I 

108TH CONGRESS 

1ST SESSION H. R. 2329

To provide for global pathogen surveillance and response. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 4, 2003

Mr. KIRK (for himself and Mrs. TAUSCHER) introduced the following bill; 

which was referred to the Committee on International Relations 

A BILL

To provide for global pathogen surveillance and response.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Global Pathogen Sur5 veillance Act of 2003’’. 

6 SEC. 2. FINDINGS; PURPOSE. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

9 (1) Bioterrorism poses a grave national security 

10 threat to the United States. The insidious nature of 

11 the threat, the likely delayed recognition in the event 

12 of an attack, and the underpreparedness of the do-
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1 mestic public health infrastructure may produce cat2 astrophic consequences following a biological weap3 ons attack upon the United States. 

4 (2) A contagious pathogen engineered as a bio5 logical weapon and developed, tested, produced, or 

6 released in another country can quickly spread to 

7 the United States. Given the realities of inter8 national travel, trade, and migration patterns, a 

9 dangerous pathogen released anywhere in the world 

10 can spread to United States territory in a matter of 

11 days, before any effective quarantine or isolation 

12 measures can be implemented. 

13 (3) To effectively combat bioterrorism and en14 sure that the United States is fully prepared to pre15 vent, diagnose, and contain a biological weapons at16 tack, measures to strengthen the domestic public 

17 health infrastructure and improve domestic surveil18 lance and monitoring, while absolutely essential, are 

19 not sufficient. 

20 (4) The United States should enhance coopera21 tion with the World Health Organization, regional 

22 health organizations, and individual countries, in23 cluding data sharing with appropriate United States 

24 departments and agencies, to help detect and quickly 
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1 contain infectious disease outbreaks or bioterrorism 

2 agents before they can spread. 

3 (5) The World Health Organization (WHO) has 

4 done an impressive job in monitoring infectious dis5 ease outbreaks around the world, including the re6 cent emergence of the Severe Acute Respiratory 

7 Syndrome (SARS) epidemic, particularly with the 

8 establishment in April 2000 of the Global Outbreak 

9 Alert and Response network. 

10 (6) The capabilities of the World Health Orga11 nization are inherently limited by the quality of the 

12 data and information it receives from member coun13 tries, the narrow range of diseases (plague, cholera, 

14 and yellow fever) upon which its disease surveillance 

15 and monitoring is based, and the consensus process 

16 it uses to add new diseases to the list. Developing 

17 countries in particular often cannot devote the nec18 essary resources to build and maintain public health 

19 infrastructures. 

20 (7) In particular, developing countries could 

21 benefit from—

22 (A) better trained public health profes23 sionals and epidemiologists to recognize disease 

24 patterns; 
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1 (B) appropriate laboratory equipment for 

2 diagnosis of pathogens; 

3 (C) disease reporting is based on symp4 toms and signs (known as ‘‘syndrome surveil5 lance’’), enabling the earliest possible oppor6 tunity to conduct an effective response; 

7 (D) a narrowing of the existing technology 

8 gap in syndrome surveillance capabilities and 

9 real-time information dissemination to public 

10 health officials; and 

11 (E) appropriate communications equip12 ment and information technology to efficiently 

13 transmit information and data within national 

14 and regional health networks, including inex15 pensive, Internet-based Geographic Information 

16 Systems (GIS) and relevant telephone-based 

17 systems for early recognition and diagnosis of 

18 diseases. 

19 (8) An effective international capability to mon20 itor and quickly diagnose infectious disease out21 breaks will offer dividends not only in the event of 

22 biological weapons development, testing, production, 

23 and attack, but also in the more likely cases of natu24 rally occurring infectious disease outbreaks that 

25 could threaten the United States. Furthermore, a
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1 robust surveillance system will serve to deter ter2 rorist use of biological weapons, as early detection 

3 will help mitigate the intended effects of such malev4 olent uses. 

5 (b) PURPOSE.—The purposes of this Act are as fol6 lows: 

7 (1) To enhance the capability and cooperation 

8 of the international community, including the World 

9 Health Organization and individual countries, 

10 through enhanced pathogen surveillance and appro11 priate data sharing, to detect, identify, and contain 

12 infectious disease outbreaks, whether the cause of 

13 those outbreaks is intentional human action or nat14 ural in origin. 

15 (2) To enhance the training of public health 

16 professionals and epidemiologists from eligible devel17 oping countries in advanced Internet-based and 

18 other electronic syndrome surveillance systems, in 

19 addition to traditional epidemiology methods, so that 

20 they may better detect, diagnose, and contain infec21 tious disease outbreaks, especially those due to

22 pathogens most likely to be used in a biological 

23 weapons attack. 

24 (3) To provide assistance to developing coun25 tries to purchase appropriate public health labora-
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1 tory equipment necessary for infectious disease sur2 veillance and diagnosis. 

3 (4) To provide assistance to developing coun4 tries to purchase appropriate communications equip5 ment and information technology, including, as ap6 propriate, relevant computer equipment, Internet 

7 connectivity mechanisms, and telephone-based appli8 cations to effectively gather, analyze, and transmit 

9 public health information for infectious disease sur10 veillance and diagnosis. 

11 (5) To make available greater numbers of 

12 United States Government public health profes13 sionals to international health organizations, re14 gional health networks, and United States diplo15 matic missions where appropriate. 

16 (6) To establish ‘‘lab-to-lab’’ cooperative rela17 tionships between United States public health lab18 oratories and established foreign counterparts. 

19 (7) To expand the training and outreach activi20 ties of overseas United States laboratories, including 

21 Centers for Disease Control and Prevention and De22 partment of Defense entities, to enhance the disease 

23 surveillance capabilities of developing countries. 
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1 (8) To provide appropriate technical assistance 

2 to existing regional health networks and, where ap3 propriate, seed money for new regional networks. 

4 SEC. 3. DEFINITIONS. 

5 In this Act: 

6 (1) ELIGIBLE DEVELOPING COUNTRY.—The 

7 term ‘‘eligible developing country’’ means any devel8 oping country that—

9 (A) has agreed to the objective of fully 

10 complying with requirements of the World 

11 Health Organization on reporting public health 

12 information on outbreaks of infectious diseases; 

13 (B) has not been determined by the Sec14 retary, for purposes of section 40 of the Arms 

15 Export Control Act (22 U.S.C. 2780), section 

16 620A of the Foreign Assistance Act of 1961 

17 (22 U.S.C. 2371), or section 6(j) of the Export 

18 Administration Act of 1979 (50 U.S.C. App. 

19 2405), to have repeatedly provided support for 

20 acts of international terrorism, unless the Sec21 retary exercises a waiver certifying that it is in 

22 the national interest of the United States to 

23 provide assistance under the provisions of this 

24 Act; and 
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1 (C) is a state party to the Biological 

2 Weapons Convention. 

3 (2) ELIGIBLE NATIONAL.—The term ‘‘eligible 

4 national’’ means any citizen or national of an eligible 

5 developing country who is eligible to receive a visa 

6 under the provisions of the Immigration and Nation7 ality Act (8 U.S.C. 1101 et seq.). 

8 (3) INTERNATIONAL HEALTH ORGANIZATION.—

9 The term ‘‘international health organization’’ in10 cludes the World Health Organization and the Pan 

11 American Health Organization. 

12 (4) LABORATORY.—The term ‘‘laboratory’’ 

13 means a facility for the biological, microbiological, 

14 serological, chemical, immuno-hematological, 

15 hematological, biophysical, cytological, pathological, 

16 or other examination of materials derived from the 

17 human body for the purpose of providing informa18 tion for the diagnosis, prevention, or treatment of 

19 any disease or impairment of, or the assessment of 

20 the health of, human beings. 

21 (5) SECRETARY.—Unless otherwise provided, 

22 the term ‘‘Secretary’’ means the Secretary of State. 

23 (6) SELECT AGENT.—The term ‘‘select agent’’ 

24 has the meaning given such term for purposes of 
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1 section 72.6 of title 42, Code of Federal Regula2 tions. 

3 (7) SYNDROME SURVEILLANCE.—The term 

4 ‘‘syndrome surveillance’’ means the recording of 

5 symptoms (patient complaints) and signs (derived 

6 from physical examination) combined with simple ge7 ographic locators to track the emergence of a disease 

8 in a population. 

9 SEC. 4. PRIORITY FOR CERTAIN COUNTRIES. 

10 Priority in the provision of United States assistance 

11 for eligible developing countries under all the provisions 

12 of this Act shall be given to those countries that permit 

13 personnel from the World Health Organization and the 

14 Centers for Disease Control and Prevention to investigate 

15 outbreaks of infectious diseases on their territories, pro16 vide early notification of disease outbreaks, and provide 

17 pathogen surveillance data to appropriate United States 

18 departments and agencies in addition to international 

19 health organizations. 

20 SEC. 5. RESTRICTION. 

21 Notwithstanding any other provision of this Act, no 

22 foreign nationals participating in programs authorized 

23 under this Act shall have access, during the course of such

24 participation, to select agents that may be used as, or in,
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1 a biological weapon, except in a supervised and controlled 

2 setting. 

3 SEC. 6. FELLOWSHIP PROGRAM. 

4 (a) ESTABLISHMENT.—There is established a fellow5 ship program (in this section referred to as the ‘‘pro6 gram’’) under which the Secretary, in consultation with 

7 the Secretary of Health and Human Services, and, subject 

8 to the availability of appropriations, award fellowships to 

9 eligible nationals to pursue public health education or 

10 training, as follows: 

11 (1) MASTER OF PUBLIC HEALTH DEGREE.—

12 Graduate courses of study leading to a master of 

13 public health degree with a concentration in epidemi14 ology from an institution of higher education in the 

15 United States with a Center for Public Health Pre16 paredness, as determined by the Centers for Disease 

17 Control and Prevention. 

18 (2) ADVANCED PUBLIC HEALTH EPIDEMIOLOGY

19 TRAINING.—Advanced public health training in epi20 demiology to be carried out at the Centers for Dis21 ease Control and Prevention (or equivalent State fa22 cility), or other Federal facility (excluding the De23 partment of Defense or United States National Lab24 oratories), for a period of not less than 6 months or 

25 more than 12 months. 
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1 (b) SPECIALIZATION IN BIOTERRORISM.—In addition 

2 to the education or training specified in subsection (a), 

3 each recipient of a fellowship under this section (in this 

4 section referred to as a ‘‘fellow’’) may take courses of 

5 study at the Centers for Disease Control and Prevention 

6 or at an equivalent facility on diagnosis and containment 

7 of likely bioterrorism agents. 

8 (c) FELLOWSHIP AGREEMENT.—

9 (1) IN GENERAL.—In awarding a fellowship 

10 under the program, the Secretary, in consultation 

11 with the Secretary of Health and Human Services, 

12 shall require the recipient to enter into an agree13 ment under which, in exchange for such assistance, 

14 the recipient—

15 (A) will maintain satisfactory academic 

16 progress (as determined in accordance with reg17 ulations issued by the Secretary and confirmed 

18 in regularly scheduled updates to the Secretary 

19 from the institution providing the education or 

20 training on the progress of the recipient’s edu21 cation or training); 

22 (B) will, upon completion of such edu23 cation or training, return to the recipient’s 

24 country of nationality or last habitual residence 

25 (so long as it is an eligible developing country) 
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1 and complete at least four years of employment 

2 in a public health position in the government or 

3 a nongovernmental, not-for-profit entity in that 

4 country or, with the approval of the Secretary 

5 in an international health organization; and 

6 (C) agrees that, if the recipient is unable 

7 to meet the requirements described in subpara8 graph (A) or (B), the recipient will reimburse 

9 the United States for the value of the assist10 ance provided to the recipient under the fellow11 ship, together with interest at a rate deter12 mined in accordance with regulations issued by 

13 the Secretary but not higher than the rate gen14 erally applied in connection with other Federal 

15 loans. 

16 (2) WAIVERS.—The Secretary may waive the 

17 application of paragraphs (1)(B) and (1)(C) if the 

18 Secretary determines that it is in the national inter19 est of the United States to do so. 

20 (d) IMPLEMENTATION.—The Secretary, in consulta21 tion with the Secretary of Health and Human Services, 

22 is authorized to enter into an agreement with any eligible 

23 developing country under which the country agrees—
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1 (1) to establish a procedure for the nomination 

2 of eligible nationals for fellowships under this sec3 tion; 

4 (2) to guarantee that a fellow will be offered a 

5 professional public health position within the country 

6 upon completion of his studies; and 

7 (3) to certify to the Secretary when a fellow has 

8 concluded the minimum period of employment in a 

9 public health position required by the fellowship 

10 agreement, with an explanation of how the require11 ment was met. 

12 (e) PARTICIPATION OF UNITED STATES CITIZENS.—

13 On a case-by-case basis, the Secretary may provide for the 

14 participation of United States citizens under the provi15 sions of this section if the Secretary determines that it 

16 is in the national interest of the United States to do so. 

17 Upon completion of such education or training, a United 

18 States recipient shall complete at least five years of em19 ployment in a public health position in an eligible devel20 oping country or the World Health Organization. 

21 SEC. 7. IN-COUNTRY TRAINING IN LABORATORY TECH22 NIQUES AND SYNDROME SURVEILLANCE. 

23 (a) IN GENERAL.—In conjunction with the Centers 

24 for Disease Control and Prevention and the Department 

25 of Defense, the Secretary shall, subject to the availability 
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1 of appropriations, support short training courses in-coun2 try (not in the United States) to laboratory technicians 

3 and other public health personnel from eligible developing 

4 countries in laboratory techniques relating to the identi5 fication, diagnosis, and tracking of pathogens responsible 

6 for possible infectious disease outbreaks. Training under 

7 this section may be conducted in overseas facilities of the 

8 Centers for Disease Control and Prevention or in Overseas 

9 Medical Research Units of the Department of Defense, as 

10 appropriate. The Secretary shall coordinate such training 

11 courses, where appropriate, with the existing programs 

12 and activities of the World Health Organization. 

13 (b) TRAINING IN SYNDROME SURVEILLANCE.—In 

14 conjunction with the Centers for Disease Control and Pre15 vention and the Department of Defense, the Secretary 

16 shall, subject to the availability of appropriations, estab17 lish and support short training courses in-country (not in 

18 the United States) for public health personnel from eligi19 ble developing countries in techniques of syndrome surveil20 lance reporting and rapid analysis of syndrome informa21 tion using Geographic Information System (GIS) and 

22 other Internet-based tools. Training under this subsection 

23 may be conducted via the Internet or in appropriate facili24 ties as determined by the Secretary. The Secretary shall 

25 coordinate such training courses, where appropriate, with
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1 the existing programs and activities of the World Health 

2 Organization. 

3 SEC. 8. ASSISTANCE FOR THE PURCHASE AND MAINTE4 NANCE OF PUBLIC HEALTH LABORATORY 

5 EQUIPMENT. 

6 (a) AUTHORIZATION.—The President is authorized, 

7 on such terms and conditions as the President may deter8 mine, to furnish assistance to eligible developing countries 

9 to purchase and maintain public health laboratory equip10 ment described in subsection (b). 

11 (b) EQUIPMENT COVERED.—Equipment described in 

12 this subsection is equipment that is—

13 (1) appropriate, where possible, for use in the 

14 intended geographic area; 

15 (2) necessary to collect, analyze, and identify 

16 expeditiously a broad array of pathogens, including 

17 mutant strains, which may cause disease outbreaks 

18 or may be used as a biological weapon; 

19 (3) compatible with general standards set forth, 

20 as appropriate, by the World Health Organization 

21 and the Centers for Disease Control and Prevention, 

22 to ensure interoperability with regional and inter23 national public health networks; and 
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1 (4) not defense articles or defense services as 

2 those terms are defined under section 47 of the 

3 Arms Export Control Act. 

4 (c) RULE OF CONSTRUCTION.—Nothing in this sec5 tion shall be construed to exempt the exporting of goods 

6 and technology from compliance with applicable provisions 

7 of the Export Administration Act of 1979 (or successor 

8 statutes). 

9 (d) LIMITATION.—Amounts appropriated to carry 

10 out this section shall not be made available for the pur11 chase from a foreign country of equipment that, if made 

12 in the United States, would be subject to the Arms Export 

13 Control Act or likely be barred or subject to special condi14 tions under the Export Administration Act of 1979 (or 

15 successor statutes). 

16 (e) HOST COUNTRY’S COMMITMENTS.—The assist17 ance provided under this section shall be contingent upon 

18 the host country’s commitment to provide the resources, 

19 infrastructure, and other assets required to house, main20 tain, support, secure, and maximize use of this equipment 

21 and appropriate technical personnel. 

22 SEC. 9. ASSISTANCE FOR IMPROVED COMMUNICATION OF 

23 PUBLIC HEALTH INFORMATION. 

24 (a) ASSISTANCE FOR PURCHASE OF COMMUNICATION

25 EQUIPMENT AND INFORMATION TECHNOLOGY.—The 
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1 President is authorized to provide, on such terms and con2 ditions as the President may determine, assistance to eligi3 ble developing countries for the purchase and maintenance 

4 of communications equipment and information technology 

5 described in subsection (b), and supporting equipment, 

6 necessary to effectively collect, analyze, and transmit pub7 lic health information. 

8 (b) COVERED EQUIPMENT.—Equipment (and infor9 mation technology) described in this subsection is equip10 ment that—

11 (1) is suitable for use under the particular con12 ditions of the area of intended use; 

13 (2) meets appropriate World Health Organiza14 tion standards to ensure interoperability with like 

15 equipment of other countries and international 

16 health organizations; and 

17 (3) is not defense articles or defense services as 

18 those terms are defined under section 47 of the 

19 Arms Export Control Act. 

20 (c) RULE OF CONSTRUCTION.—Nothing in this sec21 tion shall be construed to exempt the exporting of goods 

22 and technology from compliance with applicable provisions 

23 of the Export Administration Act of 1979 (or successor 

24 statutes). 
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1 (d) LIMITATION.—Amounts appropriated to carry 

2 out this section shall not be made available for the pur3 chase from a foreign country of equipment that, if made 

4 in the United States, would be subject to the Arms Export 

5 Control Act or likely be barred or subject to special condi6 tions under the Export Administration Act of 1979 (or 

7 successor statutes). 

8 (e) ASSISTANCE FOR STANDARDIZATION OF REPORT9 ING.—The President is authorized to provide, on such 

10 terms and conditions as the President may determine, 

11 technical assistance and grant assistance to international 

12 health organizations to facilitate standardization in the re13 porting of public health information between and among 

14 developing countries and international health organiza15 tions. 

16 (f) HOST COUNTRY’S COMMITMENTS.—The assist17 ance provided under this section shall be contingent upon 

18 the host country’s commitment to provide the resources, 

19 infrastructure, and other assets required to house, sup20 port, maintain, secure, and maximize use of this equip21 ment and appropriate technical personnel.
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1 SEC. 10. ASSIGNMENT OF PUBLIC HEALTH PERSONNEL TO 

2 UNITED STATES MISSIONS AND INTER3 NATIONAL ORGANIZATIONS. 

4 (a) IN GENERAL.—Upon the request of a United 

5 States chief of diplomatic mission or an international 

6 health organization, and with the concurrence of the Sec7 retary of State, the head of a Federal agency may assign 

8 to the respective United States mission or organization 

9 any officer or employee of the agency occupying a public 

10 health position within the agency for the purpose of en11 hancing disease and pathogen surveillance efforts in devel12 oping countries. 

13 (b) REIMBURSEMENT.—The costs incurred by a Fed14 eral agency by reason of the detail of personnel under sub15 section (a) may be reimbursed to that agency out of the 

16 applicable appropriations account of the Department of 

17 State if the Secretary determines that the relevant agency 

18 may otherwise be unable to assign such personnel on a 

19 non-reimbursable basis. 

20 SEC. 11. EXPANSION OF CERTAIN UNITED STATES GOVERN21 MENT LABORATORIES ABROAD. 

22 (a) IN GENERAL.—Subject to the availability of ap23 propriations, the Centers for Disease Control and Preven24 tion and the Department of Defense shall each—

25 (1) increase the number of personnel assigned 

26 to laboratories of the Centers or the Department, as
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1 appropriate, located in eligible developing countries 

2 that conduct research and other activities with re3 spect to infectious diseases; and 

4 (2) expand the operations of those laboratories, 

5 especially with respect to the implementation of on6 site training of foreign nationals and regional out7 reach efforts involving neighboring countries. 

8 (b) COOPERATION AND COORDINATION BETWEEN

9 LABORATORIES.—Subsection (a) shall be carried out in 

10 such a manner as to foster cooperation and avoid duplica11 tion between and among laboratories. 

12 (c) RELATION TO CORE MISSIONS AND SECURITY.—

13 The expansion of the operations of overseas laboratories 

14 of the Centers or the Department under this section shall 

15 not—

16 (1) detract from the established core missions 

17 of the laboratories; or 

18 (2) compromise the security of those labora19 tories, as well as their research, equipment, exper20 tise, and materials. 
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1 SEC. 12. ASSISTANCE FOR REGIONAL HEALTH NETWORKS 

2 AND EXPANSION OF FOREIGN EPIDEMI3 OLOGY TRAINING PROGRAMS. 

4 (a) AUTHORITY.—The President is authorized, on 

5 such terms and conditions as the President may deter6 mine, to provide assistance for the purposes of—

7 (1) enhancing the surveillance and reporting ca8 pabilities for the World Health Organization and ex9 isting regional health networks; and 

10 (2) developing new regional health networks. 

11 (b) EXPANSION OF FOREIGN EPIDEMIOLOGY TRAIN12 ING PROGRAMS.—The Secretary of Health and Human 

13 Services is authorized to establish new country or regional 

14 Foreign Epidemiology Training Programs in eligible devel15 oping countries. 

16 SEC. 13. AUTHORIZATION OF APPROPRIATIONS. 

17 (a) AUTHORIZATION OF APPROPRIATIONS.—

18 (1) IN GENERAL.—Subject to subsection (c), 

19 there are authorized to be appropriated $70,000,000 

20 for the fiscal year 2004 and $80,000,000 for fiscal 

21 year 2005, to carry out this Act. 

22 (2) ALLOCATION OF FUNDS.—Of the amounts 

23 made available under paragraph (1)—

24 (A) $50,000,000 for the fiscal year 2004 

25 and $50,000,000 for the fiscal year 2005 are 
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1 authorized to be available to carry out sections 

2 6, 7, 8, and 9; 

3 (B) $2,000,000 for the fiscal year 2004 

4 and $2,000,000 for the fiscal year 2005 are au5 thorized to be available to carry out section 10; 

6 (C) $8,000,000 for the fiscal year 2004 

7 and $18,000,000 for the fiscal year 2005 are 

8 authorized to be available to carry out section 

9 11; and 

10 (D) $10,000,000 for the fiscal year 2004 

11 and $10,000,000 for the fiscal year 2005 are 

12 authorized to be available to carry out section 

13 12. 

14 (b) AVAILABILITY OF FUNDS.—The amount appro15 priated pursuant to subsection (a) is authorized to remain 

16 available until expended. 

17 (c) REPORTING REQUIREMENT.—

18 (1) REPORT.—Not later than 90 days after the 

19 date of enactment of this Act, the Secretary shall 

20 submit a report, in conjunction with the Secretary of 

21 Health and Human Services and the Secretary of 

22 Defense, containing—

23 (A) a description of the implementation of 

24 programs under this Act; and 
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1 (B) an estimate of the level of funding re2 quired to carry out those programs at a suffi3 cient level. 

4 (2) LIMITATION ON OBLIGATION OF FUNDS.—

5 Not more than 10 percent of the amount appro6 priated pursuant to subsection (a) may be obligated 

7 before the date on which a report is submitted, or 

8 required to be submitted, whichever first occurs, 

9 under paragraph (1).

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