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[Senate Report 110-152]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 350
110th Congress                                                   Report
                                 SENATE
 1st Session                                                    110-152

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

 
                GLOBAL PATHOGEN SURVEILLANCE ACT OF 2007

                                _______
                                

               September 11, 2007.--Ordered to be printed

          Mr. Biden, from the Committee on Foreign Relations,
                        submitted the following

                                 REPORT

                         [To accompany S. 1687]

    The Committee on Foreign Relations, having had under 
consideration a bill (S. 1687), to provide for global pathogen 
surveillance and response, reports favorably thereon and 
recommends that the bill do pass.

                                CONTENTS

                                                                   Page

  I. Purpose..........................................................1
 II. Legislative History and Committee Action.........................2
III. Discussion.......................................................2
 IV. Section-By-Section Analysis......................................5
  V. Cost Estimate....................................................9
 VI. Evaluation of Regulatory Impact.................................11
VII. Changes in Existing Law.........................................11

                               I. PURPOSE

    This legislation is designed to enhance the capability of 
the international community to detect, identify, and contain 
infectious disease outbreaks, whether the cause of those 
outbreaks is intentional or natural in origin. This bill 
targets U.S. assistance to developing nations in the following 
areas:

   Training of public health personnel in epidemiology, 
        including diagnosis and containment of likely 
        bioterrorism agents;

   Acquisition of laboratory and diagnostic equipment;

   Acquisition of communications technology to quickly 
        transmit data on disease patterns and pathogen 
        diagnoses to national public health authorities and to 
        international institutions such as the World Health 
        Organization (WHO);

   Expansion of overseas Centers for Disease Control 
        and Prevention (CDC) and Department of Defense 
        laboratories engaged in infectious disease research and 
        disease surveillance, through the establishment of 
        additional laboratories, enlargement of existing 
        facilities, increases in the number of personnel, and/
        or expanding the scope of their activities; and

   Expanded assistance to the WHO and regional 
        international disease surveillance efforts, including 
        expansion of U.S.-administered Field Epidemiology 
        Training Programs.

              II. LEGISLATIVE HISTORY AND COMMITTEE ACTION

    S. 1687 was introduced by Senator Biden on June 25, 2007. 
It is cosponsored by Senators Hagel, Kennedy and Casey. On June 
27, 2007, the committee ordered the bill reported favorably by 
voice vote.

                            III. DISCUSSION

    In January 2000, the National Intelligence Council released 
a National Intelligence Estimate entitled, The Global 
Infectious Disease Threat and Its Implications for the United 
States. The key judgments in that report were sobering:

          New and reemerging infectious diseases will pose a rising 
        global health threat and will complicate US and global security 
        over the next 20 years. These diseases will endanger US 
        citizens at home and abroad, threaten US armed forces deployed 
        overseas, and exacerbate social and political instability in 
        key countries and regions in which the United States has 
        significant interests.\1\
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    \1\National Intelligence Council, ``The Global Infectious Disease 
Threat and Its Implications for the United States,'' National 
Intelligence Estimate NIE 99-17D (January 2000), p. 5.
---------------------------------------------------------------------------
          Development of an effective global surveillance and response 
        system probably is at least a decade or more away, owing to 
        inadequate coordination and funding at the international level 
        and lack of capacity, funds, and commitment in many developing 
        and former communist states.\2\
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    \2\Ibid., p. 8.
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          The probability of a bioterrorist attack against US civilian 
        and military personnel overseas or in the United States also is 
        likely to grow as more states and groups develop a biological 
        warfare capability. Although there is no evidence that the 
        recent West Nile virus outbreak in New York City was caused by 
        foreign state or nonstate actors, the scare and several earlier 
        instances of suspected bioterrorism showed the confusion and 
        fear they can sow regardless of whether or not they are 
        validated.\3\
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    \3\Ibid., p. 11.

    The Estimate went on to elaborate regarding the challenges 
to maintaining an effective world-wide disease surveillance 
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system:

          A major obstacle to effective global surveillance and control 
        of infectious diseases will continue to be poor or inaccurate 
        national health statistical reporting by many developing 
        countries and lack of both capacity and will to properly direct 
        aid ... and to follow WHO and other recommended health care 
        practices. Those areas of the world most susceptible to 
        infectious disease problems are least able to develop and 
        maintain the sophisticated and costly communications equipment 
        needed for effective disease surveillance and reporting. In 
        addition to the barriers dictated by low levels of development, 
        revealing an outbreak of a dreaded disease may harm national 
        prestige, commerce, and tourism.\4\
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    \4\Ibid., p. 34.

    In January 2001, the National Intelligence Council released 
another National Intelligence Estimate, entitled, The 
Biological Warfare Threat. The report pointed to the growing 
biological warfare capabilities of state and nonstate actors 
and, more importantly, highlighted the similar patterns and 
symptoms of a deliberately initiated disease outbreak and a 
naturally occurring outbreak. Once an outbreak is detected and 
begins to spread, it is very difficult to distinguish between a 
deliberate and a natural disease outbreak. Both are potentially 
devastating to human, animal, and plant life, moreover, as well 
as economically costly. Epidemiologists and public health 
experts rely on similar tools to help prevent, detect, and 
contain both intentional and naturally occurring disease 
outbreaks.
    According to an August 2001 report by the U.S. General 
Accounting Office (GAO, now known as the U.S. Government 
Accountability Office), WHO officials said that more than 60 
percent of laboratory equipment in developing countries was 
either outdated or non-functioning, and that the vast majority 
of national personnel were not familiar with quality assurance 
principles for handling and analyzing biological samples. 
Deficiencies in training and equipment meant that many public 
health units in Africa and Asia were simply unable to perform 
accurate and timely disease surveillance.\5\
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    \5\United States General Accounting Office, ``Global Health: 
Challenges in Improving Infectious Disease Surveillance Systems,'' GAO-
01-722 (August 2001), p.3.
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    On September 5, 2001, the Senate Foreign Relations 
Committee held a hearing regarding the threat of bioterrorism 
and the spread of infectious diseases. Witnesses included 
former Senator Sam Nunn, Dr. Donald A. Henderson of Johns 
Hopkins University (later a scientific advisor to the White 
House and the Department of Health and Human Services), and Dr. 
David L. Heymann, then Executive Director for Communicable 
Diseases at the WHO. After the appearance, later in September 
2001, of letters containing anthrax spores, which left 5 dead 
and caused major disruptions in the U.S. Senate and elsewhere, 
the committee held a March 19, 2002, hearing on the chemical 
and biological weapons threat. At that hearing, Dr. Alan P. 
Zelicoff, Senior Scientist at Sandia National Laboratories, 
testified on the role of syndromic surveillance in bioterrorism 
prevention.
    The committee believes that the threat of bioterrorism 
poses significant challenges not only for the United States, 
but for the entire world. It is difficult to protect our 
nation's health without international cooperation in an age of 
unprecedented air travel and international trade, as infectious 
pathogens are transported across borders each day. The global 
outbreak of severe acute respiratory syndrome, or SARS, was an 
unfortunate reminder of this vulnerability. More recently, a 
man thought at the time to have extensively drug-resistant 
tuberculosis flew across an ocean--twice--and drove across 
several national borders, reminding us how readily a disease 
can be spread in the modern world. Fortunately, although 
extensively drug-resistant TB is especially difficult to treat, 
it does not spread as readily as influenza or some other 
diseases. Authorities knew who the disease vector was, 
moreover, and they knew (more or less) what he had. The risk 
with H5N1 avian influenza or a bioterrorism attack is 
heightened by the likelihood that the disease will spread 
before its presence is even evident.
    Infectious disease outbreaks are transnational threats and 
the defense of our homeland is not an isolated activity. Rather 
it requires a comprehensive strategy, including a critical 
international component. Whether intentional or natural, 
infectious diseases do not recognize the boundaries set by 
national borders.
    Developing nations represent one of the weak links in a 
comprehensive global surveillance and monitoring network. For 
example, even though the world has made substantial efforts to 
combat and prepare for the possibility of a global avian 
influenza pandemic, a recent GAO report suggests that the 
surveillance capabilities of many countries--even when focused 
on a single disease--remain dangerously inadequate. The report 
cites a senior WHO official as saying that numerous ``disease 
blind spots'' around the world hamper the organization's 
ability to identify H5N1 outbreaks. It goes on to say that 
studies conducted in 2006 by the UN System Influenza 
Coordinator, in collaboration with the World Bank, found that 
about one-third of the countries surveyed lacked the capacity 
to diagnose avian influenza in humans.\6\ Unfortunately, 
naturally occurring disease outbreaks are most likely to occur 
in these areas where poor sanitary conditions, poverty, and a 
weak medical infrastructure combine to offer ideal breeding 
grounds for pathogens. In addition, some developing countries 
border rogue states or states that offer sanctuaries for 
international terrorist groups, which have a documented 
interest in biological agents.
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    \6\United States Government Accountability Office, ``Influenza 
Pandemic: Efforts to Forestall Onset Are Under Way: Indentifying 
Countries at Greatest Risk Entails Challenges,'' GAO-07-604 (June 
2007), pp. 16n and 18-19.
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    In 2005, two sets of researchers reported in the journals 
Nature and Science that, based on computer simulations, if an 
outbreak of human-to-human-transmitted avian flu were to occur 
in a rural part of Southeast Asia, it might be possible to stem 
that dangerous epidemic by using anti-viral drugs to treat the 
tens of thousands of people who might have been exposed in the 
initial outbreak. One key requirement, however, was that the 
outbreak would have to be discovered, identified and reported 
very quickly; in one study, the assumption was that 
countermeasures were instituted when only 30 people had 
observable symptoms.\7\ These simulations underscore both the 
challenge of disease surveillance and the potential benefits if 
effective and timely surveillance can be made available where 
it is most needed.
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    \7\Neil M. Ferguson, Derek A.T. Cummings, Simon Cauchemez, 
Christophe Fraser, Steven Riley, Aronrag Meeyai, Sopon Iamsirithaworn 
and Donald S. Burke, ``Strategies for containing an emerging influenza 
pandemic in Southeast Asia,'' Nature, August 3, 2005. See also I.M. 
Longini Jr., A. Nizam, S. Xu, K. Ungchusak, W. Hanshaoworakul, D.A. 
Cummings, and M.E. Halloran, ``Containing pandemic influenza at the 
source,'' Science, August 3, 2005.
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    So it is vital to give these countries the capability to 
track epidemics and to feed that information into international 
surveillance networks. Disease surveillance is a systematic 
approach that requires trained public health personnel, proper 
diagnostic equipment to identify viruses and pathogens, and 
prompt transmission of data from the doctor or clinic level all 
the way to national governments and the WHO.
    The Global Pathogen Surveillance Act will offer such help 
to those countries that agree to give the United States and the 
WHO prompt access to disease outbreaks, so that we can help 
determine their origin. Recipients of this training will also 
be able to learn to spot diseases that might be used in a 
bioterrorist attack.
    The Global Pathogen Surveillance Act was first introduced 
in 2002. The Senate Foreign Relations Committee reported this 
bill, either separately or as a title of a larger bill, on 
several occasions since 2002, and the Senate passed the bill in 
2002 and 2005. The original bill was drafted in consultation 
with the WHO, the CDC, the Department of Defense and others, 
and later versions benefited from suggestions from the State 
Department and, in 2005, from staff of the Senate Health, 
Education, Labor, and Pensions Committee.
    The primary authority for implementation of the bill's 
provisions is vested in the Department of State. The committee 
expects that the Department of Health and Human Services will 
also play a critical role, however, including being consulted 
to the greatest extent possible.
    Two years ago the Secretary of State, Dr. Condoleezza Rice, 
expressed her strong backing for this legislation in an answer 
for the record:

          We believe that the Global Pathogen Surveillance Act will 
        indeed help strengthen developing countries' abilities to 
        identify and track pathogens that could be indicators of 
        dangerous disease outbreaks--either naturally-occurring or 
        deliberately released. Improved disease surveillance and 
        communication among nations are critical defenses against both 
        bioterrorism and natural outbreaks. We look forward to working 
        with you in support of the Global Pathogen Surveillance Act. 
        ...
          One of the true ``nightmare'' scenarios--of a bioterrorist 
        attack or a naturally occurring disease--involves a contagious 
        biological agent moving swiftly through a crowded urban area of 
        a densely populated developing nation. Thus, we believe that it 
        is critical to increase efforts to strengthen the public health 
        and scientific infrastructure necessary to identify and quickly 
        respond to infectious disease outbreaks--and that the Global 
        Pathogen Surveillance Act will provide valuable support in 
        these efforts.\8\
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    \8\``The Nomination of Dr. Condoleezza Rice to be Secretary of 
State,'' Hearings before the Committee on Foreign Relations, U.S. 
Senate, January 18 and 19, 2005, S. Hrg. 109- 151, pp. 253- 254.

    The WHO also shares the committee's concern. During the 
SARS epidemic, Dr. Michael Heymann, who was the highest-ranking 
American in the WHO, stated at a press conference: ``it is 
clear that the best defense against the spread of emerging 
infections such as SARS is strong national public health--
national disease detection and response capacities that can 
identify new diseases and contain them before they spread 
internationally.'' He went on to highlight the important role 
that disease surveillance plays in combating both natural and 
---------------------------------------------------------------------------
terrorist outbreaks:

          Global partnerships to combat global microbial threats make 
        good sense as a defense strategy that brings immediate benefits 
        in terms of strengthened pubic health and surveillance systems. 
        The resulting infectious disease intelligence brings dual 
        benefits in terms of protecting populations against both 
        naturally occurring and potentially deliberately caused 
        outbreaks. As SARS has so vividly demonstrated, the need is 
        urgent and of critical importance to the health of economies as 
        well as populations.
          Support to developing countries such as proposed in the 
        Global Pathogen Surveillance Act ... will help strengthen 
        capacity of public health professionals and epidemiologists, 
        laboratory and other disease detection systems, and outbreak 
        response mechanisms for naturally occurring infectious diseases 
        such as SARS. This in turn will strengthen WHO and the world's 
        safety net for outbreak detection and response, of which the 
        United States is a major partner. And finally, strengthening 
        this global safety net to detect and contain naturally 
        occurring infectious diseases will strengthen the world's 
        capacity to detect and respond to infectious diseases that may 
        be deliberately caused.

                    IV. SECTION-BY-SECTION ANALYSIS

Section 1. Short Title

    This Act is called the ``Global Pathogen Surveillance Act 
of 2007.''

Section 2. Findings; Purpose

    This section lays out the findings and purposes of this 
Act.

Section 3. Definitions

    This section defines five terms of art and sets forth one 
routine definition. The definition of ``International Health 
Organization'' in definition (3) is meant to be illustrative, 
rather than exclusive; additional organizations to those cited 
in the definition may also qualify as international health 
organizations under the Act.

Section 4. Eligibility for Assistance

    Section 4 requires, in general, that assistance under the 
provisions of this Act be given only to those eligible 
developing countries that permit personnel from the World 
Health Organization (WHO) and the Centers for Disease Control 
and Prevention (CDC) to investigate infectious disease 
outbreaks on their territory and that provide pathogen 
surveillance data derived from such assistance to appropriate 
U.S. departments and agencies in addition to international 
health organizations. The committee intends that this 
requirement be met in a manner that does not reveal any 
classified information to persons not authorized to receive 
such information. Subsection (b) authorizes the Secretary of 
State to waive the limitation in subsection (a) if the 
Secretary determines that it is in the national interest of the 
United States to provide such a waiver.

Section 5. Restriction

    Section 5 restricts access by foreign nationals 
participating in programs authorized under this title to select 
agents that may be used as, or in, a biological weapon, except 
in a supervised and controlled setting. The committee does not 
believe that such a restriction will constrain foreign 
nationals from fully participating in various training and 
educational programs under this Act. Subsection (b) makes clear 
that this restriction may not be construed to limit the ability 
of the Secretary of Health and Human Services to prescribe, 
through regulation, standards for the handling of a select 
agent or toxin or an overlap select agent or toxin.

Section 6. Fellowship Program

    Section 6 authorizes the Secretary of State to award 
fellowships to eligible nationals of eligible developing 
countries to pursue a master of public health degree or 
advanced public health training in epidemiology within the 
United States. Each fellow may also take courses of study at 
the CDC or at an equivalent facility on diagnosis and 
containment of likely bioterrorism agents. The committee 
believes that carefully chosen programs of this sort should be 
encouraged as they not only impart technical skills utilizing 
state-of-the-art technology, but also help cultivate the 
management and organizational skills of future leaders for 
developing country public health programs.
    Subsection (c) requires that fellows enter into an 
agreement with the Secretary of State under which the fellow 
will maintain satisfactory academic performance and, upon 
completing the education or training, will return to his or her 
country of nationality or last habitual residence (so long as 
it is an eligible developing country) and complete at least 
four years of employment in a public health position in the 
government or a non-governmental, not-for-profit entity in that 
country. Alternatively, with the Secretary's consent, the 
fellow can complete part or all of this four-year requirement 
with an international health organization. If the fellow is 
unable to meet these requirements, he or she will be required 
to reimburse the U.S. government for the value of the 
assistance provided; the Secretary may waive the limitation in 
this subsection if the Secretary determines that it is in the 
national interest of the United States to provide such a 
waiver.
    Subsection (d) authorizes the Secretary of State, in 
consultation with the Secretary of Health and Human Services, 
to enter into an agreement with any eligible developing country 
to establish the procedures for implementing the program.
    Subsection (e) allows for the participation of U.S. 
citizens on a case-by-case basis, if the Secretary of State 
determines that it is in the national interest of the United 
States to provide for such participation. Such participants 
would be required, upon completion of education or training, to 
complete at least five years of employment in a public health 
position in an eligible developing country or at an 
international health organization.
    Subsection (f) allows the Secretary, with the concurrence 
of the Secretary of Health and Human Services (HHS), to use 
existing HHS programs to provide the education and training 
described in this section, if the requirements of subsections 
(b), (c) and (d) will be substantially met under such existing 
programs.

Section 7. In-Country Training in Laboratory Techniques and Disease and 
        Syndrome Surveillance

    Section 7 authorizes the provision of short-term training 
courses outside the United States for laboratory technicians 
and public health officials in laboratory techniques relating 
to the identification, diagnosis, and tracking of pathogens 
responsible for infectious disease outbreaks. This training may 
take place in overseas facilities of the CDC or the Overseas 
Medical Research Units of the Department of Defense, as 
appropriate. Any such training shall be coordinated with 
existing programs and activities of international health 
organizations. Such training courses offer the opportunity for 
public health personnel to train in their indigenous 
environment, utilizing the available technology.
    Subsection (b) authorizes short training courses, which 
shall be conducted either via the Internet or in appropriate 
facilities located in a foreign country, on disease and 
syndrome surveillance techniques. Using disease and syndrome 
surveillance, the emergence of a disease in a population is 
monitored based on geographic patterns of clinician-reported 
patient complaints and signs derived from physical examination 
and laboratory data.

Section 8. Assistance for the Purchase and Maintenance of Public Health 
        Laboratory Equipment and Supplies

    Section 8 authorizes the President to furnish assistance to 
eligible developing countries to purchase and maintain public 
health laboratory equipment and supplies that are needed to 
collect, analyze, and identify expeditiously a broad array of 
pathogens, including mutant strains, which may cause disease 
outbreaks or be used in a biological weapon. The equipment and 
supplies are to be appropriate for use in the intended 
geographic area and compatible with general standards set forth 
by the WHO and, as appropriate, the CDC. They must not be 
defense articles or articles that would be subject to the Arms 
Export Control Act or likely be barred or subject to special 
conditions under the Export Administration Act of 1979 if 
purchased in the United States. This section does not exempt 
the exporting of goods or technology from compliance with 
applicable provisions of the Export Administration Act of 1979 
(as in effect pursuant to the International Emergency Economic 
Powers Act, 50 U.S.C. 1701 et seq.).
    Subsection (e) provides that preference should be given to 
the purchase of equipment and supplies of U.S. manufacture. 
Subsection (f) requires that the eligible developing country 
agree to properly house, maintain, support, secure, and 
maximize the use of equipment and supplies provided under this 
section.

Section 9. Assistance for Improved Communication of Public Health 
        Information

    Section 9 authorizes the President to provide assistance to 
eligible developing countries to purchase and maintain 
communications equipment and information technology to 
effectively and quickly collect, analyze, and transmit public 
health information within and among developing countries and to 
and from international health organizations. The requirements 
and limitations applied to assistance in section 8 are also 
applied to section 9. In addition, subsection (f) authorizes 
the President to provide assistance to international health 
organizations to facilitate standardization in the reporting of 
public health information.

Section 10. Assignment of Public Health Personnel to United States 
        Missions and International Organizations

    Section 10 authorizes the heads of Executive branch 
departments and agencies to assign public health personnel to 
U.S. diplomatic missions and international health organizations 
when requested, with the concurrence of the Secretary of State 
and of the employee concerned, for the purpose of enhancing 
disease and pathogen surveillance efforts in developing 
countries. The Department of State is authorized, under certain 
circumstances, to reimburse an agency or department for the 
costs incurred by reason of the detail of such personnel.

Section 11. Expansion of Certain United States Government Laboratories 
        Abroad

    Section 11 mandates the expansion of the overseas 
laboratories and other related facilities of the CDC and the 
Department of Defense, subject to the availability of 
appropriations. This expansion applies to both numbers of 
personnel and the scope of operations. The intent of this 
provision is to further the goals of global pathogen 
surveillance and monitoring. Overseas CDC and Department of 
Defense facilities, working with host governments, play a 
crucial role in enhancing the capability of developing 
countries to monitor disease outbreaks and possible biological 
weapons attacks. The committee intends that the expansion of 
CDC and Department of Defense overseas laboratory activities be 
undertaken in close cooperation with host countries, to benefit 
their well-being and national security as well as that of the 
United States.
    Subsection (b) provides that the expansion be carried out 
in such a manner as to foster cooperation and avoid duplication 
between and among laboratories. Subsection (c) provides that 
the expansion may not detract from the established core 
missions of the laboratories or compromise the security of 
those laboratories.

Section 12. Assistance for International Health Networks and Expansion 
        of Field Epidemiology Training Programs

    Section 12 authorizes the President to provide assistance 
for the purposes of enhancing the surveillance and reporting 
capabilities of the WHO and existing international regional and 
international health networks and for developing new 
international regional and international health networks, as a 
means of continuing to expand the reach of a global 
surveillance network.
    Subsection (b) authorizes the Secretary of Health and Human 
Services to establish new country or regional international 
Field Epidemiology Training Programs in eligible developing 
countries. These programs offer two years of intense training 
for health professionals in entry- or mid-level positions to 
help build up indigenous capacity in epidemiology and public 
health.

Section 13. Reports

    Section 13 requires the Secretary of State to submit a 
report to the Senate Foreign Relations Committee and the House 
Foreign Affairs Committee, not later than 90 days after the 
date of enactment of this Act, on the implementation of 
programs under this Act, including an estimate of the level of 
funding required to carry out such programs at a sufficient 
level.

Section 14. Authorization of Appropriations

    This section authorizes appropriations for carrying out 
provisions of this title for Fiscal Years 2008 and 2009. The 
section authorizes $115 million in total. Of this amount, $40 
million is authorized for Fiscal Year 2008 and $75 million for 
Fiscal Year 2009. Subsection (b) provides that the amounts 
appropriated pursuant to subsection (a) are authorized to 
remain available until expended. Subsection (c) provides that 
not more than 10 percent of the amount appropriated for Fiscal 
Year 2008 may be obligated before the date on which a report is 
submitted, or required to be submitted, whichever first occurs, 
under section 13.

                            V. COST ESTIMATE

    In accordance with Rule XXVI, paragraph 11(a) of the 
Standing Rules of the Senate, the committee provides this 
estimate of the costs of this legislation prepared by the 
Congressional Budget Office.

                            United States Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 20, 2007.

Hon. Joseph R. Biden, Jr.,
Chairman, Committee on Foreign Relations,
U.S. Senate, Washington, DC.

    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 1687, the Global 
Pathogen Surveillance Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sam 
Papenfuss.
          Sincerely,
                                           Peter R. Orszag.

                                ------                                

               Congressional Budget Office Cost Estimate

                                                     July 20, 2007.

                                S. 1687

                Global Pathogen Surveillance Act of 2007

  AS ORDERED REPORTED BY THE SENATE COMMITTEE ON FOREIGN RELATIONS ON 
                             JUNE 27, 2007

    S. 1687 would authorize the appropriation of $40 million in 
2008 and $75 million in 2009 for the following activities:

   Establish a fellowship program that would allow 
        certain foreign nationals to pursue public health 
        education or training in the United States;

   Expand operations at laboratories of the Department 
        of Defense and the Centers for Disease Control and 
        Prevention that are located in developing countries, 
        and provide assistance to local individuals for 
        training in laboratory techniques related to infectious 
        diseases;

   Provide assistance to developing countries to 
        purchase and maintain public health laboratory 
        equipment and supplies and to purchase communications 
        equipment and technology to effectively collect, 
        analyze, and transmit public health information; and

   Provide assistance to the World Health Organization 
        and establish new training programs in field 
        epidemiology.

    Based on historical spending patterns for similar 
activities, CBO estimates that implementing S. 1687 would cost 
$8 million in 2008 and $108 million over the 2008-2012 period, 
assuming appropriation of the authorized amounts. Enacting the 
bill would not affect direct spending or receipts.
    S. 1687 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Sam Papenfuss. 
This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

                  VI. EVALUATION OF REGULATORY IMPACT

    Pursuant to Rule XXVI, paragraph 11(b) of the Standing 
Rules of the Senate, the committee has determined that there is 
no regulatory impact as a result of this legislation.

                      VII. CHANGES IN EXISTING LAW

    In compliance with paragraph 12 of Rule XXVI of the 
Standing Rules of the Senate, the committee notes that no 
changes to existing law are made by this bill.

                                    

      
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