[Senate Report 106-505]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 952
106th Congress                                                   Report
                                 SENATE
 2d Session                                                     106-505

======================================================================



 
               PUBLIC HEALTH THREATS AND EMERGENCIES ACT

                                _______
                                

October 18 (legislative day September 22), 2000.--Ordered to be printed

                                _______
                                

   Mr. Jeffords, from the Committee on Health, Education, Labor, and 
                   Pensions, submitted the following


                              R E P O R T

                         [To accompany S. 2731]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 2731) to amend title III of the 
Public Health Service Act to enhance the Nation's capacity to 
address public health threats and emergencies, having 
considered the same, reports favorably thereon with amendments 
and recommends that the bill (as amended) do pass.




                                CONTENTS

                                                                   Page
  I. Purpose and summary..............................................1
 II. Background and need for the legislation..........................2
III. History of the legislation.......................................4
 IV. Explanation of the bill and committee views......................4
  V. Cost estimate....................................................6
 VI. Regulatory impact statement......................................6
VII. Application of law to the legislative branch.....................6
VIII.Section-by-section analysis......................................6

 IX. Changes in existing law..........................................8

                         I. Purpose and Summary

    The Public Health Threats and Emergencies Act provides 
greater resources and better coordination to strengthen public 
health infrastructure and address the threats of antimicrobial 
resistance and bioterrorism and improve our preparedness. The 
Public Health Threats and Emergencies Act produces a more 
unified public health system by reinforcing the public health 
infrastructure. By improving national, State, and local public 
health core capacities, the Nation's front line against 
emerging public health threats, such as antimicrobial 
resistance and the possibility of a bioterrorist attack, will 
in turn be strengthened.
    To bolster public health agencies' core capacities, the 
Public Health Threats and Emergencies Act authorizes: the 
development of voluntary performance goals for public health 
systems; grants to public health agencies to conduct 
assessments and build core capacities to achieve these goals; 
and funding to rebuild and remodel the facilities of the 
Centers for Disease Control and Prevention.
    To strengthen public health capacities to combat 
antimicrobial resistance, the Act authorizes: a task force to 
coordinate Federal programs related to antimicrobial resistance 
and to improve public education on antimicrobial resistance; 
research into the development of new therapeutics against and 
improved diagnostics for resistant pathogens; and grants for 
activities to specific capacities to detect, monitor, and 
combat antimicrobial resistance.
    To strengthen public health capacities to prevent and 
respond to bioterrorism, the act authorizes: two 
interdepartmental task forces to address joint issues of 
research needs and the public health and medical consequences 
of bioterrorism; NIH and CDC research on the epidemiology of 
bioweapons and the development of new vaccines or therapeutics 
for bioweapons; and grants to public health agencies and 
hospitals and care facilities to detect, diagnose, and respond 
to bioterrorism.

              II. Background and Need for the Legislation

    Over the last 2 years, the Public Health Subcommittee has 
held three hearings, ``Global Health: U.S. Response to 
Infectious Diseases'' (March 2, 1998);'' Antimicrobial 
Resistance: Solutions for This Growing Public Health Threat'' 
(February 25, 1999); ``Bioterrorism: Our Frontline Response, 
Evaluating U.S. Public Health and Medical Readiness'' (March 
25, 1999); a forum, ``Killer Microbes: Will Anything Work? 
Drug-Resistant Strains and the Increasing Threat to Public 
Health'' (December 14, 1998) on the topic of infectious 
disease; and commissioned U.S. General Accounting Office (GAO) 
report on antimicrobial resistance, Emerging Infectious 
Diseases: Consensus on Needed Laboratory Capacity Could 
Strengthen Surveillance. The outcome of this research is clear: 
our public health infrastructure needs to improved to respond 
in a timely and effective manner to these and other public 
health threats.
    For too long, adequate funding and resources to maintain 
and improve the core capacities of our nation's public health 
infrastructure has not been provided. As the GAO report found, 
many State and local public health agencies lack even the most 
basic equipment such as computers and facsimile machines to 
assist their workload and improve communications. The report 
states:

          Surveillance and testing for important emerging 
        infectious diseases are not comprehensive in all 
        states, leaving gaps in the nation's infectious 
        diseases surveillance network.

    Additionally, inadequate staffing, information-sharing 
problems, a need for training, and a lack of core capacities 
add to the problems faced by public health agencies.
    The Nation's public health infrastructure must be 
reinforced by strengthening our Federal and local public health 
departments. These departments need updated laboratories, 
facilities, equipment, communication systems, and training of 
personnel. This need can be seen as the tremendous successes 
our Nation has experienced in public health are being countered 
by the emergence of new pathogens such as West Nile Virus and 
hantavirus and the re-emergence of adversaries such as 
tuberculosis and malaria that were once thought to be 
conquered.
    A prime example of an emerging public health threat is 
antimicrobial resistance. For most of human history, infections 
were the scourge of man's existence causing debilitating 
disease and often death. Antibiotics, initially discovered more 
than 50 years ago, quickly became the most lethal weapon in the 
crusade against disease-causing bacteria. Antibiotics were 
widely dispensed and, in the 1970's premature optimism led to a 
declaration that the war on infections had been won.
    Unfortunately, scientists discovered that bacteria are 
resilient organisms that swiftly developed resistance to 
antibiotics and adapted to drug-rich environments. Antibiotics, 
once heralded as miracle drugs, are increasingly coming up 
against resistant bacteria which are not killed by most first-
line antimicrobials. In fact, the New England Journal of 
Medicine has reported that certain Staphylococci, which are a 
common cause of post-surgical and hospital acquired infections, 
are showing intermediate resistance to vancomycin, an 
antibiotic of the last resort. Just this past April, the Food 
and Drug Administration (FDA) approved the first entirely new 
type of antibiotic in 35 years.
    In addition, the art of medicine has evolved, creating new 
opportunities for bacteria to cause infection from invasive 
procedures using catheters to organ transplant recipients who 
are treated with immunosuppressive agents to prevent rejection. 
As a result, we are seeing more life-threatening infections 
that require concurrent treatment with several antibiotics. To 
make matters worse, we are seeing infections that were on the 
decline, such as tuberculosis and malaria, re-emerging in an 
antimicrobial resistant form.
    While antimicrobial resistance is a serious public health 
threat, it is not the only one that can possibly test the 
strength of our public health system. Experts believe that a 
major bioterrorist attack is no longer a question of ``IF'' but 
rather a question of ``WHEN''. As a nation we are presently 
more vulnerable to bioweapons than other more traditional means 
of warfare. Bioweapons pose considerable challenges that are 
different from those of standard terrorist devices, including 
chemical weapons.
    The mere term ``bioweapon'' invokes visions of immense 
human pain and suffering and mass casualties. Contrastingly, 
victims of a covert bioterrorist attack do not necessarily 
develop symptoms upon exposure to the bioagent, as development 
of symptoms may be delayed until long after the bioweapon is 
dispersed.
    As a result, exposed individuals will most likely show up 
in emergency rooms, physician offices, or clinics, with 
nondescript symptoms or ones that mimic the common cold or flu. 
In all likelihood, physicians and other health care providers 
will not attribute these symptoms to a bioweapon. If the 
bioagent is communicable, such as smallpox, many more people 
may be infected in the interim, including our health care 
workers. Stephanie Bailey, the Director of Health for 
Metropolitan Nashville and Davidson County, stated during the 
Public Health Subcommittee's March 25, 1999, hearing on 
bioterrorism, ``many localities are on their own for the first 
24 to 48 hours after an attack before Federal assistance can 
arrive and be operational. This is the critical time for 
preventing mass casualties.''
    The Public Health Threats and Emergencies Act is designed 
to improve the Nation's basic capacities to address emerging 
public health threats, including antimicrobial resistance and 
bioterrorism.

                    III. History of the Legislation

    The Public Health Threats and Emergencies Act of 2000 was 
introduced on June 14, 2000, by Senators Frist and Kennedy. The 
bill was referred to the Senate Committee on Health, Education, 
Labor, and Pensions.
    On September 20, 2000, the Senate Committee on Health, 
Education, Labor and Pensions held an executive session to 
consider S. 2731. Senators Frist and Kennedy offered a 
technical amendment that was accepted without objection. S. 
2731 was ordered reported favorably by a unanimous voice vote.

            IV. Explanation of the Bill and Committee Views

    The committee seeks to strengthen our national, state, and 
local public health infrastructure in order to be able to 
respond to current and future public health threats. The 
committee is concerned that, currently, many local and State 
health departments would not be able respond rapidly and 
efficiently to an outbreak of drug resistant tuberculosis or 
smallpox in their community, because they do not even have 
necessary resources such as a facsimile machine or access to e-
mail by which to communicate or sufficient laboratory equipment 
to make an accurate diagnosis. The committee found that the 
public does not recognize the vital role of our public health 
systems. According to a poll conducted last year by the Mellman 
Group, only 16 percent of respondents correctly identified the 
public health system's role in protecting the public from 
disease. The committee intends that this legislation will 
improve national, State, and local public health core 
capacities, which will in turn strengthen the Nation's front 
line against emerging public health threats such as 
antimicrobial resistance and the possibility of a bioterrorist 
attack.
    The committee also seeks to address two specific emerging 
public health threats, antimicrobial resistance and 
bioterrorism.

Section 391B: Assessment of public health needs

    The committee expects that the Secretary and state and 
local public health officials will collaborate to develop 
commonly accepted assessment methods that facilitate comparison 
of the assessments performed by grantees under this section.

Section 319C: Grants to improve state and local public health agencies

    The committee believes that a regional approach to 
developing public health capacities is often desirable and thus 
encourages, where appropriate, groups of States or political 
subdivisions of States to form consortia, which may apply for 
grants under this section. Laboratory facilities in particular 
may benefit from a regional approach, whereby the public health 
laboratory of one State or political subdivision of a state may 
serve as a reference laboratory of one State or political 
subdivision of a state may serve as a reference laboratory for 
the surrounding region, thus eliminating unnecessary purchases 
of sophisticated and expensive laboratory equipment.
    The committee anticipates that as more States perform 
assessments under section 319B, there will be an increasing 
number of entities eligible for grants under this section in 
fiscal years 2002 through 2006 and thus expenditures under this 
section will rise in future fiscal years.

Section 319D: Revitalizing the Centers for Disease Control and 
        Prevention

    The committee finds that the Centers for Disease Control 
and Prevention (CDC) require secure and modern facilities to 
defend against and combat public health threats. Many buildings 
at CDC were built for temporary use during or just after World 
War II, but are still being used and are consequently in great 
disrepair. Research on dangerous infectious agents is conducted 
in laboratories with poor security, and CDC has been required 
to lease facilities scattered throughout the Atlanta area 
instead of being able to bring its researchers together in one 
central set of facilities. The committee anticipates that under 
this section CDC will be able to build and renovate 
laboratories and facilities to ensure its ability to safely and 
securely respond to America's public health needs.

Section 319E: Combating antimicrobial resistance

    The committee expects that the currently operating 
Interagency task force on antimicrobial resistance will 
continue and extend the work it has already done on this 
important issue. It is not the intention of the committee to 
require a new task force to be established, nor to require the 
current task force to repeat or duplicate any activities 
previously undertaken.
    The committee expects that electronic networks developed 
under this section will, to the greatest extent practicable, 
complement and be compatible with those developed by grantees 
under section 319C. It is the committee's intention to 
stimulate the development of nationally integrated data sharing 
networks, rather than separate or mutually incompatible 
systems.

Section 319F: Public health countermeasures to a bioterrorist attack

    While recognizing that medical and public health personnel 
will likely provide much of the first response to a 
bioterrorist attack, the committee expects that the working 
group on public health and medical consequences of bioterrorism 
attack and assure the quality of joint training programs 
between emergency response personnel and public health 
agencies, hospitals, and primary care facilities. Although the 
working group on readiness and the working group on consequence 
management for a bioterrorist attack are separate entities, the 
committee expects that the Secretary of HHS will ensure 
adequate coordination and communication between the two groups.
    The committee believes that a regional approach to 
developing public health capacities is often desirable and thus 
encourages, where appropriate, groups of States or political 
subdivisions of States to form consortia, which may apply for 
grants under this section. The committee expects that 
electronic networks developed under this section will, to the 
greatest extent practicable, complement and be compatible with 
those developed by grantees under sections 319C and 319D. It is 
the committee's intention to simulate the development of 
nationally integrated data sharing networks, rather than 
separate or mutually incompatible systems.

                            V. Cost Estimate

    Due to time constraints the Congressional Budget Office 
estimate was not included in the report. When received by the 
committee, it will appear in the Congressional Record at a 
later time.

                    VI. Regulatory Impact Statement

    The committee has determined that there will be no 
increases in the regulatory burden of paperwork as a result of 
this bill.

           VII. Application of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1, the Congressional 
Accountability Act (CAA), requires a description of the 
application of the bill to the legislative branch. S. 2731 
amends title III of the Public Health Service Act to enhance 
the Nation's capacity to address public health threats and 
emergencies. This bill does not apply to the legislative 
branch.

                   VIII. Section-by-Section analysis


Section 1: Short title

    This act may be cited as ``The Public Health Threats and 
Emergencies Act of 2000''

Section 2: Amendments to the Public Health Service Act

    The act updates Section 319 of the Public Health Service 
Act and adds new provisions, sections 319A through 319F.
    The act maintains section 319, which authorizes the 
Secretary of Health and Human Services (HHS) to take actions 
needed to protect the public health in the event of a public 
health emergency, such as a significant outbreak of infectious 
disease or an act of bioterrorism. The section also re-
establishes in the Treasury a fund to be designated as the 
``Public Health Emergency Fund'' to be made available to the 
Secretary only in the event of a public health emergency. The 
Secretary is required to report to Congress on expenditures 
from this fund.
    Section 319A requires the Secretary, within a year of the 
act's enactment, to develop, in collaboration with state and 
local health officials, reasonable capacities that are 
appropriate for national, State, and local public health 
departments. These core capacities should focus on enhancing 
the ability of public health agencies to detect and respond 
effectively to significant public health threats, including 
major outbreaks of infectious disease, pathogens resistant to 
antimicrobial agents, and acts of bioterrorism. The section 
also authorizes an appropriation of $4 million for what the 
committee anticipates will be a 1-year process of developing a 
consensus definition of these capacities.
    Section 319B authorizes the Secretary of HHS to award 
grants to States or political subdivisions of states to allow 
them to assess their ability to attain the capacities defined 
via the consensus process established by section 319A. Grantees 
are authorized to subcontract with an outside entity, such as a 
school of public health, to perform these assessments. This 
section requires grantees to report, within 1 year of receiving 
grants under this section, to the Secretary on the results of 
the assessments conducted using granted funds. Section 319B 
also authorizes an appropriation of $45 million for fiscal year 
2001 and such sums as may be necessary for fiscal years 2002 
and 2003. The committee anticipates that assessments performed 
under this section will be completed by the end of fiscal year 
2003.
    Section 319C authorizes the Secretary to award, on a 
competitive basis, grants to States or political subdivisions 
of States that have conducted an assessment of their needs, 
either using funds granted under section 319B or having 
conducted substantially similar assessments prior to the 
passage of this act. This section provides a list of activities 
which may be funded under this section, including training 
public health personnel, enhancing electronic data sharing 
networks, developing plans for responding to public health 
emergencies, and improving laboratory facilities. This section 
also requires the Secretary by January 1, 2005, to report to 
Congress on expenditures under this section and authorizes an 
appropriation of $50 million for fiscal year 2001 and such sums 
as may be necessary in fiscal year 2002 through 2006.
    Section 319D authorizes appropriations for constructing or 
renovating facilities at CDC. These may include laboratories, 
laboratory support buildings, health communication, or 
information centers, or office facilities. Section 319D 
authorizes an appropriation of $180 million in fiscal year 2001 
and such sums as may be necessary for fiscal years 2002 through 
2010.
    Section 319E provides statutory authorization for the 
interagency task force on antimicrobial resistance that 
currently exists at HHS, and requires this task force to seek 
input from outside experts in a variety of fields relevant to 
antimicrobial resistance. This section requires the Secretary, 
in collaboration with the task force, to develop, or improve a 
surveillance plan and electronic data sharing networks for 
monitoring antimicrobial resistance. This section also 
authorizes the Directors of National Institutes of Health 
(NIH), CDC, and the Agricultural Research Service to conduct 
research programs in areas relevant to antimicrobial 
resistance. Section 319E requires the Secretary to conduct 
educational programs to increase the awareness of the public 
about the dangers of antimicrobial resistance and to inform 
health care professionals about the prudent use of 
antimicrobials, as well as to educate laboratory personnel in 
recognizing resistant pathogens.
    Section 319E authorizes a program of competitive grants to 
State and local public health agencies to increase their 
ability to monitor and control antimicrobial resistance and 
provides activities, including providing training to public 
health personnel, developing policies to control the spread of 
resistant microbes, and developing or enhancing electronic 
systems for sharing data relevant to antimicrobial resistance. 
This section also authorizes grants for demonstration programs 
for hospitals, clinics, medical professional societies, and 
other nonprofit entities to promote judicious use of 
antimicrobial drugs or control the spread of resistant 
microbes. This section authorizes an appropriation of $40 
million for fiscal year 2001 and such sums as may be necessary 
for fiscal years 2002-2006.
    Section 319F authorizes the Secretary of HHS to establish a 
joint working group with the Secretary of Defense on readiness 
for a bioterrorist attack, focusing on the research and 
development needed to prepare for such as attack. This section 
authorizes the Secretary of HHS to establish a working group, 
comprised of the Secretary of HHS, the Director of Federal 
Emergency Management Agency (FEMA), the Attorney General, and 
the Secretary of Agriculture, on management of the consequences 
of a bioterrorist attack. This section authorizes grants or 
cooperative agreements to be awarded on a competitive basis to 
States or political subdivisions of States to increase their 
preparedness for the public health consequences of a 
bioterrorist attack. The section provides a list of activities 
that may be supported by such grants, including enhancing the 
training of health care personnel in recognizing the 
characteristics of a bioterrorist attack, identifying pathogens 
that may be used as biological weapons, coordinating medical 
care for victims of a bioterrorist attack, and facilitating the 
sharing of data among national, State, and local health 
agencies and health care providers.
    Section 319F requires the Secretary of HHS: to notify the 
Office of Justice Programs and the National Domestic 
Preparedness Office of the Department of Justice regarding 
grants awarded under this section; and to train health care 
professionals in diagnosing and providing medical care for the 
victims of a bioterrorist attack and to train laboratory 
personnel in recognizing pathogens likely to be used in a 
bioterrorist attack. The section requires grantees to 
coordinate their activities to the greatest extent practicable 
with those of a local Metropolitan Medical Response System to 
enhance local planning and response system capability to care 
for victims of a terrorist attack using biological weapons, and 
requires a GAO report on funds expended governmentwide for 
bioterrorism preparedness and an evaluation of the 
effectiveness of those expenditures. This section authorizes 
NIH and CDC to support research in areas relevant to preparing 
for a bioterrorist attack and provides a list of such 
activities. This section also authorizes an appropriation of 
$215 million for fiscal year 2001 and such sums as may be 
necessary for fiscal year 2002 through 2006.

                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



                       [public health emergencies

    [Sec. 319. (a) If the Secretary determines, after 
consultation with the Director of the National Institutes of 
Health, the Administrator of the Substance Abuse and Mental 
Health Services Administration, the Commissioner of the Food 
and Drug Administration, the Administrator of Health Resources 
and Services, or the Director of the Centers for Disease 
Control and Prevention, that--
          [(1) a disease or disorder presents a public health 
        emergency, or
          [(2) a public health emergency otherwise exists and 
        the Secretary has the authority to take action with 
        respect to such emergency,
the Secretary, acting through such Directors, Administrator, or 
Commissioner, may take such action as may be appropriate to 
respond to the public health emergency, including making grants 
and entering into contracts and conducting and supporting 
investigations into the cause, treatment, or prevention of 
disease or disorder described in paragraph (1).
    [(b)(1) There is established in the Treasury a fund 
designated the ``Public Health Emergency Fund'' to be available 
to the Secretary without fiscal year limitation to carry out 
subsection (a). There is authorized to be appropriated to the 
fund $30,000,000 for fiscal year 1984. For fiscal year 1985 and 
each fiscal year thereafter there is authorized to be 
appropriated to the fund such sums as may be necessary to have 
$45,000,000 in the fund at the beginning of such fiscal year.
    [(2) The Secretary shall report to the Committee on Energy 
and Commerce of the House of Representatives and the Committee 
on Labor and Human Resources of the Senate not later than 
ninety days after the end of a fiscal year--
          [(A) on the expenditures made from the Public Health 
        Emergency Fund in such fiscal year; and
          [(B) describing each public health emergency for 
        which the expenditures were made and the activities 
        undertaken with respect to each emergency which were 
        conducted or supported by expenditures from the Fund.]

SEC. 319. PUBLIC HEALTH EMERGENCIES.

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

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

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

SEC. 319B. ASSESSMENT OF PUBLIC HEALTH NEEDS.

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

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

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

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

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

SEC. 319E. COMBATING ANTIMICROBIAL RESISTANCE.

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

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

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

                                
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