[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.