89–010

Calendar No. 952

106TH CONGRESS REPORT

2d Session " ! SENATE 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

REPORT

[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.

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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

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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 reemergence 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

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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

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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

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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.

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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 sociVerDate 11-MAY-2000 18:33 Oct 20, 2000 Jkt 089010 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\SR505.XXX pfrm07 PsN: SR505
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eties, 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

* * * * * * *

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øPUBLIC HEALTH EMERGENCIES

øSEC. 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—

ø(1) a disease or disorder presents a public health emergency, or

ø(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).

ø(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.

ø(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—

ø(A) on the expenditures made from the Public Health Emergency Fund in such fiscal year; and

ø(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

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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.

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(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;

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(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

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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

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bers 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

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fects 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.

16

(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—

17

(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.

Æ