year for epidemiology fellowship training program 
     activities under subsections (b) and (c);
       ``(2) $5,000,000 shall be made available in each such 
     fiscal year for laboratory fellowship training programs under 
     subsection (b);
       ``(3) $5,000,000 shall be made available in each such 
     fiscal year for the Public Health Informatics Fellowship 
     Program under subsection (e); and
       ``(4) $24,500,000 shall be made available for expanding the 
     Epidemic Intelligence Service under subsection (a).

     ``SEC. 2823. NATIONALLY NOTIFIABLE DISEASES AND CONDITIONS.

       ``(a) In General.--At the request of the Council of State 
     and Territorial Epidemiologists, the Director of the Centers 
     for Disease Control and Prevention shall assist the Council 
     in developing or improving a process for States to conduct 
     surveillance and submit reports to the Director on nationally 
     notifiable diseases and conditions.
       ``(b) List of Nationally Notifiable Diseases and 
     Conditions.--The process under subsection (a) shall include a 
     list of nationally notifiable diseases and conditions as 
     follows:

[[Page S5439]]

       ``(1) The Council of State and Territorial Epidemiologists 
     and the Director of the Centers for Disease Control and 
     Prevention will jointly develop--
       ``(A) not later than 1 year after the date of the enactment 
     of the Strengthening America's Public Health System Act, a 
     list of nationally notifiable diseases and conditions; and
       ``(B) a process for reviewing the list on an annual basis 
     and, as appropriate, modifying the list, taking into account 
     newly recognized diseases and conditions of public health 
     importance and advances in diagnostic technology.
       ``(2) A disease or condition will be included on the list 
     only if a majority of the States represented on the Council 
     approve such inclusion.
       ``(3) The list will include standard definitions for 
     confirmed, probable, and suspect cases for each nationally 
     notifiable disease or condition.
       ``(4) The list will distinguish between--
       ``(A) diseases and conditions of urgent public health 
     importance for which immediate action may be needed; and
       ``(B) diseases and conditions for which reporting is less 
     urgent and mainly for the purpose of monitoring trends and 
     evaluating public health intervention programs.
       ``(c) Notifications to CDC.--The process under subsection 
     (a) shall provide for reporting to the Director of the 
     Centers for Disease Control and Prevention as follows:
       ``(1) For diseases and conditions described in subsection 
     (b)(4)(A), reporting will occur--
       ``(A) by telephone or by using a system described in 
     section 2821(c)(2)(B); and
       ``(B) within 24 hours of the State making a determination 
     that a disease or condition meets the criteria for national 
     reporting for that disease or condition.
       ``(2) For diseases and conditions described in subsection 
     (b)(4)(B), reporting will occur--
       ``(A) by using a system described in section 2821(c)(2)(B); 
     and
       ``(B) only if funding is sufficient for the State to 
     conduct individual case surveillance and to have the 
     necessary systems to support electronic reporting.
       ``(d) Definitions.--In this section, the term `nationally 
     notifiable', with respect to a disease or condition, means 
     included on the list developed pursuant to subsection (b).

     ``SEC. 2824. IMPROVING BINATIONAL SURVEILLANCE AND 
                   NOTIFICATION.

       ``(a) Findings.--The Congress finds as follows:
       ``(1) Nearly 1,000,000 people cross the international 
     border between the United States and Mexico on a daily basis, 
     and this transmobility of population presents actual cases 
     and the potential risk of transmission of infectious diseases 
     and disease agents between these countries.
       ``(2) Numerous infectious disease cases in the United 
     States are binational in origin, thus requiring improved 
     epidemiology, surveillance, follow-up investigations, and 
     disease case management along the United States and Mexico 
     border.
       ``(b) Guidelines for Binational Cooperation.--Not later 
     than 1 year after the date of the enactment of this subtitle, 
     the Director of the Centers for Disease Control and 
     Prevention shall--
       ``(1) develop an expedited review and approval process and 
     adopt the resultant version of the `Guidelines for U.S.-
     Mexico Coordination on Epidemiological Events of Mutual 
     Interest', which have been developed with input from United 
     States and Mexican State health agencies, including the 
     Mexican Federal Health Secretariat, the United States 
     Department of Health and Human Services, and the Centers for 
     Disease Control and Prevention; and
       ``(2) use these guidelines as the basis for developing 
     improved standards and protocols for binational epidemiology, 
     surveillance, laboratory analyses, and control of infectious 
     diseases between the United States and Mexico.
       ``(c) Definition.--In this section, the term `binational' 
     refers to both sides of the United States-Mexico border, 
     whether collectively, such as an activity or program being 
     carried out concurrently by or in both countries, a 
     phenomenon (for example, a disease outbreak or health 
     emergency) affecting a population or geographic area in both 
     countries, or a disease case that originated on one side of 
     the border and was transmitted to the other.

     ``SEC. 2825. EVALUATION OF BEST PRACTICES IN PUBLIC HEALTH 
                   SURVEILLANCE.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall establish a committee--
       ``(1) to evaluate best practices in public health 
     surveillance, including human and animal disease surveillance 
     and environmental health monitoring of harmful exposures 
     through air, water, soil, or other means; and
       ``(2) to assess systems needed for improving coordination 
     among public health surveillance and monitoring systems.
       ``(b) Composition.--The committee established under 
     subsection (a) shall be composed of--
       ``(1) an epidemiologist employed and designated by the 
     Director of the Centers for Disease Control and Prevention;
       ``(2) an informatics specialist designated by the Director 
     of the Centers for Disease Control and Prevention;
       ``(3) an epidemiologist designated by the Director of the 
     Centers for Disease Control and Prevention to represent the 
     National Center for Environmental Health and the Agency for 
     Toxic Substances and Disease Registry;
       ``(4) a representative of an academic center or 
     professional, scientific association designated by the 
     American Society for Microbiology;
       ``(5) a food scientist designated by the Commissioner of 
     Food and Drugs;
       ``(6) an individual designated by the Secretary of 
     Agriculture from the Division of Veterinary Services;
       ``(7) a wildlife disease specialist designated by the 
     Secretary of Agriculture;
       ``(8) an epidemiologist employed by a State and designated 
     by the Council of State and Territorial Epidemiologists;
       ``(9) a public health laboratorian employed by a State and 
     designated by the Association of Public Health Laboratories;
       ``(10) a public health veterinarian employed by a State and 
     designated by the National Association of State Public Health 
     Veterinarians;
       ``(11) a laboratorian designated by the American 
     Association of Veterinary Laboratory Diagnosticians;
       ``(12) a State health official designated by the 
     Association of State and Territorial Health Officials;
       ``(13) a local health official designated by the National 
     Association of County and City Health Officials;
       ``(14) an environmental health scientist employed and 
     designated by the Administrator of the Environmental 
     Protection Agency; and
       ``(15) a representative with expertise in the Department of 
     Veterans Affairs' disease monitoring systems.
       ``(c) Functions.--The committee established under 
     subsection (a) shall--
       ``(1) review innovative approaches adopted by State and 
     local agencies to improve disease detection;
       ``(2) evaluate best practices in public health 
     surveillance;
       ``(3) develop model data sharing agreements among local, 
     State, and Federal health agencies;
       ``(4) assess systems needed for coordinated animal and 
     human disease surveillance and develop recommendations for 
     the improvement of such surveillance; and
       ``(5) disseminate findings and recommendations to relevant 
     local, State and Federal agencies.
       ``(d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $750,000 for 
     each of fiscal years 2010 through 2011.''.
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