[Congressional Record Volume 165, Number 93 (Tuesday, June 4, 2019)]
[House]
[Pages H4245-H4265]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 PANDEMIC AND ALL-HAZARDS PREPAREDNESS AND ADVANCING INNOVATION ACT OF 
                                  2019

  Ms. ESHOO. Madam Speaker, I move to suspend the rules and pass the 
bill (S. 1379) to reauthorize certain programs under the Public Health 
Service Act and the Federal Food, Drug, and Cosmetic Act with respect 
to public health security and all-hazards preparedness and response, 
and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                S. 1379

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Pandemic 
     and All-Hazards Preparedness and Advancing Innovation Act of 
     2019''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References in Act.

      TITLE I--STRENGTHENING THE NATIONAL HEALTH SECURITY STRATEGY

Sec. 101. National Health Security Strategy.

             TITLE II--IMPROVING PREPAREDNESS AND RESPONSE

Sec. 201. Improving benchmarks and standards for preparedness and 
              response.
Sec. 202. Amendments to preparedness and response programs.
Sec. 203. Regional health care emergency preparedness and response 
              systems.
Sec. 204. Military and civilian partnership for trauma readiness.
Sec. 205. Public health and health care system situational awareness 
              and biosurveillance capabilities.
Sec. 206. Strengthening and supporting the public health emergency 
              rapid response fund.
Sec. 207. Improving all-hazards preparedness and response by public 
              health emergency volunteers.
Sec. 208. Clarifying State liability law for volunteer health care 
              professionals.
Sec. 209. Report on adequate national blood supply.
Sec. 210. Report on the public health preparedness and response 
              capabilities and capacities of hospitals, long-term care 
              facilities, and other health care facilities.

[[Page H4246]]

                  TITLE III--REACHING ALL COMMUNITIES

Sec. 301. Strengthening and assessing the emergency response workforce.
Sec. 302. Health system infrastructure to improve preparedness and 
              response.
Sec. 303. Considerations for at-risk individuals.
Sec. 304. Improving emergency preparedness and response considerations 
              for children.
Sec. 305. National advisory committees on disasters.
Sec. 306. Guidance for participation in exercises and drills.

             TITLE IV--PRIORITIZING A THREAT-BASED APPROACH

Sec. 401. Assistant Secretary for Preparedness and Response.
Sec. 402. Public Health Emergency Medical Countermeasures Enterprise.
Sec. 403. Strategic National Stockpile.
Sec. 404. Preparing for pandemic influenza, antimicrobial resistance, 
              and other significant threats.
Sec. 405. Reporting on the Federal Select Agent Program.

 TITLE V--INCREASING COMMUNICATION IN MEDICAL COUNTERMEASURE ADVANCED 
                        RESEARCH AND DEVELOPMENT

Sec. 501. Medical countermeasure budget plan.
Sec. 502. Material threat and medical countermeasure notifications.
Sec. 503. Availability of regulatory management plans.
Sec. 504. The Biomedical Advanced Research and Development Authority 
              and the BioShield Special Reserve Fund.
Sec. 505. Additional strategies for combating antibiotic resistance.

      TITLE VI--ADVANCING TECHNOLOGIES FOR MEDICAL COUNTERMEASURES

Sec. 601. Administration of countermeasures.
Sec. 602. Updating definitions of other transactions.
Sec. 603. Medical countermeasure master files.
Sec. 604. Animal rule report.
Sec. 605. Review of the benefits of genomic engineering technologies 
              and their potential role in national security.
Sec. 606. Report on vaccines development.
Sec. 607. Strengthening mosquito abatement for safety and health.

                  TITLE VII--MISCELLANEOUS PROVISIONS

Sec. 701. Reauthorizations and extensions.
Sec. 702. Location of materials in the stockpile.
Sec. 703. Cybersecurity.
Sec. 704. Strategy and report.
Sec. 705. Technical amendments.

     SEC. 2. REFERENCES IN ACT.

       Except as otherwise specified, amendments made by this Act 
     to a section or other provision of law are amendments to such 
     section or other provision of the Public Health Service Act 
     (42 U.S.C. 201 et seq.).

      TITLE I--STRENGTHENING THE NATIONAL HEALTH SECURITY STRATEGY

     SEC. 101. NATIONAL HEALTH SECURITY STRATEGY.

       Section 2802 (42 U.S.C. 300hh-1) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1)--
       (i) by striking ``2014'' and inserting ``2018''; and
       (ii) by striking the second sentence and inserting the 
     following: ``Such National Health Security Strategy shall 
     describe potential emergency health security threats and 
     identify the process for achieving the preparedness goals 
     described in subsection (b) to be prepared to identify and 
     respond to such threats and shall be consistent with the 
     national preparedness goal (as described in section 
     504(a)(19) of the Homeland Security Act of 2002), the 
     National Incident Management System (as defined in section 
     501(7) of such Act), and the National Response Plan developed 
     pursuant to section 504 of such Act, or any successor 
     plan.'';
       (B) in paragraph (2), by inserting before the period at the 
     end of the second sentence the following: ``, and an analysis 
     of any changes to the evidence-based benchmarks and objective 
     standards under sections 319C-1 and 319C-2''; and
       (C) in paragraph (3)--
       (i) by striking ``2009'' and inserting ``2022'';
       (ii) by inserting ``(including gaps in the environmental 
     health and animal health workforces, as applicable), 
     describing the status of such workforce'' after ``gaps in 
     such workforce'';
       (iii) by striking ``and identifying strategies'' and 
     inserting ``identifying strategies''; and
       (iv) by inserting before the period at the end ``, and 
     identifying current capabilities to meet the requirements of 
     section 2803''; and
       (2) in subsection (b)--
       (A) in paragraph (2)--
       (i) in subparagraph (A), by striking ``and investigation'' 
     and inserting ``investigation, and related information 
     technology activities'';
       (ii) in subparagraph (B), by striking ``and 
     decontamination'' and inserting ``decontamination, relevant 
     health care services and supplies, and transportation and 
     disposal of medical waste''; and
       (iii) by adding at the end the following:
       ``(E) Response to environmental hazards.'';
       (B) in paragraph (3)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``including mental health'' and inserting ``including 
     pharmacies, mental health facilities,''; and
       (ii) in subparagraph (F), by inserting ``or exposures to 
     agents that could cause a public health emergency'' before 
     the period;
       (C) in paragraph (5), by inserting ``and other applicable 
     compacts'' after ``Compact''; and
       (D) by adding at the end the following:
       ``(9) Zoonotic disease, food, and agriculture.--Improving 
     coordination among Federal, State, local, Tribal, and 
     territorial entities (including through consultation with the 
     Secretary of Agriculture) to prevent, detect, and respond to 
     outbreaks of plant or animal disease (including zoonotic 
     disease) that could compromise national security resulting 
     from a deliberate attack, a naturally occurring threat, the 
     intentional adulteration of food, or other public health 
     threats, taking into account interactions between animal 
     health, human health, and animals' and humans' shared 
     environment as directly related to public health emergency 
     preparedness and response capabilities, as applicable.
       ``(10) Global health security.--Assessing current or 
     potential health security threats from abroad to inform 
     domestic public health preparedness and response 
     capabilities.''.

             TITLE II--IMPROVING PREPAREDNESS AND RESPONSE

     SEC. 201. IMPROVING BENCHMARKS AND STANDARDS FOR PREPAREDNESS 
                   AND RESPONSE.

       (a) Evaluating Measurable Evidence-Based Benchmarks and 
     Objective Standards.--Section 319C-1 (42 U.S.C. 247d-3a) is 
     amended by inserting after subsection (j) the following:
       ``(k) Evaluation.--
       ``(1) In general.--Not later than 2 years after the date of 
     enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019 and every 2 years 
     thereafter, the Secretary shall conduct an evaluation of the 
     evidence-based benchmarks and objective standards required 
     under subsection (g). Such evaluation shall be submitted to 
     the congressional committees of jurisdiction together with 
     the National Health Security Strategy under section 2802, at 
     such time as such strategy is submitted.
       ``(2) Content.--The evaluation under this paragraph shall 
     include--
       ``(A) a review of evidence-based benchmarks and objective 
     standards, and associated metrics and targets;
       ``(B) a discussion of changes to any evidence-based 
     benchmarks and objective standards, and the effect of such 
     changes on the ability to track whether entities are meeting 
     or making progress toward the goals under this section and, 
     to the extent practicable, the applicable goals of the 
     National Health Security Strategy under section 2802;
       ``(C) a description of amounts received by eligible 
     entities described in subsection (b) and section 319C-2(b), 
     and amounts received by subrecipients and the effect of such 
     funding on meeting evidence-based benchmarks and objective 
     standards; and
       ``(D) recommendations, as applicable and appropriate, to 
     improve evidence-based benchmarks and objective standards to 
     more accurately assess the ability of entities receiving 
     awards under this section to better achieve the goals under 
     this section and section 2802.''.
       (b) Evaluating the Partnership for State and Regional 
     Hospital Preparedness.--Section 319C-2(i)(1) (42 U.S.C. 247-
     3b(i)(1)) is amended by striking ``section 319C-1(g), (i), 
     and (j)'' and inserting ``section 319C-1(g), (i), (j), and 
     (k)''.

     SEC. 202. AMENDMENTS TO PREPAREDNESS AND RESPONSE PROGRAMS.

       (a) Cooperative Agreement Applications for Improving State 
     and Local Public Health Security.--Section 319C-1 (42 U.S.C. 
     247d-3a) is amended--
       (1) in subsection (a), by inserting ``, acting through the 
     Director of the Centers for Disease Control and Prevention,'' 
     after ``the Secretary''; and
       (2) in subsection (b)(2)(A)--
       (A) in clause (vi), by inserting ``, including public 
     health agencies with specific expertise that may be relevant 
     to public health security, such as environmental health 
     agencies,'' after ``stakeholders'';
       (B) by redesignating clauses (vii) through (ix) as clauses 
     (viii) through (x);
       (C) by inserting after clause (vi) the following:
       ``(vii) a description of how, as applicable, such entity 
     may integrate information to account for individuals with 
     behavioral health needs following a public health 
     emergency;'';
       (D) in clause (ix), as so redesignated, by striking ``; 
     and'' and inserting a semicolon; and
       (E) by adding at the end the following:
       ``(xi) a description of how the entity will partner with 
     health care facilities, including hospitals and nursing homes 
     and other long-term care facilities, to promote and improve 
     public health preparedness and response; and
       ``(xii) a description of how, as appropriate and 
     practicable, the entity will include critical infrastructure 
     partners, such as utility companies within the entity's 
     jurisdiction, in planning pursuant to this subparagraph to 
     help ensure that critical infrastructure will

[[Page H4247]]

     remain functioning during, or return to function as soon as 
     practicable after, a public health emergency;''.
       (b) Exception Relating to Application of Certain 
     Requirements.--
       (1) In general.--Section 319C-1(g) (42 U.S.C. 247d-3a(g)) 
     is amended--
       (A) in paragraph (5)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``Beginning with fiscal year 2009'' and inserting ``Beginning 
     with fiscal year 2019''; and
       (ii) in subparagraph (A)--

       (I) by striking ``for the immediately preceding fiscal 
     year'' and inserting ``for either of the 2 immediately 
     preceding fiscal years''; and
       (II) by striking ``2008'' and inserting ``2018''; and

       (B) in paragraph (6), by amending subparagraph (A) to read 
     as follows:
       ``(A) In general.--The amounts described in this paragraph 
     are the following amounts that are payable to an entity for 
     activities described in this section or section 319C-2:
       ``(i) For no more than one of each of the first 2 fiscal 
     years immediately following a fiscal year in which an entity 
     experienced a failure described in subparagraph (A) or (B) of 
     paragraph (5), an amount equal to 10 percent of the amount 
     the entity was eligible to receive for the respective fiscal 
     year.
       ``(ii) For no more than one of the first 2 fiscal years 
     immediately following the third consecutive fiscal year in 
     which an entity experienced such a failure, in lieu of 
     applying clause (i), an amount equal to 15 percent of the 
     amount the entity was eligible to receive for the respective 
     fiscal year.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply with respect to cooperative agreements awarded on 
     or after the date of enactment of this Act.
       (c) Partnership for State and Regional Hospital 
     Preparedness To Improve Surge Capacity.--Section 319C-2 (42 
     U.S.C. 247d-3b) is amended--
       (1) in subsection (a)--
       (A) by inserting ``, acting through the Assistant Secretary 
     for Preparedness and Response,'' after ``The Secretary''; and
       (B) by striking ``preparedness for public health 
     emergencies'' and inserting ``preparedness for, and response 
     to, public health emergencies in accordance with subsection 
     (c)'';
       (2) in subsection (b)(1)(A)--
       (A) by striking ``partnership consisting of'' and inserting 
     ``coalition that includes'';
       (B) in clause (ii), by striking ``; and'' and inserting a 
     semicolon; and
       (C) by adding at the end the following:
       ``(iv) one or more emergency medical service organizations 
     or emergency management organizations; and'';
       (3) in subsection (d)--
       (A) in paragraph (1)(B), by striking ``partnership'' each 
     place it appears and inserting ``coalition''; and
       (B) in paragraph (2)(C), by striking ``medical 
     preparedness'' and inserting ``preparedness and response'';
       (4) in subsection (f), by striking ``partnership'' and 
     inserting ``coalition'';
       (5) in subsection (g)(2)--
       (A) by striking ``Partnerships'' and inserting 
     ``Coalitions'';
       (B) by striking ``partnerships'' and inserting 
     ``coalitions''; and
       (C) by inserting ``and response'' after ``preparedness''; 
     and
       (6) in subsection (i)(1)--
       (A) by striking ``An entity'' and inserting ``A 
     coalition''; and
       (B) by striking ``such partnership'' and inserting ``such 
     coalition''.
       (d) Public Health Security Grants Authorization of 
     Appropriations.--Section 319C-1(h)(1)(A) (42 U.S.C. 247d-
     3a(h)(1)(A)) is amended by striking ``$641,900,000 for fiscal 
     year 2014'' and all that follows through the period at the 
     end and inserting ``$685,000,000 for each of fiscal years 
     2019 through 2023 for awards pursuant to paragraph (3) 
     (subject to the authority of the Secretary to make awards 
     pursuant to paragraphs (4) and (5)).''.
       (e) Partnership for State and Regional Hospital 
     Preparedness Authorization of Appropriations.--Section 319C-
     2(j) (42 U.S.C. 247d-3b(j)) is amended--
       (1) by amending paragraph (1) to read as follows:
       ``(1) In general.--
       ``(A) Authorization of appropriations.--For purposes of 
     carrying out this section and section 319C-3, in accordance 
     with subparagraph (B), there is authorized to be appropriated 
     $385,000,000 for each of fiscal years 2019 through 2023.
       ``(B) Reservation of amounts for regional systems.--
       ``(i) In general.--Subject to clause (ii), of the amount 
     appropriated under subparagraph (A) for a fiscal year, the 
     Secretary may reserve up to 5 percent for the purpose of 
     carrying out section 319C-3.
       ``(ii) Reservation contingent on continued appropriations 
     for this section.--If for fiscal year 2019 or a subsequent 
     fiscal year, the amount appropriated under subparagraph (A) 
     is such that, after application of clause (i), the amount 
     remaining for the purpose of carrying out this section would 
     be less than the amount available for such purpose for the 
     previous fiscal year, the amount that may be reserved under 
     clause (i) shall be reduced such that the amount remaining 
     for the purpose of carrying out this section is not less than 
     the amount available for such purpose for the previous fiscal 
     year.
       ``(iii) Sunset.--The authority to reserve amounts under 
     clause (i) shall expire on September 30, 2023.'';
       (2) in paragraph (2), by striking ``paragraph (1) for a 
     fiscal year'' and inserting ``paragraph (1)(A) for a fiscal 
     year and not reserved for the purpose described in paragraph 
     (1)(B)(i)''; and
       (3) in paragraph (3)(A), by striking ``paragraph (1) and 
     not reserved under paragraph (2)'' and inserting ``paragraph 
     (1)(A) and not reserved under paragraph (1)(B)(i) or (2)''.

     SEC. 203. REGIONAL HEALTH CARE EMERGENCY PREPAREDNESS AND 
                   RESPONSE SYSTEMS.

       (a) In General.--Part B of title III (42 U.S.C. 243 et 
     seq.) is amended by inserting after section 319C-2 the 
     following:

     ``SEC. 319C-3. GUIDELINES FOR REGIONAL HEALTH CARE EMERGENCY 
                   PREPAREDNESS AND RESPONSE SYSTEMS.

       ``(a) Purpose.--It is the purpose of this section to 
     identify and provide guidelines for regional systems of 
     hospitals, health care facilities, and other public and 
     private sector entities, with varying levels of capability to 
     treat patients and increase medical surge capacity during, in 
     advance of, and immediately following a public health 
     emergency, including threats posed by one or more chemical, 
     biological, radiological, or nuclear agents, including 
     emerging infectious diseases.
       ``(b) Guidelines.--The Assistant Secretary for Preparedness 
     and Response, in consultation with the Director of the 
     Centers for Disease Control and Prevention, the Administrator 
     of the Centers for Medicare & Medicaid Services, the 
     Administrator of the Health Resources and Services 
     Administration, the Commissioner of Food and Drugs, the 
     Assistant Secretary for Mental Health and Substance Use, the 
     Assistant Secretary of Labor for Occupational Safety and 
     Health, the Secretary of Veterans Affairs, the heads of such 
     other Federal agencies as the Secretary determines to be 
     appropriate, and State, local, Tribal, and territorial public 
     health officials, shall, not later than 2 years after the 
     date of enactment of this section--
       ``(1) identify and develop a set of guidelines relating to 
     practices and protocols for all-hazards public health 
     emergency preparedness and response for hospitals and health 
     care facilities to provide appropriate patient care during, 
     in advance of, or immediately following, a public health 
     emergency, resulting from one or more chemical, biological, 
     radiological, or nuclear agents, including emerging 
     infectious diseases (which may include existing practices, 
     such as trauma care and medical surge capacity and 
     capabilities), with respect to--
       ``(A) a regional approach to identifying hospitals and 
     health care facilities based on varying capabilities and 
     capacity to treat patients affected by such emergency, 
     including--
       ``(i) the manner in which the system will coordinate with 
     and integrate the partnerships and health care coalitions 
     established under section 319C-2(b); and
       ``(ii) informing and educating appropriate first responders 
     and health care supply chain partners of the regional 
     emergency preparedness and response capabilities and medical 
     surge capacity of such hospitals and health care facilities 
     in the community;
       ``(B) physical and technological infrastructure, laboratory 
     capacity, staffing, blood supply, and other supply chain 
     needs, taking into account resiliency, geographic 
     considerations, and rural considerations;
       ``(C) protocols or best practices for the safety and 
     personal protection of workers who handle human remains and 
     health care workers (including with respect to protective 
     equipment and supplies, waste management processes, and 
     decontamination), sharing of specialized experience among the 
     health care workforce, behavioral health, psychological 
     resilience, and training of the workforce, as applicable;
       ``(D) in a manner that allows for disease containment 
     (within the meaning of section 2802(b)(2)(B)), coordinated 
     medical triage, treatment, and transportation of patients, 
     based on patient medical need (including patients in rural 
     areas), to the appropriate hospitals or health care 
     facilities within the regional system or, as applicable and 
     appropriate, between systems in different States or regions; 
     and
       ``(E) the needs of children and other at-risk individuals;
       ``(2) make such guidelines available on the internet 
     website of the Department of Health and Human Services in a 
     manner that does not compromise national security; and
       ``(3) update such guidelines as appropriate, including 
     based on input received pursuant to subsections (c) and (e) 
     and information resulting from applicable reports required 
     under the Pandemic and All-Hazards Preparedness and Advancing 
     Innovation Act of 2019 (including any amendments made by such 
     Act), to address new and emerging public health threats.
       ``(c) Considerations.--In identifying, developing, and 
     updating guidelines under subsection (b), the Assistant 
     Secretary for Preparedness and Response shall--
       ``(1) include input from hospitals and health care 
     facilities (including health care coalitions under section 
     319C-2), State, local, Tribal, and territorial public health 
     departments, and health care or subject matter experts 
     (including experts with relevant expertise in chemical, 
     biological, radiological, or nuclear threats, including 
     emerging infectious diseases), as the Assistant Secretary 
     determines appropriate, to meet the goals under section 
     2802(b)(3);

[[Page H4248]]

       ``(2) consult and engage with appropriate health care 
     providers and professionals, including physicians, nurses, 
     first responders, health care facilities (including 
     hospitals, primary care clinics, community health centers, 
     mental health facilities, ambulatory care facilities, and 
     dental health facilities), pharmacies, emergency medical 
     providers, trauma care providers, environmental health 
     agencies, public health laboratories, poison control centers, 
     blood banks, tissue banks, and other experts that the 
     Assistant Secretary determines appropriate, to meet the goals 
     under section 2802(b)(3);
       ``(3) consider feedback related to financial implications 
     for hospitals, health care facilities, public health 
     agencies, laboratories, blood banks, tissue banks, and other 
     entities engaged in regional preparedness planning to 
     implement and follow such guidelines, as applicable; and
       ``(4) consider financial requirements and potential 
     incentives for entities to prepare for, and respond to, 
     public health emergencies as part of the regional health care 
     emergency preparedness and response system.
       ``(d) Technical Assistance.--The Assistant Secretary for 
     Preparedness and Response, in consultation with the Director 
     of the Centers for Disease Control and Prevention and the 
     Assistant Secretary of Labor for Occupational Safety and 
     Health, may provide technical assistance and consultation 
     toward meeting the guidelines described in subsection (b).
       ``(e) Demonstration Project for Regional Health Care 
     Preparedness and Response Systems.--
       ``(1) In general.--The Assistant Secretary for Preparedness 
     and Response may establish a demonstration project pursuant 
     to the development and implementation of guidelines under 
     subsection (b) to award grants to improve medical surge 
     capacity for all hazards, build and integrate regional 
     medical response capabilities, improve specialty care 
     expertise for all-hazards response, and coordinate medical 
     preparedness and response across State, local, Tribal, 
     territorial, and regional jurisdictions.
       ``(2) Sunset.--The authority under this subsection shall 
     expire on September 30, 2023.''.
       (b) GAO Report to Congress.--
       (1) Report.--Not later than 3 years after the date of 
     enactment of this Act, the Comptroller General of the United 
     States (referred to in this subsection as the ``Comptroller 
     General'') shall submit to the Committee on Health, 
     Education, Labor, and Pensions and the Committee on Finance 
     of the Senate and the Committee on Energy and Commerce and 
     the Committee on Ways and Means of the House of 
     Representatives, a report on the extent to which hospitals 
     and health care facilities have implemented the recommended 
     guidelines under section 319C-3(b) of the Public Health 
     Service Act (as added by subsection (a)), including an 
     analysis and evaluation of any challenges hospitals or health 
     care facilities experienced in implementing such guidelines.
       (2) Content.--The Comptroller General shall include in the 
     report under paragraph (1)--
       (A) data on the preparedness and response capabilities that 
     have been informed by the guidelines under section 319C-3(b) 
     of the Public Health Service Act to improve regional 
     emergency health care preparedness and response capability, 
     including hospital and health care facility capacity and 
     medical surge capabilities to prepare for, and respond to, 
     public health emergencies; and
       (B) recommendations to reduce gaps in incentives for 
     regional health partners, including hospitals and health care 
     facilities, to improve capacity and medical surge 
     capabilities to prepare for, and respond to, public health 
     emergencies, consistent with subsection (a), which may 
     include consideration of facilities participating in programs 
     under section 319C-2 of the Public Health Service Act (42 
     U.S.C. 247d-3b) or in programs under the Centers for Medicare 
     & Medicaid Services (including innovative health care 
     delivery and payment models), and input from private sector 
     financial institutions.
       (3) Consultation.--In carrying out paragraphs (1) and (2), 
     the Comptroller General shall consult with the heads of 
     appropriate Federal agencies, including--
       (A) the Assistant Secretary for Preparedness and Response;
       (B) the Director of the Centers for Disease Control and 
     Prevention;
       (C) the Administrator of the Centers for Medicare & 
     Medicaid Services;
       (D) the Assistant Secretary for Mental Health and Substance 
     Use;
       (E) the Assistant Secretary of Labor for Occupational 
     Safety and Health; and
       (F) the Secretary of Veterans Affairs.
       (c) Annual Reports.--Section 319C-2(i)(1) (42 U.S.C. 247d-
     3b(i)(1)) is amended by inserting after the first sentence 
     the following: ``In submitting reports under this paragraph, 
     a coalition shall include information on the progress that 
     the coalition has made toward the implementation of section 
     319C-3 (or barriers to progress, if any).''.
       (d) National Health Security Strategy Incorporation of 
     Regionalized Emergency Preparedness and Response.--
     Subparagraph (G) of section 2802(b)(3) (42 U.S.C. 300hh-
     1(b)(3)) is amended to read as follows:
       ``(G) Optimizing a coordinated and flexible approach to the 
     emergency response and medical surge capacity of hospitals, 
     other health care facilities, critical care, trauma care 
     (which may include trauma centers), and emergency medical 
     systems.''.
       (e) Improving State and Local Public Health Security.--
       (1) State and local security.--Section 319C-1(e) (42 U.S.C. 
     247d-3a(e)) is amended by striking ``, and local emergency 
     plans.'' and inserting ``, local emergency plans, and any 
     regional health care emergency preparedness and response 
     system established pursuant to the applicable guidelines 
     under section 319C-3.''.
       (2) Partnerships.--Section 319C-2(d)(1)(A) (42 U.S.C. 247d-
     3b(d)(1)(A)) is amended--
       (A) in clause (i), by striking ``; and'' and inserting 
     ``;'';
       (B) by redesignating clause (ii) as clause (iii); and
       (C) by inserting after clause (i) the following:
       ``(ii) among one or more facilities in a regional health 
     care emergency system under section 319C-3; and''.

     SEC. 204. MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA 
                   READINESS.

       Title XII (42 U.S.C. 300d et seq.) is amended by adding at 
     the end the following new part:

``PART I--MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA READINESS GRANT 
                                PROGRAM

     ``SEC. 1291. MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA 
                   READINESS GRANT PROGRAM.

       ``(a) Military Trauma Team Placement Program.--
       ``(1) In general.--The Secretary, acting through the 
     Assistant Secretary for Preparedness and Response and in 
     consultation with the Secretary of Defense, shall award 
     grants to not more than 20 eligible high-acuity trauma 
     centers to enable military trauma teams to provide, on a 
     full-time basis, trauma care and related acute care at such 
     trauma centers.
       ``(2) Limitations.--In the case of a grant awarded under 
     paragraph (1) to an eligible high-acuity trauma center, such 
     grant--
       ``(A) shall be for a period of at least 3 years and not 
     more than 5 years (and may be renewed at the end of such 
     period); and
       ``(B) shall be in an amount that does not exceed $1,000,000 
     per year.
       ``(3) Availability of funds.--Notwithstanding section 1552 
     of title 31, United States Code, or any other provision of 
     law, funds available to the Secretary for obligation for a 
     grant under this subsection shall remain available for 
     expenditure for 100 days after the last day of the 
     performance period of such grant.
       ``(b) Military Trauma Care Provider Placement Program.--
       ``(1) In general.--The Secretary, acting through the 
     Assistant Secretary for Preparedness and Response and in 
     consultation with the Secretary of Defense, shall award 
     grants to eligible trauma centers to enable military trauma 
     care providers to provide trauma care and related acute care 
     at such trauma centers.
       ``(2) Limitations.--In the case of a grant awarded under 
     paragraph (1) to an eligible trauma center, such grant--
       ``(A) shall be for a period of at least 1 year and not more 
     than 3 years (and may be renewed at the end of such period); 
     and
       ``(B) shall be in an amount that does not exceed, in a 
     year--
       ``(i) $100,000 for each military trauma care provider that 
     is a physician at such eligible trauma center; and
       ``(ii) $50,000 for each other military trauma care provider 
     at such eligible trauma center.
       ``(c) Grant Requirements.--
       ``(1) Deployment and public health emergencies.--As a 
     condition of receipt of a grant under this section, a grant 
     recipient shall agree to allow military trauma care providers 
     providing care pursuant to such grant to--
       ``(A) be deployed by the Secretary of Defense for military 
     operations, for training, or for response to a mass casualty 
     incident; and
       ``(B) be deployed by the Secretary of Defense, in 
     consultation with the Secretary of Health and Human Services, 
     for response to a public health emergency pursuant to section 
     319.
       ``(2) Use of funds.--Grants awarded under this section to 
     an eligible trauma center may be used to train and 
     incorporate military trauma care providers into such trauma 
     center, including incorporation into operational exercises 
     and training drills related to public health emergencies, 
     expenditures for malpractice insurance, office space, 
     information technology, specialty education and supervision, 
     trauma programs, research, and applicable license fees for 
     such military trauma care providers.
       ``(d) Rule of Construction.--Nothing in this section shall 
     be construed to affect any other provision of law that 
     preempts State licensing requirements for health care 
     professionals, including with respect to military trauma care 
     providers.
       ``(e) Reporting Requirements.--
       ``(1) Report to the secretary and the secretary of 
     defense.--Each eligible trauma center or eligible high-acuity 
     trauma center awarded a grant under subsection (a) or (b) for 
     a year shall submit to the Secretary and the Secretary of 
     Defense a report for such year that includes information on--
       ``(A) the number and types of trauma cases managed by 
     military trauma teams or military trauma care providers 
     pursuant to such grant during such year;
       ``(B) the ability to maintain the integration of the 
     military trauma providers or

[[Page H4249]]

     teams of providers as part of the trauma center, including 
     the financial effect of such grant on the trauma center;
       ``(C) the educational effect on resident trainees in 
     centers where military trauma teams are assigned;
       ``(D) any research conducted during such year supported by 
     such grant; and
       ``(E) any other information required by the Secretaries for 
     the purpose of evaluating the effect of such grant.
       ``(2) Report to congress.--Not less than once every 2 
     years, the Secretary, in consultation with the Secretary of 
     Defense, shall submit a report to the congressional 
     committees of jurisdiction that includes information on the 
     effect of placing military trauma care providers in trauma 
     centers awarded grants under this section on--
       ``(A) maintaining military trauma care providers' readiness 
     and ability to respond to and treat battlefield injuries;
       ``(B) providing health care to civilian trauma patients in 
     urban and rural settings;
       ``(C) the capability of trauma centers and military trauma 
     care providers to increase medical surge capacity, including 
     as a result of a large-scale event;
       ``(D) the ability of grant recipients to maintain the 
     integration of the military trauma providers or teams of 
     providers as part of the trauma center;
       ``(E) efforts to incorporate military trauma care providers 
     into operational exercises and training and drills for public 
     health emergencies; and
       ``(F) the capability of military trauma care providers to 
     participate as part of a medical response during or in 
     advance of a public health emergency, as determined by the 
     Secretary, or a mass casualty incident.
       ``(f) Definitions.--For purposes of this part:
       ``(1) Eligible high-acuity trauma center.--The term 
     `eligible high-acuity trauma center' means a Level I trauma 
     center that satisfies each of the following:
       ``(A) Such trauma center has an agreement with the 
     Secretary of Defense to enable military trauma teams to 
     provide trauma care and related acute care at such trauma 
     center.
       ``(B) At least 20 percent of patients treated at such 
     trauma center in the most recent 3-month period for which 
     data are available are treated for a major trauma at such 
     trauma center.
       ``(C) Such trauma center utilizes a risk-adjusted 
     benchmarking system and metrics to measure performance, 
     quality, and patient outcomes.
       ``(D) Such trauma center is an academic training center--
       ``(i) affiliated with a medical school;
       ``(ii) that maintains residency programs and fellowships in 
     critical trauma specialties and subspecialties, and provides 
     education and supervision of military trauma team members 
     according to those specialties and subspecialties; and
       ``(iii) that undertakes research in the prevention and 
     treatment of traumatic injury.
       ``(E) Such trauma center serves as a medical and public 
     health preparedness and response leader for its community, 
     such as by participating in a partnership for State and 
     regional hospital preparedness established under section 
     319C-2 or 319C-3.
       ``(2) Eligible trauma center.--The term `eligible trauma 
     center' means a Level I, II, or III trauma center that 
     satisfies each of the following:
       ``(A) Such trauma center has an agreement with the 
     Secretary of Defense to enable military trauma care providers 
     to provide trauma care and related acute care at such trauma 
     center.
       ``(B) Such trauma center utilizes a risk-adjusted 
     benchmarking system and metrics to measure performance, 
     quality, and patient outcomes.
       ``(C) Such trauma center demonstrates a need for integrated 
     military trauma care providers to maintain or improve the 
     trauma clinical capability of such trauma center.
       ``(3) Major trauma.--The term `major trauma' means an 
     injury that is greater than or equal to 15 on the injury 
     severity score.
       ``(4) Military trauma team.--The term `military trauma 
     team' means a complete military trauma team consisting of 
     military trauma care providers.
       ``(5) Military trauma care provider.--The term `military 
     trauma care provider' means a member of the Armed Forces who 
     furnishes emergency, critical care, and other trauma acute 
     care services (including a physician, surgeon, physician 
     assistant, nurse, nurse practitioner, respiratory therapist, 
     flight paramedic, combat medic, or enlisted medical 
     technician) or other military trauma care provider as the 
     Secretary determines appropriate.
       ``(g) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $11,500,000 
     for each of fiscal years 2019 through 2023.''.

     SEC. 205. PUBLIC HEALTH AND HEALTH CARE SYSTEM SITUATIONAL 
                   AWARENESS AND BIOSURVEILLANCE CAPABILITIES.

       (a) Facilities, Capacities, and Biosurveillance 
     Capabilities.--Section 319D (42 U.S.C. 247d-4) is amended--
       (1) in the section heading, by striking ``revitalizing'' 
     and inserting ``facilities and capacities of'';
       (2) in subsection (a)--
       (A) in the subsection heading, by striking ``Facilities; 
     Capacities'' and inserting ``In General'';
       (B) in paragraph (1), by striking ``and improved'' and 
     inserting ``, improved, and appropriately maintained'';
       (C) in paragraph (3), in the matter preceding subparagraph 
     (A), by striking ``expand, enhance, and improve'' and 
     inserting ``expand, improve, enhance, and appropriately 
     maintain''; and
       (D) by adding at the end the following:
       ``(4) Study of resources for facilities and capacities.--
     Not later than June 1, 2022, the Comptroller General of the 
     United States shall conduct a study on Federal spending in 
     fiscal years 2013 through 2018 for activities authorized 
     under this subsection. Such study shall include a review and 
     assessment of obligations and expenditures directly related 
     to each activity under paragraphs (2) and (3), including a 
     specific accounting of, and delineation between, obligations 
     and expenditures incurred for the construction, renovation, 
     equipping, and security upgrades of facilities and associated 
     contracts under this subsection, and the obligations and 
     expenditures incurred to establish and improve the 
     situational awareness and biosurveillance network under 
     subsection (b), and shall identify the agency or agencies 
     incurring such obligations and expenditures.'';
       (3) in subsection (b)--
       (A) in the subsection heading, by striking ``National'' and 
     inserting ``Establishment of Systems of Public Health'';
       (B) in paragraph (1)(B), by inserting ``immunization 
     information systems,'' after ``centers,'';
       (C) in paragraph (2)--
       (i) by inserting ``develop a plan to, and'' after ``The 
     Secretary shall''; and
       (ii) by inserting ``and in a form readily usable for 
     analytical approaches'' after ``in a secure manner''; and
       (D) by amending paragraph (3) to read as follows:
       ``(3) Standards.--
       ``(A) In general.--Not later than 1 year after the date of 
     the enactment of the Pandemic and All-Hazards Preparedness 
     and Advancing Innovation Act of 2019, the Secretary, in 
     cooperation with health care providers, State, local, Tribal, 
     and territorial public health officials, and relevant Federal 
     agencies (including the Office of the National Coordinator 
     for Health Information Technology and the National Institute 
     of Standards and Technology), shall, as necessary, adopt 
     technical and reporting standards, including standards for 
     interoperability as defined by section 3000, for networks 
     under paragraph (1) and update such standards as necessary. 
     Such standards shall be made available on the internet 
     website of the Department of Health and Human Services, in a 
     manner that does not compromise national security.
       ``(B) Deference to standards development organizations.--In 
     adopting and implementing standards under this subsection and 
     subsection (c), the Secretary shall give deference to 
     standards published by standards development organizations 
     and voluntary consensus-based standards entities.'';
       (4) in subsection (c)--
       (A) in paragraph (1)--
       (i) by striking ``Not later than 2 years after the date of 
     enactment of the Pandemic and All-Hazards Preparedness 
     Reauthorization Act of 2013, the Secretary'' and inserting 
     ``The Secretary'';
       (ii) by inserting ``, and improve as applicable and 
     appropriate,'' after ``shall establish'';
       (iii) by striking ``of rapid'' and inserting ``of, rapid''; 
     and
       (iv) by striking ``such connectivity'' and inserting ``such 
     interoperability'';
       (B) by amending paragraph (2) to read as follows:
       ``(2) Coordination and consultation.--In establishing and 
     improving the network under paragraph (1), the Secretary 
     shall--
       ``(A) facilitate coordination among agencies within the 
     Department of Health and Human Services that provide, or have 
     the potential to provide, information and data to, and 
     analyses for, the situational awareness and biosurveillance 
     network under paragraph (1), including coordination among 
     relevant agencies related to health care services, the 
     facilitation of health information exchange (including the 
     Office of the National Coordinator for Health Information 
     Technology), and public health emergency preparedness and 
     response; and
       ``(B) consult with the Secretary of Agriculture, the 
     Secretary of Commerce (and the Director of the National 
     Institute of Standards and Technology), the Secretary of 
     Defense, the Secretary of Homeland Security, the Secretary of 
     Veterans Affairs, and the heads of other Federal agencies, as 
     the Secretary determines appropriate.'';
       (C) in paragraph (3)--
       (i) by redesignating subparagraphs (A) through (E) as 
     clauses (i) through (v), respectively, and adjusting the 
     margins accordingly;
       (ii) in clause (iv), as so redesignated--

       (I) by inserting ``immunization information systems,'' 
     after ``poison control,''; and
       (II) by striking ``and clinical laboratories'' and 
     inserting ``, clinical laboratories, and public environmental 
     health agencies'';

       (iii) by striking ``The network'' and inserting the 
     following:
       ``(A) In general.--The network''; and
       (iv) by adding at the end the following:
       ``(B) Review.--Not later than 2 years after the date of the 
     enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019 and every 6 years

[[Page H4250]]

     thereafter, the Secretary shall conduct a review of the 
     elements described in subparagraph (A). Such review shall 
     include a discussion of the addition of any elements pursuant 
     to clause (v), including elements added to advancing new 
     technologies, and identify any challenges in the 
     incorporation of elements under subparagraph (A). The 
     Secretary shall provide such review to the congressional 
     committees of jurisdiction.'';
       (D) in paragraph (5)--
       (i) by redesignating subparagraphs (A) through (D) as 
     clauses (i) through (iv), respectively, and adjusting the 
     margins accordingly;
       (ii) by striking ``In establishing'' and inserting the 
     following:
       ``(A) In general.--In establishing'';
       (iii) by adding at the end the following:
       ``(B) Public meeting.--
       ``(i) In general.--Not later than 180 days after the date 
     of enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019, the Secretary shall convene 
     a public meeting for purposes of discussing and providing 
     input on the potential goals, functions, and uses of the 
     network described in paragraph (1) and incorporating the 
     elements described in paragraph (3)(A).
       ``(ii) Experts.--The public meeting shall include 
     representatives of relevant Federal agencies (including 
     representatives from the Office of the National Coordinator 
     for Health Information Technology and the National Institute 
     of Standards and Technology); State, local, Tribal, and 
     territorial public health officials; stakeholders with 
     expertise in biosurveillance and situational awareness; 
     stakeholders with expertise in capabilities relevant to 
     biosurveillance and situational awareness, such as experts in 
     informatics and data analytics (including experts in 
     prediction, modeling, or forecasting); and other 
     representatives as the Secretary determines appropriate.
       ``(iii) Topics.--Such public meeting shall include a 
     discussion of--

       ``(I) data elements, including minimal or essential data 
     elements, that are voluntarily provided for such network, 
     which may include elements from public health and public and 
     private health care entities, to the extent practicable;
       ``(II) standards and implementation specifications that may 
     improve the collection, analysis, and interpretation of data 
     during a public health emergency;
       ``(III) strategies to encourage the access, exchange, and 
     use of information;
       ``(IV) considerations for State, local, Tribal, and 
     territorial capabilities and infrastructure related to data 
     exchange and interoperability;
       ``(V) privacy and security protections provided at the 
     Federal, State, local, Tribal, and territorial levels, and by 
     nongovernmental stakeholders; and
       ``(VI) opportunities for the incorporation of innovative 
     technologies to improve the network.''; and

       (iv) in subparagraph (A), as so designated by clause (ii)--

       (I) in clause (i), as so redesignated--

       (aa) by striking ``as determined'' and inserting ``as 
     adopted''; and
       (bb) by inserting ``and the National Institute of Standards 
     and Technology'' after ``Office of the National Coordinator 
     for Health Information Technology'';

       (II) in clause (iii), as so redesignated, by striking ``; 
     and'' and inserting a semicolon;
       (III) in clause (iv), as so redesignated, by striking the 
     period and inserting ``; and''; and
       (IV) by adding at the end the following:

       ``(v) pilot test standards and implementation 
     specifications, consistent with the process described in 
     section 3002(b)(3)(C), which State, local, Tribal, and 
     territorial public health entities may utilize, on a 
     voluntary basis, as a part of the network.'';
       (E) by redesignating paragraph (6) as paragraph (7);
       (F) by inserting after paragraph (5) the following:
       ``(6) Strategy and implementation plan.--
       ``(A) In general.--Not later than 18 months after the date 
     of enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019, the Secretary shall submit 
     to the congressional committees of jurisdiction a coordinated 
     strategy and an accompanying implementation plan that--
       ``(i) is informed by the public meeting under paragraph 
     (5)(B);
       ``(ii) includes a review and assessment of existing 
     capabilities of the network and related infrastructure, 
     including input provided by the public meeting under 
     paragraph (5)(B);
       ``(iii) identifies and demonstrates the measurable steps 
     the Secretary will carry out to--

       ``(I) develop, implement, and evaluate the network 
     described in paragraph (1), utilizing elements described in 
     paragraph (3)(A);
       ``(II) modernize and enhance biosurveillance activities, 
     including strategies to include innovative technologies and 
     analytical approaches (including prediction and forecasting 
     for pandemics and all-hazards) from public and private 
     entities;
       ``(III) improve information sharing, coordination, and 
     communication among disparate biosurveillance systems 
     supported by the Department of Health and Human Services, 
     including the identification of methods to improve 
     accountability, better utilize resources and workforce 
     capabilities, and incorporate innovative technologies within 
     and across agencies; and
       ``(IV) test and evaluate capabilities of the interoperable 
     network of systems to improve situational awareness and 
     biosurveillance capabilities;

       ``(iv) includes performance measures and the metrics by 
     which performance measures will be assessed with respect to 
     the measurable steps under clause (iii); and
       ``(v) establishes dates by which each measurable step under 
     clause (iii) will be implemented.
       ``(B) Annual budget plan.--Not later than 2 years after the 
     date of enactment of the Pandemic and All-Hazards 
     Preparedness and Advancing Innovation Act of 2019 and on an 
     annual basis thereafter, in accordance with the strategy and 
     implementation plan under this paragraph, the Secretary 
     shall, taking into account recommendations provided by the 
     National Biodefense Science Board, develop a budget plan 
     based on the strategy and implementation plan under this 
     section. Such budget plan shall include--
       ``(i) a summary of resources previously expended to 
     establish, improve, and utilize the nationwide public health 
     situational awareness and biosurveillance network under 
     paragraph (1);
       ``(ii) estimates of costs and resources needed to establish 
     and improve the network under paragraph (1) according to the 
     strategy and implementation plan under subparagraph (A);
       ``(iii) the identification of gaps and inefficiencies in 
     nationwide public health situational awareness and 
     biosurveillance capabilities, resources, and authorities 
     needed to address such gaps; and
       ``(iv) a strategy to minimize and address such gaps and 
     improve inefficiencies.'';
       (G) in paragraph (7), as so redesignated--
       (i) in subparagraph (A), by inserting ``(taking into 
     account zoonotic disease, including gaps in scientific 
     understanding of the interactions between human, animal, and 
     environmental health)'' after ``human health'';
       (ii) in subparagraph (B)--

       (I) by inserting ``and gaps in surveillance programs'' 
     after ``surveillance programs''; and
       (II) by striking ``; and'' and inserting a semicolon;

       (iii) in subparagraph (C)--

       (I) by inserting ``, animal health organizations related to 
     zoonotic disease,'' after ``health care entities''; and
       (II) by striking the period and inserting ``; and''; and

       (iv) by adding at the end the following:
       ``(D) provide recommendations to the Secretary on policies 
     and procedures to complete the steps described in this 
     paragraph in a manner that is consistent with section 
     2802.''; and
       (H) by adding at the end the following:
       ``(8) Situational awareness and biosurveillance as a 
     national security priority.--The Secretary, on a periodic 
     basis as applicable and appropriate, shall meet with the 
     Director of National Intelligence to inform the development 
     and capabilities of the nationwide public health situational 
     awareness and biosurveillance network.'';
       (5) in subsection (d)--
       (A) in paragraph (1)--
       (i) by inserting ``environmental health agencies,'' after 
     ``public health agencies,''; and
       (ii) by inserting ``immunization programs,'' after ``poison 
     control centers,'';
       (B) in paragraph (2)--
       (i) in subparagraph (B), by striking ``and'' at the end;
       (ii) in subparagraph (C), by striking the period and 
     inserting ``; and''; and
       (iii) by adding after subparagraph (C) the following:
       ``(D) an implementation plan that may include measurable 
     steps to achieve the purposes described in paragraph (1).''; 
     and
       (C) by striking paragraph (5) and inserting the following:
       ``(5) Technical assistance.--The Secretary may provide 
     technical assistance to States, localities, Tribes, and 
     territories or a consortium of States, localities, Tribes, 
     and territories receiving an award under this subsection 
     regarding interoperability and the technical standards set 
     forth by the Secretary.'';
       (6) by redesignating subsections (f) and (g) as subsections 
     (i) and (j), respectively; and
       (7) by inserting after subsection (e) the following:
       ``(f) Personnel Authorities.--
       ``(1) Specially qualified personnel.--In addition to any 
     other personnel authorities, to carry out subsections (b) and 
     (c), the Secretary may--
       ``(A) appoint highly qualified individuals to scientific or 
     professional positions at the Centers for Disease Control and 
     Prevention, not to exceed 30 such employees at any time 
     (specific to positions authorized by this subsection), with 
     expertise in capabilities relevant to biosurveillance and 
     situational awareness, such as experts in informatics and 
     data analytics (including experts in prediction, modeling, or 
     forecasting), and other related scientific or technical 
     fields; and
       ``(B) compensate individuals appointed under subparagraph 
     (A) in the same manner and subject to the same terms and 
     conditions in which individuals appointed under 9903 of title 
     5, United States Code, are compensated, without regard to the 
     provisions of chapter 51 and subchapter III of chapter 53 of 
     such title relating to classification and General Schedule 
     pay rates.
       ``(2) Limitations.--The Secretary shall exercise the 
     authority under paragraph (1) in a

[[Page H4251]]

     manner that is consistent with the limitations described in 
     section 319F-1(e)(2).
       ``(g) Timeline.--The Secretary shall accomplish the 
     purposes under subsections (b) and (c) no later than 
     September 30, 2023, and shall provide a justification to the 
     congressional committees of jurisdiction for any missed or 
     delayed implementation of measurable steps identified under 
     subsection (c)(6)(A)(iii).
       ``(h) Independent Evaluation.--Not later than 3 years after 
     the date of enactment of the Pandemic and All-Hazards 
     Preparedness and Advancing Innovation Act of 2019, the 
     Comptroller General of the United States shall conduct an 
     independent evaluation and submit to the Secretary and the 
     congressional committees of jurisdiction a report concerning 
     the activities conducted under subsections (b) and (c), and 
     provide recommendations, as applicable and appropriate, on 
     necessary improvements to the biosurveillance and situational 
     awareness network.''.
       (b) Authorization of Appropriations.--Subsection (i) of 
     section 319D (42 U.S.C. 247d-4), as redesignated by 
     subsection (a)(6), is amended by striking ``$138,300,000 for 
     each of fiscal years 2014 through 2018'' and inserting 
     ``$161,800,000 for each of fiscal years 2019 through 2023''.
       (c) Biological Threat Detection Report.--The Secretary of 
     Health and Human Services shall, in coordination with the 
     Secretary of Defense and the Secretary of Homeland Security, 
     not later than 180 days after the date of enactment of this 
     Act, report to the Committee on Energy and Commerce, the 
     Committee on Armed Services, and the Committee on Homeland 
     Security of the House of Representatives and the Committee on 
     Health, Education, Labor, and Pensions, the Committee on 
     Armed Services, and the Committee on Homeland Security and 
     Governmental Affairs of the Senate on the state of Federal 
     biological threat detection efforts, including the following:
       (1) An identification of technological, operational, and 
     programmatic successes and failures of domestic detection 
     programs supported by Federal departments and agencies for 
     intentionally introduced or accidentally released biological 
     threat agents and naturally occurring infectious diseases.
       (2) A description of Federal efforts to facilitate the 
     exchange of information related to the information described 
     in paragraph (1) among Federal departments and agencies that 
     utilize biological threat detection technology.
       (3) A description of the capabilities of detection systems 
     in use by Federal departments and agencies including the 
     capability to--
       (A) rapidly detect, identify, characterize, and confirm the 
     presence of biological threat agents;
       (B) recover live biological agents from collection devices;
       (C) determine the geographical distribution of biological 
     agents;
       (D) determine the extent of environmental contamination and 
     persistence of biological agents; and
       (E) provide advanced molecular diagnostics to State, local, 
     Tribal, and territorial public health and other laboratories 
     that support biological threat detection activities.
       (4) A description of Federal interagency coordination 
     related to biological threat detection.
       (5) A description of efforts by Federal departments and 
     agencies that utilize biological threat detection technology 
     to collaborate with State, local, Tribal, and territorial 
     public health laboratories and other users of biological 
     threat detection systems, including collaboration regarding 
     the development of--
       (A) biological threat detection requirements or standards;
       (B) a standardized integration strategy;
       (C) training requirements or guidelines;
       (D) guidelines for a coordinated public health response, 
     including preparedness capabilities, and, as applicable, for 
     coordination with public health surveillance systems; and
       (E) a coordinated environmental remediation plan, as 
     applicable.
       (6) Recommendations related to research, advanced research, 
     development, and procurement for Federal departments and 
     agencies to improve and enhance biological threat detection 
     systems, including recommendations on the transfer of 
     biological threat detection technology among Federal 
     departments and agencies, as necessary and appropriate.

     SEC. 206. STRENGTHENING AND SUPPORTING THE PUBLIC HEALTH 
                   EMERGENCY RAPID RESPONSE FUND.

       Section 319 (42 U.S.C. 247d) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1)--
       (i) in the first sentence, by inserting ``or if the 
     Secretary determines there is the significant potential for a 
     public health emergency, to allow the Secretary to rapidly 
     respond to the immediate needs resulting from such public 
     health emergency or potential public health emergency'' 
     before the period; and
       (ii) by inserting ``The Secretary shall plan for the 
     expedited distribution of funds to appropriate agencies and 
     entities.'' after the first sentence;
       (B) by redesignating paragraph (2) as paragraph (3);
       (C) by inserting after paragraph (1) the following:
       ``(2) Uses.--The Secretary may use amounts in the Fund 
     established under paragraph (1), to--
       ``(A) facilitate coordination between and among Federal, 
     State, local, Tribal, and territorial entities and public and 
     private health care entities that the Secretary determines 
     may be affected by a public health emergency or potential 
     public health emergency referred to in paragraph (1) 
     (including communication of such entities with relevant 
     international entities, as applicable);
       ``(B) make grants, provide for awards, enter into 
     contracts, and conduct supportive investigations pertaining 
     to a public health emergency or potential public health 
     emergency, including further supporting programs under 
     section 319C-1, 319C-2, or 319C-3;
       ``(C) facilitate and accelerate, as applicable, advanced 
     research and development of security countermeasures (as 
     defined in section 319F-2), qualified countermeasures (as 
     defined in section 319F-1), or qualified pandemic or epidemic 
     products (as defined in section 319F-3), that are applicable 
     to the public health emergency or potential public health 
     emergency under paragraph (1);
       ``(D) strengthen biosurveillance capabilities and 
     laboratory capacity to identify, collect, and analyze 
     information regarding such public health emergency or 
     potential public health emergency, including the systems 
     under section 319D;
       ``(E) support initial emergency operations and assets 
     related to preparation and deployment of intermittent 
     disaster response personnel under section 2812 and the 
     Medical Reserve Corps under section 2813; and
       ``(F) carry out other activities, as the Secretary 
     determines applicable and appropriate.''; and
       (D) by inserting after paragraph (3), as so redesignated, 
     the following:
       ``(4) Review.--Not later than 2 years after the date of 
     enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019, the Secretary, in 
     coordination with the Assistant Secretary for Preparedness 
     and Response, shall conduct a review of the Fund under this 
     section and provide recommendations to the Committee on 
     Health, Education, Labor, and Pensions and the Committee on 
     Appropriations of the Senate and the Committee on Energy and 
     Commerce and the Committee on Appropriations of the House of 
     Representatives on policies to improve such Fund for the uses 
     described in paragraph (2).
       ``(5) GAO report.--Not later than 4 years after the date of 
     enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019, the Comptroller General of 
     the United States shall--
       ``(A) conduct a review of the Fund under this section, 
     including its uses and the resources available in the Fund; 
     and
       ``(B) submit to the Committee on Health, Education, Labor, 
     and Pensions of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives a report on such 
     review, including recommendations related to such review, as 
     applicable.''; and
       (2) in subsection (c)--
       (A) by inserting ``rapidly respond to public health 
     emergencies or potential public health emergencies and'' 
     after ``used to''; and
       (B) by striking ``section.'' and inserting ``Act or funds 
     otherwise provided for emergency response.''.

     SEC. 207. IMPROVING ALL-HAZARDS PREPAREDNESS AND RESPONSE BY 
                   PUBLIC HEALTH EMERGENCY VOLUNTEERS.

       (a) In General.--Section 319I (42 U.S.C. 247d-7b) is 
     amended--
       (1) in the section heading, by striking ``health 
     professions volunteers'' and inserting ``volunteer health 
     professional'';
       (2) in subsection (a), by adding at the end the following: 
     ``Such health care professionals may include members of the 
     National Disaster Medical System, members of the Medical 
     Reserve Corps, and individual health care professionals.'';
       (3) in subsection (i), by adding at the end the following: 
     ``In order to inform the development of such mechanisms by 
     States, the Secretary shall make available information and 
     material provided by States that have developed mechanisms to 
     waive the application of licensing requirements to applicable 
     health professionals seeking to provide medical services 
     during a public health emergency. Such information shall be 
     made publicly available in a manner that does not compromise 
     national security.''; and
       (4) in subsection (k), by striking ``2014 through 2018'' 
     and inserting ``2019 through 2023''.
       (b) All-Hazards Public Health Emergency Preparedness and 
     Response Plan.--Section 319C-1(b)(2)(A)(iv) (42 U.S.C. 247d-
     3a(b)(2)(A)(iv)) is amended to read as follows:
       ``(iv) a description of the mechanism the entity will 
     implement to utilize the Emergency Management Assistance 
     Compact, or other mutual aid agreement, for medical and 
     public health mutual aid, and, as appropriate, the activities 
     such entity will implement pursuant to section 319I to 
     improve enrollment and coordination of volunteer health care 
     professionals seeking to provide medical services during a 
     public health emergency, which may include--
       ``(I) providing a public method of communication for 
     purposes of volunteer coordination (such as a phone number);
       ``(II) providing for optional registration to participate 
     in volunteer services during processes related to State 
     medical licensing, registration, or certification or renewal 
     of such licensing, registration, or certification; or

[[Page H4252]]

       ``(III) other mechanisms as the State determines 
     appropriate;''.

     SEC. 208. CLARIFYING STATE LIABILITY LAW FOR VOLUNTEER HEALTH 
                   CARE PROFESSIONALS.

       (a) In General.--Title II (42 U.S.C. 202 et seq.) is 
     amended by inserting after section 224 the following:

     ``SEC. 225. HEALTH CARE PROFESSIONALS ASSISTING DURING A 
                   PUBLIC HEALTH EMERGENCY.

       ``(a) Limitation on Liability.--Notwithstanding any other 
     provision of law, a health care professional who is a member 
     of the Medical Reserve Corps under section 2813 or who is 
     included in the Emergency System for Advance Registration of 
     Volunteer Health Professionals under section 319I and who--
       ``(1) is responding--
       ``(A) to a public health emergency determined under section 
     319(a), during the initial period of not more than 90 days 
     (as determined by the Secretary) of the public health 
     emergency determination (excluding any period covered by a 
     renewal of such determination); or
       ``(B) to a major disaster or an emergency as declared by 
     the President under section 401 of the Robert T. Stafford 
     Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170) 
     or under section 201 of the National Emergencies Act (50 
     U.S.C. 1621) during the initial period of such declaration;
       ``(2) is alleged to be liable for an act or omission--
       ``(A) during the initial period of a determination or 
     declaration described in paragraph (1) and related to the 
     treatment of individuals in need of health care services due 
     to such public health emergency, major disaster, or 
     emergency;
       ``(B) in the State or States for which such determination 
     or declaration is made;
       ``(C) in the health care professional's capacity as a 
     member of the Medical Reserve Corps or a professional 
     included in the Emergency System for Advance Registration of 
     Volunteer Health Professionals under section 319I; and
       ``(D) in the course of providing services that are within 
     the scope of the license, registration, or certification of 
     the professional, as defined by the State of licensure, 
     registration, or certification; and
       ``(3) prior to the rendering of such act or omission, was 
     authorized by the State's authorization of deploying such 
     State's Emergency System for Advance Registration of 
     Volunteer Health Professionals described in section 319I or 
     the Medical Reserve Corps established under section 2813, to 
     provide health care services,

     shall be subject only to the State liability laws of the 
     State in which such act or omission occurred, in the same 
     manner and to the same extent as a similar health care 
     professional who is a resident of such State would be subject 
     to such State laws, except with respect to the licensure, 
     registration, and certification of such individual.
       ``(b) Volunteer Protection Act.--Nothing in this section 
     shall be construed to affect an individual's right to 
     protections under the Volunteer Protection Act of 1997.
       ``(c) Preemption.--This section shall supersede the laws of 
     any State that would subject a health care professional 
     described in subsection (a) to the liability laws of any 
     State other than the State liability laws to which such 
     individual is subject pursuant to such subsection.
       ``(d) Definitions.--In this section:
       ``(1) The term `health care professional' means an 
     individual licensed, registered, or certified under Federal 
     or State laws or regulations to provide health care services.
       ``(2) The term `health care services' means any services 
     provided by a health care professional, or by any individual 
     working under the supervision of a health care professional, 
     that relate to--
       ``(A) the diagnosis, prevention, or treatment of any human 
     disease or impairment; or
       ``(B) the assessment or care of the health of human beings.
       ``(e) Effective Date.--
       ``(1) In general.--This section shall take effect 90 days 
     after the date of the enactment of the Pandemic and All-
     Hazards Preparedness and Advancing Innovation Act of 2019.
       ``(2) Application.--This section shall apply to a claim for 
     harm only if the act or omission that caused such harm 
     occurred on or after the effective date described in 
     paragraph (1).''.
       (b) GAO Study.--Not later than one year after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall conduct a review of--
       (1) the number of health care providers who register under 
     the Emergency System for Advance Registration of Volunteer 
     Health Professionals under section 319I of the Public Health 
     Service Act (42 U.S.C. 247d-7b) in advance to provide 
     services during a public health emergency;
       (2) the number of health care providers who are 
     credentialed to provide services during the period of a 
     public health emergency declaration, including those who are 
     credentialed though programs established in the Emergency 
     System for Advance Registration of Volunteer Health 
     Professionals under such section 319I and those credentialed 
     by authorities within the State in which the emergency 
     occurred;
       (3) the average time to verify the credentials of a health 
     care provider during the period of a public health emergency 
     declaration, including the average time pursuant to the 
     Emergency System for Advance Registration of Volunteer Health 
     Professionals under such section 319I and for an individual's 
     credentials to be verified by an authority within the State; 
     and
       (4) the Emergency System for Advance Registration of 
     Volunteer Health Professionals program in States, including 
     whether physician or medical groups, associations, or other 
     relevant provider organizations utilize such program for 
     purposes of volunteering during public health emergencies.

     SEC. 209. REPORT ON ADEQUATE NATIONAL BLOOD SUPPLY.

       Not later than 1 year after the date of the enactment of 
     this Act, the Secretary of Health and Human Services shall 
     submit to Congress a report containing recommendations 
     related to maintaining an adequate national blood supply, 
     including--
       (1) challenges associated with the continuous recruitment 
     of blood donors (including those newly eligible to donate);
       (2) ensuring the adequacy of the blood supply in the case 
     of public health emergencies;
       (3) implementation of the transfusion transmission 
     monitoring system; and
       (4) other measures to promote safety and innovation, such 
     as the development, use, or implementation of new 
     technologies, processes, and procedures to improve the safety 
     and reliability of the blood supply.

     SEC. 210. REPORT ON THE PUBLIC HEALTH PREPAREDNESS AND 
                   RESPONSE CAPABILITIES AND CAPACITIES OF 
                   HOSPITALS, LONG-TERM CARE FACILITIES, AND OTHER 
                   HEALTH CARE FACILITIES.

       (a) Study.--
       (1) In general.--Not later than one year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall enter into an agreement with an appropriate 
     entity to conduct a study regarding the public health 
     preparedness and response capabilities and medical surge 
     capacities of hospitals, long-term care facilities, and other 
     health care facilities to prepare for, and respond to, public 
     health emergencies, including natural disasters.
       (2) Consultation.--In conducting the study under paragraph 
     (1), the entity shall consult with Federal, State, local, 
     Tribal, and territorial public health officials (as 
     appropriate), and health care providers and facilities with 
     experience in public health preparedness and response 
     activities.
       (3) Evaluation.--The study under paragraph (1) shall 
     include--
       (A) an evaluation of the current benchmarks and objective 
     standards, as applicable, related to programs that support 
     hospitals, long-term care facilities, and other health care 
     facilities, and their effect on improving public health 
     preparedness and response capabilities and medical surge 
     capacities, including the Hospital Preparedness Program, the 
     Public Health Emergency Preparedness cooperative agreements, 
     and the Regional Health Care Emergency Preparedness and 
     Response Systems under section 319C-3 of the Public Health 
     Service Act (as added by section 203);
       (B) the identification of gaps in preparedness, including 
     with respect to such benchmarks and objective standards, such 
     as those identified during recent public health emergencies, 
     for hospitals, long-term care facilities, and other health 
     care facilities to address future potential public health 
     threats;
       (C) an evaluation of coordination efforts between the 
     recipients of Federal funding for programs described in 
     subparagraph (A) and entities with expertise in emergency 
     power systems and other critical infrastructure partners 
     during a public health emergency, to ensure a functioning 
     critical infrastructure, to the greatest extent practicable, 
     during a public health emergency;
       (D) an evaluation of coordination efforts between the 
     recipients of Federal funding for programs described in 
     subparagraph (A) and environmental health agencies with 
     expertise in emergency preparedness and response planning for 
     hospitals, long-term care facilities, and other health care 
     facilities; and
       (E) an evaluation of current public health preparedness and 
     response capabilities and medical surge capacities related to 
     at-risk individuals during public health emergencies, 
     including an identification of gaps in such preparedness as 
     they relate to such individuals.
       (b) Report.--
       (1) In general.--The agreement under subsection (a) shall 
     require the entity to submit to the Secretary of Health and 
     Human Services and the congressional committees of 
     jurisdiction, not later than 3 years after the date of 
     enactment of this Act, a report on the results of the study 
     conducted pursuant to this section.
       (2) Contents.--The report under paragraph (1) shall--
       (A) describe the findings and conclusions of the evaluation 
     conducted pursuant to subsection (a); and
       (B) provide recommendations for improving public health 
     preparedness and response capability and medical surge 
     capacity for hospitals, long-term care facilities, and other 
     health care facilities, including--
       (i) improving the existing benchmarks and objective 
     standards for the Federal grant programs described in 
     subsection (a)(3)(A) or developing new benchmarks and 
     standards for such programs; and
       (ii) identifying best practices for improving public health 
     preparedness and response programs and medical surge capacity 
     at hospitals, long-term care facilities, and other

[[Page H4253]]

     health care facilities, including recommendations for the 
     evaluation under subparagraphs (C) and (D) of subsection 
     (a)(3).

                  TITLE III--REACHING ALL COMMUNITIES

     SEC. 301. STRENGTHENING AND ASSESSING THE EMERGENCY RESPONSE 
                   WORKFORCE.

       (a) National Disaster Medical System.--
       (1) Strengthening the national disaster medical system.--
     Clause (ii) of section 2812(a)(3)(A) (42 U.S.C. 300hh-
     11(a)(3)(A)) is amended to read as follows:
       ``(ii) be present at locations, and for limited periods of 
     time, specified by the Secretary on the basis that the 
     Secretary has determined that a location is at risk of a 
     public health emergency during the time specified, or there 
     is a significant potential for a public health emergency.''.
       (2) Review of the national disaster medical system.--
     Section 2812(b)(2) (42 U.S.C. 300hh-11(b)(2)) is amended to 
     read as follows:
       ``(2) Joint review and medical surge capacity strategic 
     plan.--
       ``(A) Review.--Not later than 180 days after the date of 
     enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019, the Secretary, in 
     coordination with the Secretary of Homeland Security, the 
     Secretary of Defense, and the Secretary of Veterans Affairs, 
     shall conduct a joint review of the National Disaster Medical 
     System. Such review shall include--
       ``(i) an evaluation of medical surge capacity, as described 
     in section 2803(a);
       ``(ii) an assessment of the available workforce of the 
     intermittent disaster response personnel described in 
     subsection (c);
       ``(iii) the capacity of the workforce described in clause 
     (ii) to respond to all hazards, including capacity to 
     simultaneously respond to multiple public health emergencies 
     and the capacity to respond to a nationwide public health 
     emergency;
       ``(iv) the effectiveness of efforts to recruit, retain, and 
     train such workforce; and
       ``(v) gaps that may exist in such workforce and 
     recommendations for addressing such gaps.
       ``(B) Updates.--As part of the National Health Security 
     Strategy under section 2802, the Secretary shall update the 
     findings from the review under subparagraph (A) and provide 
     recommendations to modify the policies of the National 
     Disaster Medical System as necessary.''.
       (3) Notification of shortage.--Section 2812(c) (42 U.S.C. 
     300hh-11(c)) is amended by adding at the end the following:
       ``(3) Notification.--Not later than 30 days after the date 
     on which the Secretary determines the number of intermittent 
     disaster-response personnel of the National Disaster Medical 
     System is insufficient to address a public health emergency 
     or potential public health emergency, the Secretary shall 
     submit to the congressional committees of jurisdiction a 
     notification detailing--
       ``(A) the impact such shortage could have on meeting public 
     health needs and emergency medical personnel needs during a 
     public health emergency; and
       ``(B) any identified measures to address such shortage.
       ``(4) Certain appointments.--
       ``(A) In general.--If the Secretary determines that the 
     number of intermittent disaster response personnel within the 
     National Disaster Medical System under this section is 
     insufficient to address a public health emergency or 
     potential public health emergency, the Secretary may appoint 
     candidates directly to personnel positions for intermittent 
     disaster response within such system. The Secretary shall 
     provide updates on the number of vacant or unfilled positions 
     within such system to the congressional committees of 
     jurisdiction each quarter for which this authority is in 
     effect.
       ``(B) Sunset.--The authority under this paragraph shall 
     expire on September 30, 2021.''.
       (4) Authorization of appropriations.--Section 2812(g) (42 
     U.S.C. 300hh-11(g)) is amended by striking ``$52,700,000 for 
     each of fiscal years 2014 through 2018'' and inserting 
     ``$57,400,000 for each of fiscal years 2019 through 2023''.
       (b) Volunteer Medical Reserve Corps.--
       (1) In general.--Section 2813(a) (42 U.S.C. 42 U.S.C. 
     300hh-15(a)) is amended by striking the second sentence and 
     inserting ``The Secretary may appoint a Director to head the 
     Corps and oversee the activities of the Corps chapters that 
     exist at the State, local, Tribal, and territorial levels.''.
       (2) Authorization of appropriations.--Section 2813(i) (42 
     U.S.C. 300hh-15(i)) is amended by striking ``2014 through 
     2018'' and inserting ``2019 through 2023''.
       (c) Strengthening the Epidemic Intelligence Service.--
     Section 317F (42 U.S.C. Sec. 247b-7) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1)--
       (i) by inserting ``or preparedness and response activities, 
     including rapid response to public health emergencies and 
     significant public health threats'' after ``conduct 
     prevention activities''; and
       (ii) by striking ``$35,000'' and inserting ``$50,000''; and
       (B) in paragraph (2)(B), by striking ``3 years'' and 
     inserting ``2 years''; and
       (2) in subsection (c)--
       (A) by striking ``For the purpose of carrying out this 
     section'' and inserting the following:
       ``(1) In general.--For the purpose of carrying out this 
     section, except as described in paragraph (2)''; and
       (B) by adding at the end the following:
       ``(2) Epidemic intelligence service program.--For purposes 
     of carrying out this section with respect to qualified health 
     professionals serving in the Epidemic Intelligence Service, 
     as authorized under section 317G, there is authorized to be 
     appropriated $1,000,000 for each of fiscal years 2019 through 
     2023.''.
       (d) Service Benefit for National Disaster Medical System 
     Volunteers.--
       (1) In general.--Section 2812(c) (42 U.S.C. 300hh-11(c)), 
     as amended by subsection (a)(3), is further amended by adding 
     at the end the following:
       ``(5) Service benefit.--Individuals appointed to serve 
     under this subsection shall be considered eligible for 
     benefits under part L of title I of the Omnibus Crime Control 
     and Safe Streets Act of 1968. The Secretary shall provide 
     notification to any eligible individual of any effect such 
     designation may have on other benefits for which such 
     individual is eligible, including benefits from private 
     entities.''.
       (2) Public safety officer benefits.--Section 1204(9) of 
     title I of the Omnibus Crime Control and Safe Streets Act of 
     1968 (34 U.S.C. 10284(9)) is amended--
       (A) in subparagraph (C)(ii), by striking ``or'' at the end;
       (B) in subparagraph (D), by striking the period and 
     inserting ``; or''; and
       (C) by inserting after subparagraph (D) the following:
       ``(E) an individual appointed to the National Disaster 
     Medical System under section 2812 of the Public Health 
     Service Act (42 U.S.C. 300hh-11) who is performing official 
     duties of the Department of Health and Human Services, if 
     those official duties are--
       ``(i) related to responding to a public health emergency or 
     potential public health emergency, or other activities for 
     which the Secretary of Health and Human Services has 
     activated such National Disaster Medical System; and
       ``(ii) determined by the Secretary of Health and Human 
     Services to be hazardous.''.
       (3) Sunset.--The amendments made by paragraphs (1) and (2) 
     shall cease to have force or effect on October 1, 2021.
       (e) Mission Readiness Report to Congress.--
       (1) Report.--Not later than one year after the date of 
     enactment of this section, the Comptroller General of the 
     United States (referred to in this subsection as the 
     ``Comptroller General'') shall submit to the Committee on 
     Health, Education, Labor, and Pensions of the Senate and the 
     Committee on Energy and Commerce of the House of 
     Representatives, a report on the medical surge capacity of 
     the United States in the event of a public health emergency, 
     including the capacity and capability of the current health 
     care workforce to prepare for, and respond to, the full range 
     of public health emergencies or potential public health 
     emergencies, and recommendations to address any gaps 
     identified in such workforce.
       (2) Contents.--The Comptroller General shall include in the 
     report under paragraph (1)--
       (A) the number of health care providers who have 
     volunteered to provide health care services during a public 
     health emergency, including members of the National Disaster 
     Medical System, the Disaster Medical Assistant Teams, the 
     Medical Reserve Corps, and other volunteer health care 
     professionals in the verification network pursuant to section 
     319I of the Public Health Service Act (42 U.S.C. 247d-7b);
       (B) the capacity of the workforce described in subparagraph 
     (A) to respond to a public health emergency or potential 
     public health emergency, including the capacity to respond to 
     multiple concurrent public health emergencies and the 
     capacity to respond to a nationwide public health emergency;
       (C) the preparedness and response capabilities and mission 
     readiness of the workforce described in subparagraph (A) 
     taking into account areas of health care expertise and 
     considerations for at-risk individuals (as defined in section 
     2802(b)(4)(B) of the Public Health Service Act (42 U.S.C. 
     300hh-1(b)(4)(B)));
       (D) an assessment of the effectiveness of efforts to 
     recruit, retain, and train such workforce; and
       (E) identification of gaps that may exist in such workforce 
     and recommendations for addressing such gaps, the extent to 
     which the Assistant Secretary for Preparedness and Response 
     plans to address such gaps, and any recommendations from the 
     Comptroller General to address such gaps.

     SEC. 302. HEALTH SYSTEM INFRASTRUCTURE TO IMPROVE 
                   PREPAREDNESS AND RESPONSE.

       (a) Coordination of Preparedness.--Section 2811(b)(5) (42 
     U.S.C. 300hh-10(b)(5)) is amended by adding at the end the 
     following: ``Such logistical support shall include working 
     with other relevant Federal, State, local, Tribal, and 
     territorial public health officials and private sector 
     entities to identify the critical infrastructure assets, 
     systems, and networks needed for the proper functioning of 
     the health care and public health sectors that need to be 
     maintained through any emergency or disaster, including 
     entities capable of assisting with, responding to, and 
     mitigating the effect of a public health emergency, including 
     a public health emergency determined by the Secretary 
     pursuant to section 319(a) or an emergency or major disaster 
     declared by the President under the

[[Page H4254]]

     Robert T. Stafford Disaster Relief and Emergency Assistance 
     Act or the National Emergencies Act, including by 
     establishing methods to exchange critical information and 
     deliver products consumed or used to preserve, protect, or 
     sustain life, health, or safety, and sharing of specialized 
     expertise.''.
       (b) Manufacturing Capacity.--Section 2811(d)(2)(C) (42 
     U.S.C. 300hh-10(d)(2)(C)) is amended by inserting ``, and 
     ancillary medical supplies to assist with the utilization of 
     such countermeasures or products,'' after ``products''.
       (c) Evaluation of Barriers to Rapid Delivery of Medical 
     Countermeasures.--
       (1) Rapid delivery study.--The Assistant Secretary for 
     Preparedness and Response may conduct a study on issues that 
     have the potential to adversely affect the handling and rapid 
     delivery of medical countermeasures to individuals during 
     public health emergencies occurring in the United States.
       (2) Notice to congress.--Not later than 9 months after the 
     date of the enactment of this Act, the Assistant Secretary 
     for Preparedness and Response shall notify the Committee on 
     Energy and Commerce of the House of Representatives and the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate if the Assistant Secretary for Preparedness and 
     Response does not plan to conduct the study under paragraph 
     (1) and shall provide such committees a summary explanation 
     for such decision.
       (3) Report to congress.--Not later than 1 year after the 
     Assistant Secretary for Preparedness and Response conducts 
     the study under paragraph (1), such Assistant Secretary shall 
     submit a report to the Committee on Energy and Commerce of 
     the House of Representatives and the Committee on Health, 
     Education, Labor, and Pensions of the Senate containing the 
     findings of such study.

     SEC. 303. CONSIDERATIONS FOR AT-RISK INDIVIDUALS.

       (a) At-Risk Individuals in the National Health Security 
     Strategy.--Section 2802(b)(4)(B) (42 U.S.C. 300hh-1(b)(4)(B)) 
     is amended--
       (1) by striking ``this section and sections 319C-1, 319F, 
     and 319L,'' and inserting ``this Act,''; and
       (2) by striking ``special'' and inserting ``access or 
     functional''.
       (b) Countermeasure Considerations.--Section 319L(c)(6) (42 
     U.S.C. 247d-7e(c)(6)) is amended--
       (1) by striking ``elderly'' and inserting ``older adults''; 
     and
       (2) by inserting ``with relevant characteristics that 
     warrant consideration during the process of researching and 
     developing such countermeasures and products'' before the 
     period.
       (c) Biosurveillance of Emerging Public Health Threats.--
     Section 2814 is amended--
       (1) in paragraph (7), by striking ``; and'' and inserting a 
     semicolon;
       (2) in paragraph (8), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(9) facilitate coordination to ensure that, in 
     implementing the situational awareness and biosurveillance 
     network under section 319D, the Secretary considers 
     incorporating data and information from Federal, State, 
     local, Tribal, and territorial public health officials and 
     entities relevant to detecting emerging public health threats 
     that may affect at-risk individuals, such as pregnant and 
     postpartum women and infants, including adverse health 
     outcomes of such populations related to such emerging public 
     health threats.''.

     SEC. 304. IMPROVING EMERGENCY PREPAREDNESS AND RESPONSE 
                   CONSIDERATIONS FOR CHILDREN.

       Part B of title III (42 U.S.C. 243 et seq.) is amended by 
     inserting after section 319D the following:

     ``SEC. 319D-1. CHILDREN'S PREPAREDNESS UNIT.

       ``(a) Enhancing Emergency Preparedness for Children.--The 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention (referred to in this 
     subsection as the `Director'), shall maintain an internal 
     team of experts, to be known as the Children's Preparedness 
     Unit (referred to in this subsection as the `Unit'), to work 
     collaboratively to provide guidance on the considerations 
     for, and the specific needs of, children before, during, and 
     after public health emergencies. The Unit shall inform the 
     Director regarding emergency preparedness and response 
     efforts pertaining to children at the Centers for Disease 
     Control and Prevention.
       ``(b) Expertise.--The team described in subsection (a) 
     shall include one or more pediatricians, which may be a 
     developmental-behavioral pediatrician, and may also include 
     behavioral scientists, child psychologists, epidemiologists, 
     biostatisticians, health communications staff, and 
     individuals with other areas of expertise, as the Secretary 
     determines appropriate.
       ``(c) Duties.--The team described in subsection (a) may--
       ``(1) assist State, local, Tribal, and territorial 
     emergency planning and response activities related to 
     children, which may include developing, identifying, and 
     sharing best practices;
       ``(2) provide technical assistance, training, and 
     consultation to Federal, State, local, Tribal, and 
     territorial public health officials to improve preparedness 
     and response capabilities with respect to the needs of 
     children, including providing such technical assistance, 
     training, and consultation to eligible entities in order to 
     support the achievement of measurable evidence-based 
     benchmarks and objective standards applicable to sections 
     319C-1 and 319C-2;
       ``(3) improve the utilization of methods to incorporate the 
     needs of children in planning for and responding to a public 
     health emergency, including public awareness of such methods;
       ``(4) coordinate with, and improve, public-private 
     partnerships, such as health care coalitions pursuant to 
     sections 319C-2 and 319C-3, to address gaps and 
     inefficiencies in emergency preparedness and response efforts 
     for children;
       ``(5) provide expertise and input during the development of 
     guidance and clinical recommendations to address the needs of 
     children when preparing for, and responding to, public health 
     emergencies, including pursuant to section 319C-3; and
       ``(6) carry out other duties related to preparedness and 
     response activities for children, as the Secretary determines 
     appropriate.''.

     SEC. 305. NATIONAL ADVISORY COMMITTEES ON DISASTERS.

       (a) Reauthorizing the National Advisory Committee on 
     Children and Disasters.--Section 2811A (42 U.S.C. 300hh-10a) 
     is amended--
       (1) in subsection (b)(2), by inserting ``, mental and 
     behavioral,'' after ``medical'';
       (2) in subsection (d)--
       (A) in paragraph (1), by striking ``15'' and inserting 
     ``25''; and
       (B) by striking paragraph (2) and inserting the following:
       ``(2) Required non-federal members.--The Secretary, in 
     consultation with such other heads of Federal agencies as may 
     be appropriate, shall appoint to the Advisory Committee under 
     paragraph (1) at least 13 individuals, including--
       ``(A) at least 2 non-Federal professionals with expertise 
     in pediatric medical disaster planning, preparedness, 
     response, or recovery;
       ``(B) at least 2 representatives from State, local, Tribal, 
     or territorial agencies with expertise in pediatric disaster 
     planning, preparedness, response, or recovery;
       ``(C) at least 4 members representing health care 
     professionals, which may include members with expertise in 
     pediatric emergency medicine; pediatric trauma, critical 
     care, or surgery; the treatment of pediatric patients 
     affected by chemical, biological, radiological, or nuclear 
     agents, including emerging infectious diseases; pediatric 
     mental or behavioral health related to children affected by a 
     public health emergency; or pediatric primary care; and
       ``(D) other members as the Secretary determines 
     appropriate, of whom--
       ``(i) at least one such member shall represent a children's 
     hospital;
       ``(ii) at least one such member shall be an individual with 
     expertise in schools or child care settings;
       ``(iii) at least one such member shall be an individual 
     with expertise in children and youth with special health care 
     needs; and
       ``(iv) at least one such member shall be an individual with 
     expertise in the needs of parents or family caregivers, 
     including the parents or caregivers of children with 
     disabilities.
       ``(3) Federal members.--The Advisory Committee under 
     paragraph (1) shall include the following Federal members or 
     their designees (who may be nonvoting members, as determined 
     by the Secretary):
       ``(A) The Assistant Secretary for Preparedness and 
     Response.
       ``(B) The Director of the Biomedical Advanced Research and 
     Development Authority.
       ``(C) The Director of the Centers for Disease Control and 
     Prevention.
       ``(D) The Commissioner of Food and Drugs.
       ``(E) The Director of the National Institutes of Health.
       ``(F) The Assistant Secretary of the Administration for 
     Children and Families.
       ``(G) The Administrator of the Health Resources and 
     Services Administration.
       ``(H) The Administrator of the Federal Emergency Management 
     Agency.
       ``(I) The Administrator of the Administration for Community 
     Living.
       ``(J) The Secretary of Education.
       ``(K) Representatives from such Federal agencies (such as 
     the Substance Abuse and Mental Health Services Administration 
     and the Department of Homeland Security) as the Secretary 
     determines appropriate to fulfill the duties of the Advisory 
     Committee under subsections (b) and (c).
       ``(4) Term of appointment.--Each member of the Advisory 
     Committee appointed under paragraph (2) shall serve for a 
     term of 3 years, except that the Secretary may adjust the 
     terms of the Advisory Committee appointees serving on the 
     date of enactment of the Pandemic and All-Hazards 
     Preparedness and Advancing Innovation Act of 2019, or 
     appointees who are initially appointed after such date of 
     enactment, in order to provide for a staggered term of 
     appointment for all members.
       ``(5) Consecutive appointments; maximum terms.--A member 
     appointed under paragraph (2) may serve not more than 3 terms 
     on the Advisory Committee, and not more than two of such 
     terms may be served consecutively.'';
       (3) in subsection (e), by adding at the end ``At least one 
     meeting per year shall be an in-person meeting.'';

[[Page H4255]]

       (4) by redesignating subsection (f) as subsection (g);
       (5) by inserting after subsection (e) the following:
       ``(f) Coordination.--The Secretary shall coordinate duties 
     and activities authorized under this section in accordance 
     with section 2811D.''; and
       (6) in subsection (g), as so redesignated, by striking 
     ``2018'' and inserting ``2023''.
       (b) Authorizing the National Advisory Committee on Seniors 
     and Disasters.--Subtitle B of title XXVIII (42 U.S.C. 300hh 
     et seq.) is amended by inserting after section 2811A the 
     following:

     ``SEC. 2811B. NATIONAL ADVISORY COMMITTEE ON SENIORS AND 
                   DISASTERS.

       ``(a) Establishment.--The Secretary, in consultation with 
     the Secretary of Homeland Security and the Secretary of 
     Veterans Affairs, shall establish an advisory committee to be 
     known as the National Advisory Committee on Seniors and 
     Disasters (referred to in this section as the `Advisory 
     Committee').
       ``(b) Duties.--The Advisory Committee shall--
       ``(1) provide advice and consultation with respect to the 
     activities carried out pursuant to section 2814, as 
     applicable and appropriate;
       ``(2) evaluate and provide input with respect to the 
     medical and public health needs of seniors related to 
     preparation for, response to, and recovery from all-hazards 
     emergencies; and
       ``(3) provide advice and consultation with respect to State 
     emergency preparedness and response activities relating to 
     seniors, including related drills and exercises pursuant to 
     the preparedness goals under section 2802(b).
       ``(c) Additional Duties.--The Advisory Committee may 
     provide advice and recommendations to the Secretary with 
     respect to seniors and the medical and public health grants 
     and cooperative agreements as applicable to preparedness and 
     response activities under this title and title III.
       ``(d) Membership.--
       ``(1) In general.--The Secretary, in consultation with such 
     other heads of agencies as appropriate, shall appoint not 
     more than 17 members to the Advisory Committee. In appointing 
     such members, the Secretary shall ensure that the total 
     membership of the Advisory Committee is an odd number.
       ``(2) Required members.--The Advisory Committee shall 
     include Federal members or their designees (who may be 
     nonvoting members, as determined by the Secretary) and non-
     Federal members, as follows:
       ``(A) The Assistant Secretary for Preparedness and 
     Response.
       ``(B) The Director of the Biomedical Advanced Research and 
     Development Authority.
       ``(C) The Director of the Centers for Disease Control and 
     Prevention.
       ``(D) The Commissioner of Food and Drugs.
       ``(E) The Director of the National Institutes of Health.
       ``(F) The Administrator of the Centers for Medicare & 
     Medicaid Services.
       ``(G) The Administrator of the Administration for Community 
     Living.
       ``(H) The Administrator of the Federal Emergency Management 
     Agency.
       ``(I) The Under Secretary for Health of the Department of 
     Veterans Affairs.
       ``(J) At least 2 non-Federal health care professionals with 
     expertise in geriatric medical disaster planning, 
     preparedness, response, or recovery.
       ``(K) At least 2 representatives of State, local, Tribal, 
     or territorial agencies with expertise in geriatric disaster 
     planning, preparedness, response, or recovery.
       ``(L) Representatives of such other Federal agencies (such 
     as the Department of Energy and the Department of Homeland 
     Security) as the Secretary determines necessary to fulfill 
     the duties of the Advisory Committee.
       ``(e) Meetings.--The Advisory Committee shall meet not less 
     frequently than biannually. At least one meeting per year 
     shall be an in-person meeting.
       ``(f) Coordination.--The Secretary shall coordinate duties 
     and activities authorized under this section in accordance 
     with section 2811D.
       ``(g) Sunset.--
       ``(1) In general.--The Advisory Committee shall terminate 
     on September 30, 2023.
       ``(2) Extension of committee.--Not later than October 1, 
     2022, the Secretary shall submit to Congress a recommendation 
     on whether the Advisory Committee should be extended.''.
       (c) National Advisory Committee on Individuals With 
     Disabilities and Disasters.--Subtitle B of title XXVIII (42 
     U.S.C. 300hh et seq.), as amended by subsection (b), is 
     further amended by inserting after section 2811B the 
     following:

     ``SEC. 2811C. NATIONAL ADVISORY COMMITTEE ON INDIVIDUALS WITH 
                   DISABILITIES AND DISASTERS.

       ``(a) Establishment.--The Secretary, in consultation with 
     the Secretary of Homeland Security, shall establish a 
     national advisory committee to be known as the National 
     Advisory Committee on Individuals with Disabilities and 
     Disasters (referred to in this section as the `Advisory 
     Committee').
       ``(b) Duties.--The Advisory Committee shall--
       ``(1) provide advice and consultation with respect to 
     activities carried out pursuant to section 2814, as 
     applicable and appropriate;
       ``(2) evaluate and provide input with respect to the 
     medical, public health, and accessibility needs of 
     individuals with disabilities related to preparation for, 
     response to, and recovery from all-hazards emergencies; and
       ``(3) provide advice and consultation with respect to State 
     emergency preparedness and response activities, including 
     related drills and exercises pursuant to the preparedness 
     goals under section 2802(b).
       ``(c) Membership.--
       ``(1) In general.--The Secretary, in consultation with such 
     other heads of agencies and departments as appropriate, shall 
     appoint not more than 17 members to the Advisory Committee. 
     In appointing such members, the Secretary shall ensure that 
     the total membership of the Advisory Committee is an odd 
     number.
       ``(2) Required members.--The Advisory Committee shall 
     include Federal members or their designees (who may be 
     nonvoting members, as determined by the Secretary) and non-
     Federal members, as follows:
       ``(A) The Assistant Secretary for Preparedness and 
     Response.
       ``(B) The Administrator of the Administration for Community 
     Living.
       ``(C) The Director of the Biomedical Advanced Research and 
     Development Authority.
       ``(D) The Director of the Centers for Disease Control and 
     Prevention.
       ``(E) The Commissioner of Food and Drugs.
       ``(F) The Director of the National Institutes of Health.
       ``(G) The Administrator of the Federal Emergency Management 
     Agency.
       ``(H) The Chair of the National Council on Disability.
       ``(I) The Chair of the United States Access Board.
       ``(J) The Under Secretary for Health of the Department of 
     Veterans Affairs.
       ``(K) At least 2 non-Federal health care professionals with 
     expertise in disability accessibility before, during, and 
     after disasters, medical and mass care disaster planning, 
     preparedness, response, or recovery.
       ``(L) At least 2 representatives from State, local, Tribal, 
     or territorial agencies with expertise in disaster planning, 
     preparedness, response, or recovery for individuals with 
     disabilities.
       ``(M) At least 2 individuals with a disability with 
     expertise in disaster planning, preparedness, response, or 
     recovery for individuals with disabilities.
       ``(d) Meetings.--The Advisory Committee shall meet not less 
     frequently than biannually. At least one meeting per year 
     shall be an in-person meeting.
       ``(e) Disability Defined.--For purposes of this section, 
     the term `disability' has the meaning given such term in 
     section 3 of the Americans with Disabilities Act of 1990.
       ``(f) Coordination.--The Secretary shall coordinate duties 
     and activities authorized under this section in accordance 
     with section 2811D.
       ``(g) Sunset.--
       ``(1) In general.--The Advisory Committee shall terminate 
     on September 30, 2023.
       ``(2) Recommendation.--Not later than October 1, 2022, the 
     Secretary shall submit to Congress a recommendation on 
     whether the Advisory Committee should be extended.''.
       (d) Advisory Committee Coordination.--Subtitle B of title 
     XXVIII (42 U.S.C. 300hh et seq.), as amended by subsection 
     (c), is further amended by inserting after section 2811C the 
     following:

     ``SEC. 2811D. ADVISORY COMMITTEE COORDINATION.

       ``(a) In General.--The Secretary shall coordinate duties 
     and activities authorized under sections 2811A, 2811B, and 
     2811C, and make efforts to reduce unnecessary or duplicative 
     reporting, or unnecessary duplicative meetings and 
     recommendations under such sections, as practicable. Members 
     of the advisory committees authorized under such sections, or 
     their designees, shall annually meet to coordinate any 
     recommendations, as appropriate, that may be similar, 
     duplicative, or overlapping with respect to addressing the 
     needs of children, seniors, and individuals with disabilities 
     during public health emergencies. If such coordination occurs 
     through an in-person meeting, it shall not be considered the 
     required in-person meetings under any of sections 2811A(e), 
     2811B(e), or 2811C(d).
       ``(b) Coordination and Alignment.--The Secretary, acting 
     through the employee designated pursuant to section 2814, 
     shall align preparedness and response programs or activities 
     to address similar, dual, or overlapping needs of children, 
     seniors, and individuals with disabilities, and any 
     challenges in preparing for and responding to such needs.
       ``(c) Notification.--The Secretary shall annually notify 
     the congressional committees of jurisdiction regarding the 
     steps taken to coordinate, as appropriate, the 
     recommendations under this section, and provide a summary 
     description of such coordination.''.

     SEC. 306. GUIDANCE FOR PARTICIPATION IN EXERCISES AND DRILLS.

       Not later than 2 years after the date of enactment of this 
     Act, the Secretary of Health and Human Services shall issue 
     final guidance regarding the ability of personnel funded by 
     programs authorized under this Act (including the amendments 
     made by this Act) to participate in drills and operational 
     exercises related to all-hazards medical and public health 
     preparedness and response. Such drills and operational 
     exercises may include activities that incorporate medical 
     surge capacity planning, medical countermeasure distribution 
     and administration, and preparing for and responding to 
     identified threats for that region. Such personnel

[[Page H4256]]

     may include State, local, Tribal, and territorial public 
     health department or agency personnel funded under this Act 
     (including the amendments made by this Act). The Secretary 
     shall consult with the Department of Homeland Security, the 
     Department of Defense, the Department of Veterans Affairs, 
     and other applicable Federal departments and agencies as 
     necessary and appropriate in the development of such 
     guidance. The Secretary shall make the guidance available on 
     the internet website of the Department of Health and Human 
     Services.

             TITLE IV--PRIORITIZING A THREAT-BASED APPROACH

     SEC. 401. ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE.

       Section 2811(b) (42 U.S.C. 300hh-10(b)) is amended--
       (1) in the matter preceding paragraph (1), by inserting 
     ``utilize experience related to public health emergency 
     preparedness and response, biodefense, medical 
     countermeasures, and other relevant topics to'' after 
     ``shall''; and
       (2) in paragraph (4), by adding at the end the following:
       ``(I) Threat awareness.--Coordinate with the Director of 
     the Centers for Disease Control and Prevention, the Director 
     of National Intelligence, the Secretary of Homeland Security, 
     the Assistant to the President for National Security Affairs, 
     the Secretary of Defense, and other relevant Federal 
     officials, such as the Secretary of Agriculture, to maintain 
     a current assessment of national security threats and inform 
     preparedness and response capabilities based on the range of 
     the threats that have the potential to result in a public 
     health emergency.''.

     SEC. 402. PUBLIC HEALTH EMERGENCY MEDICAL COUNTERMEASURES 
                   ENTERPRISE.

       (a) In General.--Title XXVIII is amended by inserting after 
     section 2811 (42 U.S.C. 300hh-10) the following:

     ``SEC. 2811-1. PUBLIC HEALTH EMERGENCY MEDICAL 
                   COUNTERMEASURES ENTERPRISE.

       ``(a) In General.--The Secretary shall establish the Public 
     Health Emergency Medical Countermeasures Enterprise (referred 
     to in this section as the `PHEMCE'). The Assistant Secretary 
     for Preparedness and Response shall serve as chair of the 
     PHEMCE.
       ``(b) Members.--The PHEMCE shall include each of the 
     following members, or the designee of such members:
       ``(1) The Assistant Secretary for Preparedness and 
     Response.
       ``(2) The Director of the Centers for Disease Control and 
     Prevention.
       ``(3) The Director of the National Institutes of Health.
       ``(4) The Commissioner of Food and Drugs.
       ``(5) The Secretary of Defense.
       ``(6) The Secretary of Homeland Security.
       ``(7) The Secretary of Agriculture.
       ``(8) The Secretary of Veterans Affairs.
       ``(9) The Director of National Intelligence.
       ``(10) Representatives of any other Federal agency, which 
     may include the Director of the Biomedical Advanced Research 
     and Development Authority, the Director of the Strategic 
     National Stockpile, the Director of the National Institute of 
     Allergy and Infectious Diseases, and the Director of the 
     Office of Public Health Preparedness and Response, as the 
     Secretary determines appropriate.
       ``(c) Functions.--
       ``(1) In general.--The functions of the PHEMCE shall 
     include the following:
       ``(A) Utilize a process to make recommendations to the 
     Secretary regarding research, advanced research, development, 
     procurement, stockpiling, deployment, distribution, and 
     utilization with respect to countermeasures, as defined in 
     section 319F-2(c), including prioritization based on the 
     health security needs of the United States. Such 
     recommendations shall be informed by, when available and 
     practicable, the National Health Security Strategy pursuant 
     to section 2802, the Strategic National Stockpile needs 
     pursuant to section 319F-2, and assessments of current 
     national security threats, including chemical, biological, 
     radiological, and nuclear threats, including emerging 
     infectious diseases. In the event that members of the PHEMCE 
     do not agree upon a recommendation, the Secretary shall 
     provide a determination regarding such recommendation.
       ``(B) Identify national health security needs, including 
     gaps in public health preparedness and response related to 
     countermeasures and challenges to addressing such needs 
     (including any regulatory challenges), and support alignment 
     of countermeasure procurement with recommendations to address 
     such needs under subparagraph (A).
       ``(C) Assist the Secretary in developing strategies related 
     to logistics, deployment, distribution, dispensing, and use 
     of countermeasures that may be applicable to the activities 
     of the strategic national stockpile under section 319F-2(a).
       ``(D) Provide consultation for the development of the 
     strategy and implementation plan under section 2811(d).
       ``(2) Input.--In carrying out subparagraphs (B) and (C) of 
     paragraph (1), the PHEMCE shall solicit and consider input 
     from State, local, Tribal, and territorial public health 
     departments or officials, as appropriate.''.
       (b) Public Health Emergency Medical Countermeasures 
     Enterprise Strategy and Implementation Plan.--Section 2811(d) 
     (42 U.S.C. 300hh-10(d)) is amended--
       (1) in paragraph (1)--
       (A) by striking ``Not later than 180 days after the date of 
     enactment of this subsection, and every year thereafter'' and 
     inserting ``Not later than March 15, 2020, and biennially 
     thereafter''; and
       (B) by striking ``Director of the Biomedical'' and all that 
     follows through ``Food and Drugs'' and inserting ``Public 
     Health Emergency Medical Countermeasures Enterprise 
     established under section 2811-1''; and
       (2) in paragraph (2)(J)(v), by striking ``one-year period'' 
     and inserting ``2-year period''.

     SEC. 403. STRATEGIC NATIONAL STOCKPILE.

       (a) In General.--Section 319F-2(a) (42 U.S.C. 247d-6b(a)) 
     is amended--
       (1) by redesignating paragraphs (2) and (3) as paragraphs 
     (3) and (4), respectively; and
       (2) in paragraph (1)--
       (A) by inserting ``the Assistant Secretary for Preparedness 
     and Response and'' after ``collaboration with'';
       (B) by inserting ``and optimize'' after ``provide for'';
       (C) by inserting ``and, as informed by existing 
     recommendations of, or consultations with, the Public Health 
     Emergency Medical Countermeasure Enterprise established under 
     section 2811-1, make necessary additions or modifications to 
     the contents of such stockpile or stockpiles based on the 
     review conducted under paragraph (2)'' before the period of 
     the first sentence; and
       (D) by striking the second sentence;
       (3) by inserting after paragraph (1) the following:
       ``(2) Threat-based review.--
       ``(A) In general.--The Secretary shall conduct an annual 
     threat-based review (taking into account at-risk individuals) 
     of the contents of the stockpile under paragraph (1), 
     including non-pharmaceutical supplies, and, in consultation 
     with the Public Health Emergency Medical Countermeasures 
     Enterprise established under section 2811-1, review contents 
     within the stockpile and assess whether such contents are 
     consistent with the recommendations made pursuant to section 
     2811-1(c)(1)(A). Such review shall be submitted on June 15, 
     2019, and on March 15 of each year thereafter, to the 
     Committee on Health, Education, Labor, and Pensions and the 
     Committee on Appropriations of the Senate and the Committee 
     on Energy and Commerce and the Committee on Appropriations of 
     the House of Representatives, in a manner that does not 
     compromise national security.
       ``(B) Additions, modifications, and replenishments.--Each 
     annual threat-based review under subparagraph (A) shall, for 
     each new or modified countermeasure procurement or 
     replenishment, provide--
       ``(i) information regarding--

       ``(I) the quantities of the additional or modified 
     countermeasure procured for, or contracted to be procured 
     for, the stockpile;
       ``(II) planning considerations for appropriate 
     manufacturing capacity and capability to meet the goals of 
     such additions or modifications (without disclosing 
     proprietary information), including consideration of the 
     effect such additions or modifications may have on the 
     availability of such products and ancillary medical supplies 
     in the health care system;
       ``(III) the presence or lack of a commercial market for the 
     countermeasure at the time of procurement;
       ``(IV) the emergency health security threat or threats such 
     countermeasure procurement is intended to address, including 
     whether such procurement is consistent with meeting emergency 
     health security needs associated with such threat or threats;
       ``(V) an assessment of whether the emergency health 
     security threat or threats described in subclause (IV) could 
     be addressed in a manner that better utilizes the resources 
     of the stockpile and permits the greatest possible increase 
     in the level of emergency preparedness to address such 
     threats;
       ``(VI) whether such countermeasure is replenishing an 
     expiring or expired countermeasure, is a different 
     countermeasure with the same indication that is replacing an 
     expiring or expired countermeasure, or is a new addition to 
     the stockpile;
       ``(VII) a description of how such additions or 
     modifications align with projected investments under previous 
     countermeasures budget plans under section 2811(b)(7), 
     including expected life-cycle costs, expenditures related to 
     countermeasure procurement to address the threat or threats 
     described in subclause (IV), replenishment dates (including 
     the ability to extend the maximum shelf life of a 
     countermeasure), and the manufacturing capacity required to 
     replenish such countermeasure; and
       ``(VIII) appropriate protocols and processes for the 
     deployment, distribution, or dispensing of the countermeasure 
     at the State and local level, including plans for relevant 
     capabilities of State and local entities to dispense, 
     distribute, and administer the countermeasure; and

       ``(ii) an assurance, which need not be provided in advance 
     of procurement, that for each countermeasure procured or 
     replenished under this subsection, the Secretary completed a 
     review addressing each item listed under this subsection in 
     advance of such procurement or replenishment.'';
       (4) in paragraph (3), as so redesignated--
       (A) in subparagraph (A), by inserting ``and the Public 
     Health Emergency Medical Countermeasures Enterprise 
     established under section 2811-1'' before the semicolon;
       (B) in subparagraph (C), by inserting ``, and the 
     availability, deployment, dispensing, and administration of 
     countermeasures'' before the semicolon;

[[Page H4257]]

       (C) by amending subparagraph (E) to read as follows:
       ``(E) devise plans for effective and timely supply-chain 
     management of the stockpile, in consultation with the 
     Director of the Centers for Disease Control and Prevention, 
     the Assistant Secretary for Preparedness and Response, the 
     Secretary of Transportation, the Secretary of Homeland 
     Security, the Secretary of Veterans Affairs, and the heads of 
     other appropriate Federal agencies; State, local, Tribal, and 
     territorial agencies; and the public and private health care 
     infrastructure, as applicable, taking into account the 
     manufacturing capacity and other available sources of 
     products and appropriate alternatives to supplies in the 
     stockpile;'';
       (D) in subparagraph (G), by striking ``; and'' and 
     inserting a semicolon;
       (E) in subparagraph (H), by striking the period and 
     inserting a semicolon; and
       (F) by adding at the end the following:
       ``(I) ensure that each countermeasure or product under 
     consideration for procurement pursuant to this subsection 
     receives the same consideration regardless of whether such 
     countermeasure or product receives or had received funding 
     under section 319L, including with respect to whether the 
     countermeasure or product is most appropriate to meet the 
     emergency health security needs of the United States; and
       ``(J) provide assistance, including technical assistance, 
     to maintain and improve State and local public health 
     preparedness capabilities to distribute and dispense medical 
     countermeasures and products from the stockpile, as 
     appropriate.''; and
       (5) by adding at the end the following:
       ``(5) GAO report.--
       ``(A) In general.--Not later than 3 years after the date of 
     enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019, and every 5 years 
     thereafter, the Comptroller General of the United States 
     shall conduct a review of any changes to the contents or 
     management of the stockpile since January 1, 2015. Such 
     review shall include--
       ``(i) an assessment of the comprehensiveness and 
     completeness of each annual threat-based review under 
     paragraph (2), including whether all newly procured or 
     replenished countermeasures within the stockpile were 
     described in each annual review, and whether, consistent with 
     paragraph (2)(B), the Secretary conducted the necessary 
     internal review in advance of such procurement or 
     replenishment;
       ``(ii) an assessment of whether the Secretary established 
     health security and science-based justifications, and a 
     description of such justifications for procurement decisions 
     related to health security needs with respect to the 
     identified threat, for additions or modifications to the 
     stockpile based on the information provided in such reviews 
     under paragraph (2)(B), including whether such review was 
     conducted prior to procurement, modification, or 
     replenishment;
       ``(iii) an assessment of the plans developed by the 
     Secretary for the deployment, distribution, and dispensing of 
     countermeasures procured, modified, or replenished under 
     paragraph (1), including whether such plans were developed 
     prior to procurement, modification, or replenishment;
       ``(iv) an accounting of countermeasures procured, modified, 
     or replenished under paragraph (1) that received advanced 
     research and development funding from the Biomedical Advanced 
     Research and Development Authority;
       ``(v) an analysis of how such procurement decisions made 
     progress toward meeting emergency health security needs 
     related to the identified threats for countermeasures added, 
     modified, or replenished under paragraph (1);
       ``(vi) a description of the resources expended related to 
     the procurement of countermeasures (including additions, 
     modifications, and replenishments) in the stockpile, and how 
     such expenditures relate to the ability of the stockpile to 
     meet emergency health security needs;
       ``(vii) an assessment of the extent to which additions, 
     modifications, and replenishments reviewed under paragraph 
     (2) align with previous relevant reports or reviews by the 
     Secretary or the Comptroller General;
       ``(viii) with respect to any change in the Federal 
     organizational management of the stockpile, an assessment and 
     comparison of the processes affected by such change, 
     including planning for potential countermeasure deployment, 
     distribution, or dispensing capabilities and processes 
     related to procurement decisions, use of stockpiled 
     countermeasures, and use of resources for such activities; 
     and
       ``(ix) an assessment of whether the processes and 
     procedures described by the Secretary pursuant to section 
     403(b) of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019 are sufficient to ensure 
     countermeasures and products under consideration for 
     procurement pursuant to subsection (a) receive the same 
     consideration regardless of whether such countermeasures and 
     products receive or had received funding under section 319L, 
     including with respect to whether such countermeasures and 
     products are most appropriate to meet the emergency health 
     security needs of the United States.
       ``(B) Submission.--Not later than 6 months after completing 
     a classified version of the review under subparagraph (A), 
     the Comptroller General shall submit an unclassified version 
     of the review to the congressional committees of 
     jurisdiction.''.
       (b) Additional Reporting.--In the first threat-based review 
     submitted after the date of enactment of this Act pursuant to 
     paragraph (2) of section 319F-2(a) of the Public Health 
     Service Act (42 U.S.C. 247d-6b(a)), as amended by subsection 
     (a), the Secretary shall include a description of the 
     processes and procedures through which the Director of the 
     Strategic National Stockpile and the Director of the 
     Biomedical Advanced Research and Development Authority 
     coordinate with respect to countermeasures and products 
     procured under such section 319F-2(a), including such 
     processes and procedures in place to ensure countermeasures 
     and products under consideration for procurement pursuant to 
     such section 319F-2(a) receive the same consideration 
     regardless of whether such countermeasures or products 
     receive or had received funding under section 319L of the 
     Public Health Service Act (42 U.S.C. 247d-7e), and whether 
     such countermeasures and products are the most appropriate to 
     meet the emergency health security needs of the United 
     States.
       (c) Authorization of Appropriations, Strategic National 
     Stockpile.--Section 319F-2(f)(1) (42 U.S.C. 247d-6b(f)(1)) is 
     amended by striking ``$533,800,000 for each of fiscal years 
     2014 through 2018'' and inserting ``$610,000,000 for each of 
     fiscal years 2019 through 2023, to remain available until 
     expended''.

     SEC. 404. PREPARING FOR PANDEMIC INFLUENZA, ANTIMICROBIAL 
                   RESISTANCE, AND OTHER SIGNIFICANT THREATS.

       (a) Strategic Initiatives.--Section 319L(c)(4) (247d-
     7e(c)(4)) is amended by adding at the end the following:
       ``(F) Strategic initiatives.--The Secretary, acting through 
     the Director of BARDA, may implement strategic initiatives, 
     including by building on existing programs and by awarding 
     contracts, grants, and cooperative agreements, or entering 
     into other transactions, to support innovative candidate 
     products in preclinical and clinical development that address 
     priority, naturally occurring and man-made threats that, as 
     determined by the Secretary, pose a significant level of risk 
     to national security based on the characteristics of a 
     chemical, biological, radiological or nuclear threat, or 
     existing capabilities to respond to such a threat (including 
     medical response and treatment capabilities and manufacturing 
     infrastructure). Such initiatives shall accelerate and 
     support the advanced research, development, and procurement 
     of countermeasures and products, as applicable, to address 
     areas including--
       ``(i) chemical, biological, radiological, or nuclear 
     threats, including emerging infectious diseases, for which 
     insufficient approved, licensed, or authorized 
     countermeasures exist, or for which such threat, or the 
     result of an exposure to such threat, may become resistant to 
     countermeasures or existing countermeasures may be rendered 
     ineffective;
       ``(ii) threats that consistently exist or continually 
     circulate and have a significant potential to become a 
     pandemic, such as pandemic influenza, which may include the 
     advanced research and development, manufacturing, and 
     appropriate stockpiling of qualified pandemic or epidemic 
     products, and products, technologies, or processes to support 
     the advanced research and development of such countermeasures 
     (including multiuse platform technologies for diagnostics, 
     vaccines, and therapeutics; virus seeds; clinical trial lots; 
     novel virus strains; and antigen and adjuvant material); and
       ``(iii) threats that may result primarily or secondarily 
     from a chemical, biological, radiological, or nuclear agent, 
     or emerging infectious diseases, and which may present 
     increased treatment complications such as the occurrence of 
     resistance to available countermeasures or potential 
     countermeasures, including antimicrobial resistant 
     pathogens.''.
       (b) Protection of National Security From Threats.--Section 
     2811 (42 U.S.C. 300hh-10) is amended by adding at the end the 
     following:
       ``(f) Protection of National Security From Threats.--
       ``(1) In general.--In carrying out subsection (b)(3), the 
     Assistant Secretary for Preparedness and Response shall 
     implement strategic initiatives or activities to address 
     threats, including pandemic influenza and which may include a 
     chemical, biological, radiological, or nuclear agent 
     (including any such agent with a significant potential to 
     become a pandemic), that pose a significant level of risk to 
     public health and national security based on the 
     characteristics of such threat. Such initiatives shall 
     include activities to--
       ``(A) accelerate and support the advanced research, 
     development, manufacturing capacity, procurement, and 
     stockpiling of countermeasures, including initiatives under 
     section 319L(c)(4)(F);
       ``(B) support the development and manufacturing of virus 
     seeds, clinical trial lots, and stockpiles of novel virus 
     strains; and
       ``(C) maintain or improve preparedness activities, 
     including for pandemic influenza.
       ``(2) Authorization of appropriations.--
       ``(A) In general.--To carry out this subsection, there is 
     authorized to be appropriated $250,000,000 for each of fiscal 
     years 2019 through 2023.
       ``(B) Supplement, not supplant.--Amounts appropriated under 
     this paragraph shall be used to supplement and not supplant

[[Page H4258]]

     funds provided under sections 319L(d) and 319F-2(g).
       ``(C) Documentation required.--The Assistant Secretary for 
     Preparedness and Response, in accordance with subsection 
     (b)(7), shall document amounts expended for purposes of 
     carrying out this subsection, including amounts appropriated 
     under the heading `Public Health and Social Services 
     Emergency Fund' under the heading `Office of the Secretary' 
     under title II of division H of the Consolidated 
     Appropriations Act, 2018 (Public Law 115-141) and allocated 
     to carrying out section 319L(c)(4)(F).''.

     SEC. 405. REPORTING ON THE FEDERAL SELECT AGENT PROGRAM.

       Section 351A(k) (42 U.S.C. 262a(k)) is amended--
       (1) by striking ``The Secretary'' and inserting the 
     following:
       ``(1) In general.--The Secretary''; and
       (2) by adding at the end the following:
       ``(2) Implementation of recommendations of the federal 
     experts security advisory panel and the fast track action 
     committee on select agent regulations.--
       ``(A) In general.--Not later than 1 year after the date of 
     the enactment of the Pandemic and All-Hazards Preparedness 
     and Advancing Innovation Act of 2019, the Secretary shall 
     report to the congressional committees of jurisdiction on the 
     implementation of recommendations of the Federal Experts 
     Security Advisory Panel concerning the select agent program.
       ``(B) Continued updates.--The Secretary shall report to the 
     congressional committees of jurisdiction annually following 
     the submission of the report under subparagraph (A) until the 
     recommendations described in such subparagraph are fully 
     implemented, or a justification is provided for the delay in, 
     or lack of, implementation.''.

 TITLE V--INCREASING COMMUNICATION IN MEDICAL COUNTERMEASURE ADVANCED 
                        RESEARCH AND DEVELOPMENT

     SEC. 501. MEDICAL COUNTERMEASURE BUDGET PLAN.

       Section 2811(b)(7) (42 U.S.C. 300hh-10(b)(7)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``March 1'' and inserting ``March 15'';
       (2) in subparagraph (A)--
       (A) in clause (ii), by striking ``; and'' and inserting 
     ``;''; and
       (B) by striking clause (iii) and inserting the following:
       ``(iii) procurement, stockpiling, maintenance, and 
     potential replenishment (including manufacturing 
     capabilities) of all products in the Strategic National 
     Stockpile;
       ``(iv) the availability of technologies that may assist in 
     the advanced research and development of countermeasures and 
     opportunities to use such technologies to accelerate and 
     navigate challenges unique to countermeasure research and 
     development; and
       ``(v) potential deployment, distribution, and utilization 
     of medical countermeasures; development of clinical guidance 
     and emergency use instructions for the use of medical 
     countermeasures; and, as applicable, potential postdeployment 
     activities related to medical countermeasures;'';
       (3) by redesignating subparagraphs (D) and (E) as 
     subparagraphs (E) and (F), respectively; and
       (4) by inserting after subparagraph (C), the following:
       ``(D) identify the full range of anticipated medical 
     countermeasure needs related to research and development, 
     procurement, and stockpiling, including the potential need 
     for indications, dosing, and administration technologies, and 
     other countermeasure needs as applicable and appropriate;''.

     SEC. 502. MATERIAL THREAT AND MEDICAL COUNTERMEASURE 
                   NOTIFICATIONS.

       (a) Congressional Notification of Material Threat 
     Determination.--Section 319F-2(c)(2)(C) (42 U.S.C. 247d-
     6b(c)(2)(C)) is amended by striking ``The Secretary and the 
     Homeland Security Secretary shall promptly notify the 
     appropriate committees of Congress'' and inserting ``The 
     Secretary and the Secretary of Homeland Security shall send 
     to Congress, on an annual basis, all current material threat 
     determinations and shall promptly notify the Committee on 
     Health, Education, Labor, and Pensions and the Committee on 
     Homeland Security and Governmental Affairs of the Senate and 
     the Committee on Energy and Commerce and the Committee on 
     Homeland Security of the House of Representatives''.
       (b) Contracting Communication.--Section 319F-
     2(c)(7)(B)(ii)(III) (42 U.S.C. 247d-6b(c)(7)(B)(ii)(III)) is 
     amended by adding at the end the following: ``The Secretary 
     shall notify the vendor within 90 days of a determination by 
     the Secretary to renew, extend, or terminate such 
     contract.''.

     SEC. 503. AVAILABILITY OF REGULATORY MANAGEMENT PLANS.

       Section 565(f) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 360bbb-4(f)) is amended--
       (1) by redesignating paragraphs (3) through (6) as 
     paragraphs (4) through (7), respectively;
       (2) by inserting after paragraph (2) the following:
       ``(3) Publication.--The Secretary shall make available on 
     the internet website of the Food and Drug Administration 
     information regarding regulatory management plans, 
     including--
       ``(A) the process by which an applicant may submit a 
     request for a regulatory management plan;
       ``(B) the timeframe by which the Secretary is required to 
     respond to such request;
       ``(C) the information required for the submission of such 
     request;
       ``(D) a description of the types of development milestones 
     and performance targets that could be discussed and included 
     in such plans; and
       ``(E) contact information for beginning the regulatory 
     management plan process.'';
       (3) in paragraph (6), as so redesignated, in the matter 
     preceding subparagraph (A)--
       (A) by striking ``paragraph (4)(A)'' and inserting 
     ``paragraph (5)(A)''; and
       (B) by striking ``paragraph (4)(B)'' and inserting 
     ``paragraph (5)(B)''; and
       (4) in paragraph (7)(A), as so redesignated, by striking 
     ``paragraph (3)(A)'' and inserting ``paragraph (4)(A)''.

     SEC. 504. THE BIOMEDICAL ADVANCED RESEARCH AND DEVELOPMENT 
                   AUTHORITY AND THE BIOSHIELD SPECIAL RESERVE 
                   FUND.

       (a) BioShield Special Reserve Fund.--Section 319F-2(g)(1) 
     (42 U.S.C. 247d-6b(g)(1)) is amended--
       (1) by striking ``$2,800,000,000 for the period of fiscal 
     years 2014 through 2018'' and inserting ``$7,100,000,000 for 
     the period of fiscal years 2019 through 2028, to remain 
     available until expended''; and
       (2) by striking the second sentence.
       (b) The Biomedical Advanced Research and Development 
     Authority.--Section 319L(d)(2) (42 U.S.C. 247d-7e(d)(2)) is 
     amended by striking ``$415,000,000 for each of fiscal years 
     2014 through 2018'' and inserting ``$611,700,000 for each of 
     fiscal years 2019 through 2023''.

     SEC. 505. ADDITIONAL STRATEGIES FOR COMBATING ANTIBIOTIC 
                   RESISTANCE.

       (a) Advisory Council.--The Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     may continue the Presidential Advisory Council on Combating 
     Antibiotic-Resistant Bacteria, referred to in this section as 
     the ``Advisory Council''.
       (b) Duties.--The Advisory Council shall advise and provide 
     information and recommendations to the Secretary regarding 
     programs and policies intended to reduce or combat 
     antibiotic-resistant bacteria that may present a public 
     health threat and improve capabilities to prevent, diagnose, 
     mitigate, or treat such resistance. Such advice, information, 
     and recommendations may be related to improving--
       (1) the effectiveness of antibiotics;
       (2) research and advanced research on, and the development 
     of, improved and innovative methods for combating or reducing 
     antibiotic resistance, including new treatments, rapid point-
     of-care diagnostics, alternatives to antibiotics, including 
     alternatives to animal antibiotics, and antimicrobial 
     stewardship activities;
       (3) surveillance of antibiotic-resistant bacterial 
     infections, including publicly available and up-to-date 
     information on resistance to antibiotics;
       (4) education for health care providers and the public with 
     respect to up-to-date information on antibiotic resistance 
     and ways to reduce or combat such resistance to antibiotics 
     related to humans and animals;
       (5) methods to prevent or reduce the transmission of 
     antibiotic-resistant bacterial infections, including 
     stewardship programs; and
       (6) coordination with respect to international efforts in 
     order to inform and advance United States capabilities to 
     combat antibiotic resistance.
       (c) Meetings and Coordination.--
       (1) Meetings.--The Advisory Council shall meet not less 
     than biannually and, to the extent practicable, in 
     coordination with meetings of the Antimicrobial Resistance 
     Task Force established in section 319E(a) of the Public 
     Health Service Act.
       (2) Coordination.--The Advisory Council shall, to the 
     greatest extent practicable, coordinate activities carried 
     out by the Council with the Antimicrobial Resistance Task 
     Force established under section 319E(a) of the Public Health 
     Service Act (42 U.S.C. 247d-5(a)).
       (d) FACA.--The Federal Advisory Committee Act (5 U.S.C. 
     App.) shall apply to the activities and duties of the 
     Advisory Council.
       (e) Extension of Advisory Council.--Not later than October 
     1, 2022, the Secretary shall submit to the Committee on 
     Health, Education, Labor, and Pensions of the Senate and the 
     Committee on Energy and Commerce of the House of 
     Representatives a recommendation on whether the Advisory 
     Council should be extended, and in addition, identify whether 
     there are other committees, councils, or task forces that 
     have overlapping or similar duties to that of the Advisory 
     Council, and whether such committees, councils, or task 
     forces should be combined, including with respect to section 
     319E(a) of the Public Health Service Act (42 U.S.C. 247d-
     5(a)).

      TITLE VI--ADVANCING TECHNOLOGIES FOR MEDICAL COUNTERMEASURES

     SEC. 601. ADMINISTRATION OF COUNTERMEASURES.

       Section 319L(c)(4)(D)(iii) (42 U.S.C. 247d-
     7e(c)(4)(D)(iii)) is amended by striking ``and platform 
     technologies'' and inserting ``platform technologies, 
     technologies to administer countermeasures, and technologies 
     to improve storage and transportation of countermeasures''.

     SEC. 602. UPDATING DEFINITIONS OF OTHER TRANSACTIONS.

       Section 319L (42 U.S.C. 247d-7e) is amended--

[[Page H4259]]

       (1) in subsection (a)(3), by striking ``, such as'' and all 
     that follows through ``Code''; and
       (2) in subsection (c)(5)(A)--
       (A) in clause (i), by striking ``under this subsection'' 
     and all that follows through ``Code'' and inserting ``(as 
     defined in subsection (a)(3)) under this subsection''; and
       (B) in clause (ii)--
       (i) by amending subclause (I) to read as follows:

       ``(I) In general.--To the maximum extent practicable, 
     competitive procedures shall be used when entering into 
     transactions to carry out projects under this subsection.''; 
     and

       (ii) in subclause (II)--

       (I) by striking ``$20,000,000'' and inserting 
     ``$100,000,000'';
       (II) by striking ``senior procurement executive for the 
     Department (as designated for purpose of section 16(c) of the 
     Office of Federal Procurement Policy Act (41 U.S.C. 
     414(c)))'' and inserting ``Assistant Secretary for Financial 
     Resources''; and
       (III) by striking ``senior procurement executive under'' 
     and inserting ``Assistant Secretary for Financial Resources 
     under''.

     SEC. 603. MEDICAL COUNTERMEASURE MASTER FILES.

       (a) In General.--The purpose of this section (including 
     section 565B of the Federal Food, Drug, and Cosmetic Act, as 
     added by subsection (b)) is to support and advance the 
     development or manufacture of security countermeasures, 
     qualified countermeasures, and qualified pandemic or epidemic 
     products by facilitating and encouraging submission of data 
     and information to support the development of such products, 
     and through clarifying the authority to cross-reference to 
     data and information previously submitted to the Secretary of 
     Health and Human Services (referred to in this section as the 
     ``Secretary''), including data and information submitted to 
     medical countermeasure master files or other master files.
       (b) Medical Countermeasure Master Files.--Chapter V of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) 
     is amended by inserting after section 565A the following:

     ``SEC. 565B. MEDICAL COUNTERMEASURE MASTER FILES.

       ``(a) Applicability of Reference.--
       ``(1) In general.--A person may submit data and information 
     in a master file to the Secretary with the intent to 
     reference, or to authorize, in writing, another person to 
     reference, such data or information to support a medical 
     countermeasure submission (including a supplement or 
     amendment to any such submission), without requiring the 
     master file holder to disclose the data and information to 
     any such persons authorized to reference the master file. 
     Such data and information shall be available for reference by 
     the master file holder or by a person authorized by the 
     master file holder, in accordance with applicable privacy and 
     confidentiality protocols and regulations.
       ``(2) Reference of certain master files.--In the case that 
     data or information within a medical countermeasure master 
     file is used only to support the conditional approval of an 
     application filed under section 571, such master file may be 
     relied upon to support the effectiveness of a product that is 
     the subject of a subsequent medical countermeasure submission 
     only if such application is supplemented by additional data 
     or information to support review and approval in a manner 
     consistent with the standards applicable to such review and 
     approval for such countermeasure, qualified countermeasure, 
     or qualified pandemic or epidemic product.
       ``(b) Medical Countermeasure Master File Content.--
       ``(1) In general.--A master file under this section may 
     include data or information to support--
       ``(A) the development of medical countermeasure submissions 
     to support the approval, licensure, classification, 
     clearance, conditional approval, or authorization of one or 
     more security countermeasures, qualified countermeasures, or 
     qualified pandemic or epidemic products; and
       ``(B) the manufacture of security countermeasures, 
     qualified countermeasures, or qualified pandemic or epidemic 
     products.
       ``(2) Required updates.--The Secretary may require, as 
     appropriate, that the master file holder ensure that the 
     contents of such master file are updated during the time such 
     master file is referenced for a medical countermeasure 
     submission.
       ``(c) Sponsor Reference.--
       ``(1) In general.--Each incorporation of data or 
     information within a medical countermeasure master file shall 
     describe the incorporated material in a manner in which the 
     Secretary determines appropriate and that permits the review 
     of such information within such master file without 
     necessitating resubmission of such data or information. 
     Master files shall be submitted in an electronic format in 
     accordance with sections 512(b)(4), 571(a)(4), and 745A, as 
     applicable, and as specified in applicable guidance.
       ``(2) Reference by a master file holder.--A master file 
     holder that is the sponsor of a medical countermeasure 
     submission shall notify the Secretary in writing of the 
     intent to reference the medical countermeasure master file as 
     a part of the submission.
       ``(3) Reference by an authorized person.--A person 
     submitting an application for review may, where the Secretary 
     determines appropriate, incorporate by reference all or part 
     of the contents of a medical countermeasure master file, if 
     the master file holder authorizes the incorporation in 
     writing.
       ``(d) Acknowledgment of and Reliance Upon a Master File by 
     the Secretary.--
       ``(1) In general.--The Secretary shall provide the master 
     file holder with a written notification indicating that the 
     Secretary has reviewed and relied upon specified data or 
     information within a master file and the purposes for which 
     such data or information was incorporated by reference if the 
     Secretary has reviewed and relied upon such specified data or 
     information to support the approval, classification, 
     conditional approval, clearance, licensure, or authorization 
     of a security countermeasure, qualified countermeasure, or 
     qualified pandemic or epidemic product. The Secretary may 
     rely upon the data and information within the medical 
     countermeasure master file for which such written 
     notification was provided in additional applications, as 
     applicable and appropriate and upon the request of the master 
     file holder so notified in writing or by an authorized person 
     of such holder.
       ``(2) Certain applications.--If the Secretary has reviewed 
     and relied upon specified data or information within a 
     medical countermeasure master file to support the conditional 
     approval of an application under section 571 to subsequently 
     support the approval, clearance, licensure, or authorization 
     of a security countermeasure, qualified countermeasure, or 
     qualified pandemic or epidemic product, the Secretary shall 
     provide a brief written description to the master file holder 
     regarding the elements of the application fulfilled by the 
     data or information within the master file and how such data 
     or information contained in such application meets the 
     standards of evidence under subsection (c) or (d) of section 
     505, subsection (d) of section 512, or section 351 of the 
     Public Health Service Act (as applicable), which shall not 
     include any trade secret or confidential commercial 
     information.
       ``(e) Rules of Construction.--Nothing in this section shall 
     be construed to--
       ``(1) limit the authority of the Secretary to approve, 
     license, clear, conditionally approve, or authorize drugs, 
     biological products, or devices pursuant to, as applicable, 
     this Act or section 351 of the Public Health Service Act (as 
     such applicable Act is in effect on the day before the date 
     of enactment of the Pandemic and All-Hazards Preparedness and 
     Advancing Innovation Act of 2019), including the standards of 
     evidence, and applicable conditions, for approval under the 
     applicable Act;
       ``(2) alter the standards of evidence with respect to 
     approval, licensure, or clearance, as applicable, of drugs, 
     biological products, or devices under this Act or section 351 
     of the Public Health Service Act, including, as applicable, 
     the substantial evidence standards under sections 505(d) and 
     512(d) or this Act and section 351(a) of the Public Health 
     Service Act; or
       ``(3) alter the authority of the Secretary under this Act 
     or the Public Health Service Act to determine the types of 
     data or information previously submitted by a sponsor or any 
     other person that may be incorporated by reference in an 
     application, request, or notification for a drug, biological 
     product, or device submitted under sections 505(i), 505(b), 
     505(j), 512(b)(1), 512(b)(2), 512(j), 564, 571, 520(g), 
     515(c), 513(f)(2), or 510(k) of this Act, or subsection (a) 
     or (k) of section 351 of the Public Health Service Act, 
     including a supplement or amendment to any such submission, 
     and the requirements associated with such reference.
       ``(f) Definitions.--In this section:
       ``(1) The term `master file holder' means a person who 
     submits data and information to the Secretary with the intent 
     to reference or authorize another person to reference such 
     data or information to support a medical countermeasure 
     submission, as described in subsection (a).
       ``(2) The term `medical countermeasure submission' means an 
     investigational new drug application under section 505(i), a 
     new drug application under section 505(b), or an abbreviated 
     new drug application under section 505(j) of this Act, a 
     biological product license application under section 351(a) 
     of the Public Health Service Act or a biosimilar biological 
     product license application under section 351(k) of the 
     Public Health Service Act, a new animal drug application 
     under section 512(b)(1) or abbreviated new animal drug 
     application under section 512(b)(2), an application for 
     conditional approval of a new animal drug under section 571, 
     an investigational device application under section 520(g), 
     an application with respect to a device under section 515(c), 
     a request for classification of a device under section 
     513(f)(2), a notification with respect to a device under 
     section 510(k), or a request for an emergency use 
     authorization under section 564 to support--
       ``(A) the approval, licensure, classification, clearance, 
     conditional approval, or authorization of a security 
     countermeasure, qualified countermeasure, or qualified 
     pandemic or epidemic product; or
       ``(B) a new indication to an approved security 
     countermeasure, qualified countermeasure, or qualified 
     pandemic or epidemic product.
       ``(3) The terms `qualified countermeasure', `security 
     countermeasure', and `qualified pandemic or epidemic product' 
     have the meanings given such terms in sections 319F-1, 319F-
     2, and 319F-3, respectively, of the Public Health Service 
     Act.''.
       (c) Stakeholder Input.--Not later than 18 months after the 
     date of enactment of this

[[Page H4260]]

     Act, the Secretary, acting through the Commissioner of Food 
     and Drugs and in consultation with the Assistant Secretary 
     for Preparedness and Response, shall solicit input from 
     stakeholders, including stakeholders developing security 
     countermeasures, qualified countermeasures, or qualified 
     pandemic or epidemic products, and stakeholders developing 
     technologies to assist in the development of such 
     countermeasures with respect to how the Food and Drug 
     Administration can advance the use of tools and technologies 
     to support and advance the development or manufacture of 
     security countermeasures, qualified countermeasures, and 
     qualified pandemic or epidemic products, including through 
     reliance on cross-referenced data and information contained 
     within master files and submissions previously submitted to 
     the Secretary as set forth in section 565B of the Federal 
     Food, Drug, and Cosmetic Act, as added by subsection (b).
       (d) Guidance.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary, acting through the 
     Commissioner of Food and Drugs, shall publish draft guidance 
     about how reliance on cross-referenced data and information 
     contained within master files under section 565B of the 
     Federal Food, Drug, and Cosmetic Act, as added by subsection 
     (b) or submissions otherwise submitted to the Secretary may 
     be used for specific tools or technologies (including 
     platform technologies) that have the potential to support and 
     advance the development or manufacture of security 
     countermeasures, qualified countermeasures, and qualified 
     pandemic or epidemic products. The Secretary, acting through 
     the Commissioner of Food and Drugs, shall publish the final 
     guidance not later than 3 years after the enactment of this 
     Act.

     SEC. 604. ANIMAL RULE REPORT.

       (a) Study.--The Comptroller General of the United States 
     shall conduct a study on the application of the requirements 
     under subsections (c) and (d) of section 565 of the of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-4) 
     (referred to in this section as the ``animal rule'') as a 
     component of medical countermeasure advanced development 
     under the Biomedical Advanced Research and Development 
     Authority and regulatory review by the Food and Drug 
     Administration. In conducting such study, the Comptroller 
     General shall examine the following:
       (1) The extent to which advanced development and review of 
     a medical countermeasure are coordinated between the 
     Biomedical Advanced Research and Development Authority and 
     the Food and Drug Administration, including activities that 
     facilitate appropriate and efficient design of studies to 
     support approval, licensure, and authorization under the 
     animal rule, consistent with the recommendations in the 
     animal rule guidance, issued pursuant to section 565(c) of 
     the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-
     4(c)) and entitled ``Product Development Under the Animal 
     Rule: Guidance for Industry'' (issued in October 2015), to 
     resolve discrepancies in the design of adequate and well-
     controlled efficacy studies conducted in animal models 
     related to the provision of substantial evidence of 
     effectiveness for the product approved, licensed, or 
     authorized under the animal rule.
       (2) The consistency of the application of the animal rule 
     among and between review divisions within the Food and Drug 
     Administration.
       (3) The flexibility pursuant to the animal rule to address 
     variations in countermeasure development and review 
     processes, including the extent to which qualified animal 
     models are adopted and used within the Food and Drug 
     Administration in regulatory decisionmaking with respect to 
     medical countermeasures.
       (4) The extent to which the guidance issued under section 
     565(c) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     360bbb-4(c)), entitled, ``Product Development Under the 
     Animal Rule: Guidance for Industry'' (issued in October 
     2015), has assisted in achieving the purposes described in 
     paragraphs (1), (2), and (3).
       (b) Consultations.--In conducting the study under 
     subsection (a), the Comptroller General of the United States 
     shall consult with--
       (1) the Federal agencies responsible for advancing, 
     reviewing, and procuring medical countermeasures, including 
     the Office of the Assistant Secretary for Preparedness and 
     Response, the Biomedical Advanced Research and Development 
     Authority, the Food and Drug Administration, and the 
     Department of Defense;
       (2) manufacturers involved in the research and development 
     of medical countermeasures to address biological, chemical, 
     radiological, or nuclear threats; and
       (3) other biodefense stakeholders, as applicable.
       (c) Report.--Not later than 3 years after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to the Committee on Health, Education, 
     Labor, and Pensions of the Senate and the Committee on Energy 
     and Commerce of the House of Representatives a report 
     containing the results of the study conducted under 
     subsection (a) and recommendations to improve the application 
     and consistency of the requirements under subsections (c) and 
     (d) of section 565 of the Federal Food, Drug, and Cosmetic 
     Act (21 U.S.C. 360bbb-4) to support and expedite the research 
     and development of medical countermeasures, as applicable.
       (d) Protection of National Security.--The Comptroller 
     General of the United States shall conduct the study and 
     issue the assessment and report under this section in a 
     manner that does not compromise national security.

     SEC. 605. REVIEW OF THE BENEFITS OF GENOMIC ENGINEERING 
                   TECHNOLOGIES AND THEIR POTENTIAL ROLE IN 
                   NATIONAL SECURITY.

       (a) Meeting.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     shall convene a meeting to discuss the potential role 
     advancements in genomic engineering technologies (including 
     genome editing technologies) may have in advancing national 
     health security. Such meeting shall be held in a manner that 
     does not compromise national security.
       (2) Attendees.--The attendees of the meeting under 
     paragraph (1)--
       (A) shall include--
       (i) representatives from the Office of the Assistant 
     Secretary for Preparedness and Response, the National 
     Institutes of Health, the Centers for Disease Control and 
     Prevention, and the Food and Drug Administration; and
       (ii) representatives from academic, private, and nonprofit 
     entities with expertise in genome engineering technologies, 
     biopharmaceuticals, medicine, or biodefense, and other 
     relevant stakeholders; and
       (B) may include--
       (i) other representatives from the Department of Health and 
     Human Services, as the Secretary determines appropriate; and
       (ii) representatives from the Department of Homeland 
     Security, the Department of Defense, the Department of 
     Agriculture, and other departments, as the Secretary may 
     request for the meeting.
       (3) Topics.--The meeting under paragraph (1) shall include 
     a discussion of--
       (A) the current state of the science of genomic engineering 
     technologies related to national health security, including--
       (i) medical countermeasure development, including potential 
     efficiencies in the development pathway and detection 
     technologies; and
       (ii) the international and domestic regulation of products 
     utilizing genome editing technologies; and
       (B) national security implications, including--
       (i) capabilities of the United States to leverage genomic 
     engineering technologies as a part of the medical 
     countermeasure enterprise, including current applicable 
     research, development, and application efforts underway 
     within the Department of Defense;
       (ii) the potential for state and non-state actors to 
     utilize genomic engineering technologies as a national health 
     security threat; and
       (iii) security measures to monitor and assess the potential 
     threat that may result from utilization of genomic 
     engineering technologies and related technologies for the 
     purpose of compromising national health security.
       (b) Report.--Not later than 270 days after the meeting 
     described in subsection (a) is held, the Assistant Secretary 
     for Preparedness and Response shall issue a report to the 
     congressional committees of jurisdiction on the topics 
     discussed at such meeting, and provide recommendations, as 
     applicable, to utilize innovations in genomic engineering 
     (including genome editing) and related technologies as a part 
     of preparedness and response activities to advance national 
     health security. Such report shall be issued in a manner that 
     does not compromise national security.

     SEC. 606. REPORT ON VACCINES DEVELOPMENT.

       Not later than one year after the date of the enactment of 
     this Act, the Secretary of Health and Human Services shall 
     submit to the Committee on Health, Education, Labor, and 
     Pensions of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives a report describing 
     efforts and activities to coordinate with other countries and 
     international partners during recent public health 
     emergencies with respect to the research and advanced 
     research on, and development of, qualified pandemic or 
     epidemic products (as defined in section 319F-3 of the Public 
     Health Service Act (42 U.S.C. 247d-6d)). Such report may 
     include information regarding relevant work carried out under 
     section 319L(c)(5)(E) of the Public Health Service Act (42 
     U.S.C. 247d-7e(c)(5)(E)), through public-private 
     partnerships, and through collaborations with other countries 
     to assist with or expedite the research and development of 
     qualified pandemic or epidemic products. Such report shall 
     not include information that may compromise national 
     security.

     SEC. 607. STRENGTHENING MOSQUITO ABATEMENT FOR SAFETY AND 
                   HEALTH.

       (a) Reauthorization of Mosquito Abatement for Safety and 
     Health Program.--Section 317S (42 U.S.C. 247b-21) is 
     amended--
       (1) in subsection (a)(1)(B)--
       (A) by inserting ``including programs to address emerging 
     infectious mosquito-borne diseases,'' after ``subdivisions 
     for control programs,''; and
       (B) by inserting ``or improving existing control programs'' 
     before the period at the end;
       (2) in subsection (b)--
       (A) in paragraph (1), by inserting ``, including 
     improvement,'' after ``operation'';

[[Page H4261]]

       (B) in paragraph (2)--
       (i) in subparagraph (A)--

       (I) in clause (ii), by striking ``or'' at the end;
       (II) in clause (iii), by striking the semicolon at the end 
     and inserting ``, including an emerging infectious mosquito-
     borne disease that presents a serious public health threat; 
     or''; and
       (III) by adding at the end the following:

       ``(iv) a public health emergency due to the incidence or 
     prevalence of a mosquito-borne disease that presents a 
     serious public health threat;''; and
       (ii) by amending subparagraph (D) to read as follows:
       ``(D)(i) is located in a State that has received a grant 
     under subsection (a); or
       ``(ii) that demonstrates to the Secretary that the control 
     program is consistent with existing State mosquito control 
     plans or policies, or other applicable State preparedness 
     plans.'';
       (C) in paragraph (4)(C), by striking ``that extraordinary'' 
     and all that follows through the period at the end and 
     inserting the following: ``that--
       ``(i) extraordinary economic conditions in the political 
     subdivision or consortium of political subdivisions involved 
     justify the waiver; or
       ``(ii) the geographical area covered by a political 
     subdivision or consortium for a grant under paragraph (1) has 
     an extreme mosquito control need due to--

       ``(I) the size or density of the potentially impacted human 
     population;
       ``(II) the size or density of a mosquito population that 
     requires heightened control; or
       ``(III) the severity of the mosquito-borne disease, such 
     that expected serious adverse health outcomes for the human 
     population justify the waiver.''; and

       (D) by amending paragraph (6) to read as follows:
       ``(6) Number of grants.--A political subdivision or a 
     consortium of political subdivisions may not receive more 
     than one grant under paragraph (1).''; and
       (3) in subsection (f)--
       (A) in paragraph (1) by striking ``for fiscal year 2003, 
     and such sums as may be necessary for each of fiscal years 
     2004 through 2007'' and inserting ``for each of fiscal years 
     2019 through 2023'';
       (B) in paragraph (2), by striking ``the Public Health 
     Security and Bioterrorism Preparedness and Response Act of 
     2002'' and inserting ``this Act and other medical and public 
     health preparedness and response laws''; and
       (C) in paragraph (3)--
       (i) in the paragraph heading, by striking ``2004'' and 
     inserting ``2019''; and
       (ii) by striking ``2004,'' and inserting ``2019,''.
       (b) Epidemiology-Laboratory Capacity Grants.--Section 2821 
     (42 U.S.C. 300hh-31) is amended--
       (1) in subsection (a)(1), by inserting ``, including 
     mosquito and other vector-borne diseases,'' after 
     ``infectious diseases''; and
       (2) in subsection (b), by striking ``2010 through 2013'' 
     and inserting ``2019 through 2023''.

                  TITLE VII--MISCELLANEOUS PROVISIONS

     SEC. 701. REAUTHORIZATIONS AND EXTENSIONS.

       (a) Veterans Affairs.--Section 8117(g) of title 38, United 
     States Code, is amended by striking ``2014 through 2018'' and 
     inserting ``2019 through 2023''.
       (b) Vaccine Tracking and Distribution.--Section 319A(e) (42 
     U.S.C. 247d-1(e)) is amended by striking ``2014 through 
     2018'' and inserting ``2019 through 2023''.
       (c) Temporary Reassignment.--Section 319(e)(8) (42 U.S.C. 
     247d(e)(8)) is amended by striking ``2018'' and inserting 
     ``2023''.
       (d) Strategic Innovation Partner.--Section 
     319L(c)(4)(E)(ix) (42 U.S.C. 247d-7e(c)(4)(E)(ix)) is amended 
     by striking ``2022'' and inserting ``2023''.
       (e) Limited Antitrust Exemption.--
       (1) In general.--Section 405 of the Pandemic and All-
     Hazards Preparedness Act (Public Law 109-417; 42 U.S.C. 247d-
     6a note) is amended--
       (A) in subsection (a)(1)(A)--
       (i) by striking ``Secretary of Health and Human Services 
     (referred to in this subsection as the `Secretary')'' and 
     inserting ``Secretary'';
       (ii) by striking ``of the Public Health Service Act (42 
     U.S.C. 247d-6b)) (as amended by this Act'';
       (iii) by striking ``of the Public Health Service Act (42 
     U.S.C. 247d-6a)) (as amended by this Act''; and
       (iv) by striking ``of the Public Health Service Act (42 
     U.S.C. 247d-6d)'';
       (B) in subsection (b), by striking ``12-year'' and 
     inserting ``17-year'';
       (C) by redesignating such section 405 as section 319L-1; 
     and
       (D) by transferring such section 319L-1, as redesignated, 
     to the Public Health Service Act (42 U.S.C. 201 et seq.), to 
     appear after section 319L of such Act (42 U.S.C. 247d-7e).
       (2) Conforming amendments.--
       (A) Table of contents.--The table of contents in section 
     1(b) of the Pandemic and All-Hazards Preparedness Act (Public 
     Law 109-417) is amended by striking the item related to 
     section 405.
       (B) Reference.--Section 319L(c)(4)(A)(iii) (42 U.S.C. 247d-
     7e) is amended by striking ``section 405 of the Pandemic and 
     All-Hazards Preparedness Act'' and inserting ``section 319L-
     1''.
       (f) Inapplicability of Certain Provisions.--Subsection 
     (e)(1) of section 319L (42 U.S.C. 247d-7e(e)(1)) is amended--
       (1) by amending subparagraph (A) to read as follows:
       ``(A) Nondisclosure of information.--
       ``(i) In general.--Information described in clause (ii) 
     shall be deemed to be information described in section 
     552(b)(3) of title 5, United States Code.
       ``(ii) Information described.--The information described in 
     this clause is information relevant to programs of the 
     Department of Health and Human Services that could compromise 
     national security and reveal significant and not otherwise 
     publicly known vulnerabilities of existing medical or public 
     health defenses against chemical, biological, radiological, 
     or nuclear threats, and is comprised of--

       ``(I) specific technical data or scientific information 
     that is created or obtained during the countermeasure and 
     product advanced research and development carried out under 
     subsection (c);
       ``(II) information pertaining to the location security, 
     personnel, and research materials and methods of high-
     containment laboratories conducting research with select 
     agents, toxins, or other agents with a material threat 
     determination under section 319F-2(c)(2); or
       ``(III) security and vulnerability assessments.'';

       (2) by redesignating subparagraph (C) as subparagraph (D);
       (3) by inserting after subparagraph (B) the following:
       ``(C) Reporting.--One year after the date of enactment of 
     the Pandemic and All-Hazards Preparedness and Advancing 
     Innovation Act of 2019, and annually thereafter, the 
     Secretary shall report to the Committee on Health, Education, 
     Labor, and Pensions of the Senate and the Committee on Energy 
     and Commerce of the House of Representatives on the number of 
     instances in which the Secretary has used the authority under 
     this subsection to withhold information from disclosure, as 
     well as the nature of any request under section 552 of title 
     5, United States Code that was denied using such 
     authority.''; and
       (4) in subparagraph (D), as so redesignated, by striking 
     ``12'' and inserting ``17''.

     SEC. 702. LOCATION OF MATERIALS IN THE STOCKPILE.

       Subsection (d) of section 319F-2 (42 U.S.C. 247d-6b) is 
     amended to read as follows:
       ``(d) Disclosures.--No Federal agency may disclose under 
     section 552 of title 5, United States Code any information 
     identifying the location at which materials in the stockpile 
     described in subsection (a) are stored, or other information 
     regarding the contents or deployment capability of the 
     stockpile that could compromise national security.''.

     SEC. 703. CYBERSECURITY.

       (a) Strategy for Public Health Preparedness and Response to 
     Cybersecurity Threats.--
       (1) Strategy.--Not later than 18 months after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     shall prepare and submit to the relevant committees of 
     Congress a strategy for public health preparedness and 
     response to address cybersecurity threats (as defined in 
     section 102 of Cybersecurity Information Sharing Act of 2015 
     (6 U.S.C. 1501)) that present a threat to national health 
     security. Such strategy shall include--
       (A) identifying the duties, functions, and preparedness 
     goals for which the Secretary is responsible in order to 
     prepare for and respond to such cybersecurity threats, 
     including metrics by which to measure success in meeting 
     preparedness goals;
       (B) identifying gaps in public health capabilities to 
     achieve such preparedness goals; and
       (C) strategies to address identified gaps and strengthen 
     public health emergency preparedness and response 
     capabilities to address such cybersecurity threats.
       (2) Protection of national security.--The Secretary shall 
     make such strategy available to the Committee on Health, 
     Education, Labor, and Pensions of the Senate, the Committee 
     on Energy and Commerce of the House of Representatives, and 
     other congressional committees of jurisdiction, in a manner 
     that does not compromise national security.
       (b) Coordination of Preparedness for and Response to All-
     Hazards Public Health Emergencies.--Subparagraph (D) of 
     section 2811(b)(4) (42 U.S.C. 300hh-10(b)(4)) is amended to 
     read as follows:
       ``(D) Policy coordination and strategic direction.--Provide 
     integrated policy coordination and strategic direction, 
     before, during, and following public health emergencies, with 
     respect to all matters related to Federal public health and 
     medical preparedness and execution and deployment of the 
     Federal response for public health emergencies and incidents 
     covered by the National Response Plan described in section 
     504(a)(6) of the Homeland Security Act of 2002 (6 U.S.C. 
     314(a)(6)), or any successor plan; and such Federal responses 
     covered by the National Cybersecurity Incident Response Plan 
     developed under section 228(c) of the Homeland Security Act 
     of 2002 (6 U.S.C. 149(c)), including public health 
     emergencies or incidents related to cybersecurity threats 
     that present a threat to national health security.''.

     SEC. 704. STRATEGY AND REPORT.

       Not later than 14 days after the date of the enactment of 
     this Act, the Secretary of Health and Human Services, in 
     coordination

[[Page H4262]]

     with the Assistant Secretary for Preparedness and Response 
     and the Assistant Secretary for the Administration on 
     Children and Families or other appropriate office, and in 
     collaboration with other departments, as appropriate, shall 
     submit to the Committee on Energy and Commerce of the House 
     of Representatives, the Committee on Health, Education, 
     Labor, and Pensions of the Senate, and other relevant 
     congressional committees--
       (1) a formal strategy, including interdepartmental actions 
     and efforts to reunify children with their parents or 
     guardians, in all cases in which such children have been 
     separated from their parents or guardians as a result of the 
     initiative announced on April 6, 2018, and due to prosecution 
     under section 275(a) of the Immigration and Nationality Act 
     (8 U.S.C. 1325(a)), if the parent or guardian chooses such 
     reunification and the child--
       (A) was separated from a parent or guardian and placed into 
     a facility funded by the Department of Health and Human 
     Services;
       (B) as of the date of the enactment of this Act, remains in 
     the care of the Department of Health and Human Services; and
       (C) can be safely reunited with such parent or guardian; 
     and
       (2) a report on challenges and deficiencies related to the 
     oversight of, and care for, unaccompanied alien children and 
     appropriately reuniting such children with their parents or 
     guardians, and the actions taken to address any challenges 
     and deficiencies related to unaccompanied alien children in 
     the custody of the Department of Health and Human Services, 
     including deficiencies identified and publicly reported by 
     Congress, the Government Accountability Office, or the 
     inspectors general of the Department of Health and Human 
     Services or other Federal departments.

     SEC. 705. TECHNICAL AMENDMENTS.

       (a) Public Health Service Act.--Title III (42 U.S.C. 241 et 
     seq.) is amended--
       (1) in paragraphs (1) and (5) of section 319F-1(a) (42 
     U.S.C. 247d-6a(a)), by striking ``section 319F(h)'' each 
     place such term appears and inserting ``section 319F(e)''; 
     and
       (2) in section 319K(a) (42 U.S.C. 247d-7d(a)), by striking 
     ``section 319F(h)(4)'' and inserting ``section 319F(e)(4)''.
       (b) Public Health Security Grants.--Section 319C-1(b)(2) 
     (42 U.S.C. 247d-3a(b)(2)) is amended--
       (1) in subparagraph (C), by striking ``individuals,,'' and 
     inserting ``individuals,''; and
       (2) in subparagraph (F), by striking ``make satisfactory 
     annual improvement and describe'' and inserting ``makes 
     satisfactory annual improvement and describes''.
       (c) Emergency Use Instructions.--Subparagraph (A) of 
     section 564A(e)(2) of the Federal Food, Drug, and Cosmetic 
     Act (21 U.S.C. 360bbb-3a(e)(2)) is amended by striking 
     ``subsection (a)(1)(C)(i)'' and inserting ``subsection 
     (a)(1)(C)''.
       (d) Products Held for Emergency Use.--Section 564B(2) of 
     the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-
     3b) is amended--
       (1) in subparagraph (B), by inserting a comma after 
     ``505''; and
       (2) in subparagraph (C), by inserting ``or section 564A'' 
     before the period at the end.
       (e) Transparency.--Section 507(c)(3) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 357(c)(3)) is amended--
       (1) by striking ``Nothing in'' and inserting the following:
       ``(A) In general.--Nothing in'';
       (2) by inserting ``or directing'' after ``authorizing'';
       (3) by striking ``disclose any'' and inserting ``disclose--
       ``(i) any'';
       (4) by striking the period and inserting ``; or''; and
       (5) by adding at the end the following:
       ``(ii) in the case of a drug development tool that may be 
     used to support the development of a qualified 
     countermeasure, security countermeasure, or qualified 
     pandemic or epidemic product, as defined in sections 319F-1, 
     319F-2, and 319F-3, respectively, of the Public Health 
     Service Act, any information that the Secretary determines 
     has a significant potential to affect national security.
       ``(B) Public acknowledgment.--In the case that the 
     Secretary, pursuant to subparagraph (A)(ii), does not make 
     information publicly available, the Secretary shall provide 
     on the internet website of the Food and Drug Administration 
     an acknowledgment of the information that has not been 
     disclosed, pursuant to subparagraph (A)(ii).''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
California (Ms. Eshoo) and the gentlewoman from Indiana (Mrs. Brooks) 
each will control 20 minutes.
  The Chair recognizes the gentlewoman from California.


                             General Leave

  Ms. ESHOO. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on S. 1379.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from California?
  There was no objection.
  Ms. ESHOO. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise in support of this bipartisan legislation, the 
Pandemic and All-Hazards Preparedness and Advancing Innovation Act, 
fondly called PAHPA, so that is the way I am going to refer to it.
  In January of this year, the House passed a version of this 
legislation by a vote of 401-17. It was the first suspension that was 
considered in this new Congress, and so I am really very, very pleased 
that the Senate finally took up this critical legislation and sent it 
back to the House for us to consider once again.
  The bill strips out an unrelated issue that the Senate had to 
struggle with, and it simply includes the public health emergency and 
response legislation that my wonderful partner, Representative Susan 
Brooks, and I have worked on for over a year. Imagine how relieved we 
are and thrilled we are to be on the floor today with this. Our 
legislation reflects months of negotiations and compromise reached by 
the House and Senate.
  We know the importance of the bill we are considering today, and it 
actually is critical to our national security.
  In 2001, our country endured the horrific attacks on September 11 and 
the anthrax attacks that followed shortly thereafter. Congress realized 
at that time that our country was not prepared to coordinate responses 
to mass casualty events or chemical attacks, and it is why I wrote the 
legislation with then-Representative Richard Burr to address these 
shortfalls. This bill updates that original legislation by directing 
Federal agencies to respond to new and emerging threats and also 
strengthen our Nation's existing preparedness and response programs.
  This bill reauthorizes critical programs that ensure our Nation is 
prepared to respond to naturally occurring and manmade disasters. 
Events over the past few years--the ongoing measles outbreak, 
destructive wildfires and hurricanes, and the reemergence of Ebola--as 
well as the constant looming threat of a biological attack by another 
nation or a hostile state enemy underscore the importance of this 
legislation.
  These threats are real, and our country must be prepared to 
adequately respond to them. Our experience with each one of those 
hazards reminds us that our country is not yet adequately prepared to 
deal with potentially devastating, widespread public health crises. 
That is why this legislation is so critical, and this reauthorization 
meets the challenges that we face today and those we anticipate facing 
in the future.
  The bill provides the authorization and Federal resources to invest 
in programs that allow the Biomedical Advanced Research and Development 
Authority, or BARDA, to develop medical countermeasures for use after a 
public health emergency and to address antimicrobial resistance. PAHPA-
I reauthorizes the HHS National Advisory Committee on Children and 
Disasters and also authorizes the Children's Preparedness Unit at the 
CDC.
  It also establishes an advisory council for people with disabilities 
and an advisory council on seniors to focus on the needs of these 
special populations during a public health emergency.

                              {time}  1445

  It also, very importantly, includes a proposal to prioritize bringing 
nursing homes back onto the power grid at the same time as hospitals 
after a disaster, and it includes provisions related to regional health 
partnerships, pregnant and postpartum women, and environmental health.
  PAHPA expired last September 30--that is, September 30 of 2018--so 
reauthorizing these programs is imperative to our national security.
  Madam Speaker, I am proud of the legislation. I urge my colleagues to 
once again vote for it.
  I have said this many times, but it is worth restating again: I 
salute and couldn't have had a better, more dedicated partner in this 
effort than Congresswoman Susan Brooks. We look forward to the bill 
going directly to the President's desk and being signed into law so we 
can get to work on other things.
  Madam Speaker, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Madam Speaker, I yield myself such time as I 
may consume.

[[Page H4263]]

  Madam Speaker, I rise today in support of the Pandemic and All-
Hazards Preparedness and Advancing Innovation Act of 2019, or PAHPA.
  I am proud to have worked with my dear friend and colleague from 
California, Representative Eshoo, who was one of the original authors 
and a leader in the 2006 PAHPA bill and the lead author of the last 
reauthorization in 2013.
  Along with Representative Eshoo, this work would not have been done 
without Chairman Pallone, Ranking Member Walden, and Representative Dr. 
Burgess. We have worked closely with Senators Burr, Alexander, Casey, 
and Murray to craft this reauthorization of PAHPA.
  PAHPA is a bipartisan public health and national security effort to 
ensure our Nation is better prepared to respond to public health 
emergencies resulting from chemical, biological, radiological, or 
nuclear attacks, whether it be from a terrorist group or nation-state, 
a natural disaster or emerging infectious diseases.
  I was the United States attorney for the Southern District of Indiana 
during the 2001 anthrax attacks. In September of `01, shortly after 9/
11, the anthrax attacks infected more than 17 people and killed 5.
  Not only was Congress a target, with letters containing anthrax 
spores sent to Senators Daschle and Leahy, but even my own U.S. 
attorney's office in Indiana dealt with a hoax when we received a 
letter with powder inside.
  It was a scary time because those types of letters were sent all 
across the country. It was a very scary time for our Nation, the hoaxes 
that I and others received, but it helped illustrate the importance of 
having accurate diagnostics.
  In the 18 years since then, these types of threats--the actual 
threats of chemical, biological, radiological, and nuclear--continue to 
grow. In fact, every day, our adversaries are looking for more 
effective and faster ways to produce a threat. It is not a question of 
if we will face a threat; it is a question of when.
  People may not realize, but a single gallon of concentrated anthrax 
can contain enough spores to kill every individual on the planet.
  According to a 2017 report from the Harvard Kennedy School, the 
Belfer Center for Science and International Affairs, in 2015, the North 
Korean State media released a series of photographs of the Pyongyang 
Biotechnical Institute. The photos revealed that North Korea could 
produce military-sized batches of biological weapons--specifically, 
anthrax--at this facility.
  North Korea is believed to have started a biological weapons program 
in the sixties and is now assumed to have several pathogens in 
possession.
  Smallpox is highly contagious, and individuals remain contagious 
until that last smallpox scab falls off. Untreated smallpox is twice as 
contagious as the flu and more than three times as deadly, potentially 
killing every third person infected.
  But, thanks to PAHPA and the work of the Energy and Commerce 
Committee with the 21st Century Cures Act, we are more prepared for 
biological threats and attacks. Last year, the FDA approved the first 
drug ever to treat smallpox and approved an autoinjector which provides 
that one-time dose of an antidote to block the effects of nerve agents. 
The approval of TPOXX and Seizalam will help protect Americans from 
biological attacks.
  But the threats we are facing are not hypothetical. The ongoing Ebola 
outbreak--and it is ongoing--is now the second largest outbreak in 
history. Since August of 2018, more than 1,000 people in the DRC, 
Democratic Republic of the Congo, have died from Ebola. More than 2,000 
cases have been reported, with 14 new, confirmed cases just within the 
last week.
  We also know that Zika virus continues to be a threat. The majority 
of people infected with Zika don't develop symptoms, but the Zika 
infection during pregnancy can cause horrible congenital abnormalities. 
Eighty-six countries have reported evidence of mosquito-transmitted 
Zika.
  I share this because of the threats like Ebola and Zika. 
Reauthorizing and increasing funding for the BioShield Special Reserve 
Fund and BARDA, the Biomedical Advanced Research and Development 
Authority, are critically important.
  PAHPA increases funding for BARDA from $2.8 billion to $7.1 billion 
over 10 years because BARDA's work over the last decade has resulted in 
FDA approvals of more than 42 different medical countermeasures.
  Development of medical countermeasures is lengthy. It is a risky 
endeavor. It is why sending a clear signal that BARDA remains a strong 
and committed partner with academic institutions and the private sector 
in these efforts is so important.
  So, while the investments BARDA is making into innovative research 
and new treatments are critical, it is also important that we continue 
to address the threats that have been around for years.
  In 1918, the pandemic influenza killed about 20 to 50 million people 
around the globe, including 675,000 people here in the United States. 
Experts predict we are due for another global pandemic influenza.

  Research funded by BARDA has already significantly expanded our 
domestic vaccine production capability, and the bill we are considering 
today will authorize $250 million more for the Assistant Secretary for 
Preparedness and Response, or the ASPR, to address threats like 
pandemic influenza.
  Specifically, PAHPA directs the ASPR to work to increase 
manufacturing capacity and stockpile these medical countermeasures. 
While the PAHPA bill we are considering today authorizes funding for 
research into known threats like pan flu, it maintains the flexibility 
that is the foundation of our medical countermeasure enterprise to deal 
with the unknown threats for which we may have no defense.
  PAHPA also improves State and local public health security by 
reauthorizing the National Disaster Medical System so that we have the 
needed workforce, the experts in the workforce, when facing a public 
health emergency like we currently face right now with 981 measle cases 
across 26 States.
  The current number of measles cases is the highest number of cases in 
the United States in nearly three decades, with just 41 new cases 
reported last week. So this allows the ASPR to reassign and move health 
professionals during public health emergencies.
  PAHPA also ensures a coordinated healthcare response to natural 
disasters. The many hurricanes--Florence, Harvey, Irma, Jose, and 
Maria--killed hundreds of Americans and showed us we have to do better 
to prioritize the needs of every person in our community. PAHPA does 
that by prioritizing our most vulnerable populations: children, 
seniors, and people with disabilities.
  We can't forget about the volunteers who work to save lives in the 
wake of natural disasters. In addition to Good Samaritan provisions 
within PAHPA that will provide new liability protections for medical 
professionals who volunteer after a disaster, this bill also ensures 
that more healthcare professionals, like nurses and doctors, can be 
hired and trained when facing a public health crisis by strengthening 
our National Disaster Medical System.
  And, very importantly, it ensures we have a robust supply of 
vaccines; basic equipment like gloves, Hazmat suits, and masks; and 
more in our strategic national stockpile located all across the country 
so that these professionals have the equipment and the tools that they 
need.
  Finally, PAHPA includes provisions from the Subcommittee on Health 
Ranking Member Burgess' MISSION ZERO bill. Today will be the fifth time 
the House has passed these provisions that authorize grants to trauma 
centers to enable military trauma teams to provide care at our centers.
  These important provisions will integrate military trauma providers 
into trainings and drills for public health emergencies to not only 
allow civilians the chance to learn about the military's best 
practices, but give our military trauma care providers the opportunity 
to use their cutting-edge expertise without leaving the military.
  This public health, national security bill is the result of months of 
work, and I want to commend the Energy and Commerce staff on both sides 
of the aisle and, particularly, our staffs--Catherine Knowles and 
Rachel Fybel--for their tireless work in ensuring that this got through 
both the House and the Senate.

[[Page H4264]]

  Madam Speaker, I cannot emphasize enough how important it is to 
reauthorize PAHPA. I urge all Members to support this piece of critical 
legislation, and I reserve the balance of my time.
  Ms. ESHOO. Madam Speaker, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Madam Speaker, I yield 3 minutes to the 
gentleman from Oregon (Mr. Walden), ranking member of the Committee on 
Energy and Commerce. He had been chair at one time, when it passed one 
time out of the House, but now is ranking. I want to thank him so much 
for his work.
  Mr. WALDEN. Madam Speaker, I thank both my friend from California and 
my friend from Indiana, who really did amazing work on this 
legislation--not once, but twice, and probably a few times in between--
to get it to this point.
  I am delighted to stand on this House floor once again and support 
PAHPA, the Pandemic and All-Hazards Preparedness and Advancing 
Innovation Act.
  This is really important. I think my colleagues have spoken of the 
specific reasons that we can talk about here on the House floor. In the 
classified settings that we have had, we all know how serious this 
threat is and how important it is for us to work together to address 
it, and we have done that in the last Congress and now in this 
Congress.
  So, I want to thank my friend Mr. Pallone, who chairs the committee 
now, for continuing this effort to advance this bill forward, and 
especially thank Representatives Brooks and Eshoo for their tireless 
work to really get this across the finish line.
  PAHPA does enable critical partnerships between the Federal 
Government and State and local authorities and the private sector. This 
will help ensure that our country is responsibly prepared for and able 
to respond to public health emergencies.
  It is not a matter of if, as everyone said already, but when the next 
pandemic or emergency will strike. From pandemic flu to cybersecurity 
incidents, our government agencies at all levels must have the tools to 
respond to these threats, and we must make sure they have them.
  In my own State of Oregon, we face a constant threat from wildfires, 
floods, air quality issues, and other things. But we also have begun to 
prepare for what we are told will be a devastating earthquake at some 
point, known as Cascadia, which could take thousands of lives in Oregon 
and leave behind tens of billions of dollars worth of damage and 
disable our major airport, take down bridges. Basically, everybody on 
the west side of the State would have to come over to the east side. 
This is predicted. Earthquakes have happened before; recorded history 
shows it; and we are overdue.

  So this is the kind of legislation that would help. It would make 
sure that they can put a pallet load of the right drugs and medicines 
on a plane and get it right there, and they will have a system all 
ready to distribute that. That is just one of many things that this 
legislation accomplishes.
  Sending this to the President's desk is long overdue. I am glad we 
are going to have this vote today. Our government officials need these 
tools at their disposal, and I thank my colleagues for the terrific 
work they have done to get us to this point.
  Mrs. BROOKS of Indiana. Madam Speaker, I yield 3 minutes to the 
gentleman from Georgia (Mr. Carter), a fellow Energy and Commerce 
Committee member, the only pharmacist in Congress, who knows more about 
these issues than most. I appreciate his partnership and work on this 
important piece of legislation.
  Mr. CARTER of Georgia. Madam Speaker, I thank the gentlewoman for 
yielding.
  Madam Speaker, I rise today in support of the Pandemic and All-
Hazards Preparedness and Advancing Innovation Act, also known as PAHPA.
  It is a good thing we are here to vote on this bill today, but the 
work on this issue has been going on for a while.
  We held reauthorization hearings in the Energy and Commerce Committee 
in June of last year and were able to pass the bill through the 
committee and out of the House shortly thereafter.
  We again passed PAHPA in January, which has continued to be 
championed by my good friend Mrs. Brooks of Indiana.
  PAHPA is important legislation that will improve our Nation's public 
health, medical preparedness, and response capabilities for 
emergencies. Whether it is a natural disaster, an accidental 
catastrophe, or a deliberate act of terror, it is the contents of this 
bill that will keep Americans safe.
  This bill will upgrade our preparedness by boosting our domestic 
biological surveillance systems and help upgrade our medical 
countermeasures.
  This bill also takes a particular look at how we address 
antimicrobial resistance so we can help protect future generations from 
the threat of widespread pandemic.

                              {time}  1500

  Living on the Georgia coast, my district understands the threat of 
natural disasters in the form of hurricanes all too well. This bill 
improves our disaster response coordination, so we minimize the human 
toll of these deadly storms.
  Since funding expired on September 30th of last year, the House has 
voted multiple times to reauthorize PAHPA. I look forward to President 
Trump signing this vital, lifesaving legislation into law.
  I urge my colleagues to support this legislation.
  Mrs. BROOKS of Indiana. Madam Speaker, I am prepared to close.
  I yield myself such time as I may consume.
  Madam Speaker, I appreciate my colleagues for speaking out and their 
support of this important legislation.
  The provisions in PAHPA we are reauthorizing today do complement the 
National Biodefense Strategy the administration released last fall, and 
it will ensure that our Nation is better prepared. The administration's 
National Biodefense Strategy is designed to improve the coordination 
and communication between agencies, so the United States is better 
protected against naturally-occurring threats, or whether they might be 
deliberate attacks.
  Again, I urge my colleagues to support this critical piece of 
legislation. It would not have been possible but for the incredible 
partnership of Congresswoman Eshoo and the leadership that she and her 
office and the Energy and Commerce Committee has demonstrated in this 
very important piece of public health and national security 
legislation.
  Madam Speaker, I yield back the balance of my time.
  Ms. ESHOO. Madam Speaker, I yield myself such time as I may consume.
  I would just like to make a few comments in closing because I don't 
have any more speakers and assert my right to close last.
  I think every good word that could be said about this legislation has 
already been stated, so I want to urge all of my colleagues to vote 
``aye'' on this. It is legislation that has been scrutinized and re-
scrutinized, and even though it has taken time and gone past its 
reauthorization date, that makes it all the more important that it be 
passed because the agencies really cannot do what we have been 
describing, and this has gone on since last October.
  I think that the bookends on this are national security and public 
health preparedness for manmade disasters and others, and neither one 
of these can be addressed by any individual. This has to be done by us 
on behalf of our country.
  So I want to thank Catherine Knowles for her very fine work in 
working with Rachel Fybel from my office. We really pay tribute to you 
because they have worked so hard every single day, not just for weeks, 
not just for months, but well over a year to get us to this point.
  I urge all colleagues to support this legislation. We are proud to 
recommend it to them.
  Madam Speaker, I yield back the balance of my time,
  Ms. JACKSON LEE. Madam Speaker, I rise in strong support of S. 1379, 
the ``Pandemic and All-Hazards Preparedness and Advancing Innovation 
Act of 2019'' (PAHPAI), which increases our essential efforts to ensure 
the United States is prepared to respond to national disasters and 
crises.
  After the horrific terrorist attacks of September 11, 2001 and the 
preceding anthrax attacks, Congress recognized that the United

[[Page H4265]]

States was underprepared to respond to public health emergencies and 
national disasters and passed the original Pandemic and All-Hazards 
Preparedness Act, Pub. L. 109-417 to address this weakness.
  PAHPAI was reauthorized in 2013, but in recent years, the threats to 
our country have changed, and PAHPAI must be updated to ensure that we 
are prepared to respond to increasing natural disasters, emerging 
infectious diseases, and chemical, biological, and nuclear attacks.
  S. 1379 has been adapted to meet the mounting challenges that face us 
today and those that will face our children tomorrow.
  As a biodefense bill, PAHPAI will further protect our country from 
internal and external terrorists.
  As a health care response bill, PAHPAI creates and ensures 
coordinated healthcare efforts in the face of natural disasters such as 
hurricanes.
  This bill also addresses the nation's need for pandemic preparedness.
  Texas has experienced pandemics first hand--with the first diagnosed 
case of Ebola in the United States in 2014.
  Thomas Eric Duncan after traveling from Africa to visit family 
members in Dallas, Texas became ill.
  He went to Texas Health Presbyterian Hospital Dallas for care but was 
not admitted after presenting with a 103-degree temperature, and Ebola 
symptoms.
  At the time the CDC had alerted all doctors, hospitals, clinics, and 
pharmacies with alerts to screen all patients for Ebola symptoms.
  Mr. Duncan's Ebola symptoms worsened over the days following his 
visit to Texas Health Presbyterian Hospital Dallas, and he returned by 
ambulance to the hospital and only then was he finally admitted for 
treatment.
  By that time his condition had worsened, and Mr. Duncan died from 
Ebola.
  His death was a tragedy and the two nurses who were infected while 
trying to care for him are heroes.
  Two years later, in 2016, the Zika Virus pandemic reached Texas 
carried by mosquitoes.
  This disease attacked babies while developing in their mother's womb, 
which destroyed brain tissue, resulting in severe brain and cranial 
deformities.
  Houston, Texas, has a tropical climate with many climatic 
similarities with other states along the Gulf Coast, parts of Central 
and South America as well as the Caribbean. Tropical climates are 
hospitable to mosquitoes that carry the Zika Virus.
  I have shared concerns among Federal, state, and local agency 
officials regarding a need to have a plan to address future pandemics 
our nation may face.
  This bill will pave the way for much needed work in pandemic 
preparedness.
  PAHPAI will ensure that more health care professionals can be hired 
and trained to prioritize vulnerable populations such as children, the 
elderly, and people with disabilities.
  To incentivize and protect practitioners, this bill will also provide 
health care professionals who volunteer after natural disasters with 
liability coverage.
  To support disaster workers and devastated communities, PAHPAI will 
also ensure the availability of health care supplies by stocking the 
Strategic National Stockpiles, located across the United States, with 
vaccines, gloves, masks, and more.
  PAHPAI also renews and increases funding to the BioShield Special 
Reserve Fund and Biomedical Advanced Research and Development Authority 
(BARDA), which is invaluable to our response capabilities.
  S. 1379 is essential to ensuring that the United States is prepared 
to provide quality care to those in need after devastating events.
  Madam Speaker, I urge my colleagues to join me in supporting S. 1379 
to establish and strengthen the nation's emergency preparedness in the 
face of health crises and national disasters.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from California (Ms. Eshoo) that the House suspend the 
rules and pass the bill, S. 1379.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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