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[Senate Report 107-210]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 388
107th Congress                                                   Report
                                 SENATE
 2d Session                                                     107-210

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

 
              THE GLOBAL PATHOGEN SURVEILLANCE ACT OF 2002

                                _______
                                

                 July 15, 2002.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 2487]

    The Committee on Foreign Relations, to which was referred 
the bill S. 2487, to provide for global pathogen surveillance 
and response, having considered the same, reports favorably 
thereon and recommends that the bill do pass.

                                CONTENTS

                                                                   Page

  I. Committee Action.................................................1
 II. Background and Purposes of the Bill..............................1
III. Section-by-Section Analysis......................................4
 IV. Evaluation of Regulatory Impact.................................10
  V. Cost Estimate...................................................10
 VI. Changes in Existing Law.........................................13

                          I. Committee Action

    The Committee held a hearing on September 5, 2001 on ``The 
Threat of Bioterrorism and the Spread of Infectious Diseases.'' 
At that hearing, the Committee heard testimony supporting the 
development of a global pathogen surveillance and monitoring 
network. S. 2487 was introduced on May 9, 2002 by Senators 
Biden, Helms, Kennedy, and Frist. On May 23, 2002, the 
Committee ordered the bill reported by voice vote with a 
favorable recommendation.

                II. Background and Purposes of the Bill

    The anthrax attacks in the United States in the fall of 
2001 underscored the need to address the growing threat of 
bioterrorism to our nation. While the anthrax attacks were 
delivered through the U.S. postal system, the next biological 
attack against the United States could in fact originate in a 
foreign country. It could also be developed or tested overseas, 
or be derived from a new disease or strain that first appears 
overseas. Limited capabilities exist to identify and contain a 
biological weapons attack or a naturally occurring infectious 
disease outbreak, especially in developing countries. 
Accordingly, an essential building block in any effort to 
combat bioterrorism--a global pathogen surveillance and 
monitoring network--is hampered by serious gaps in developing 
countries.
    Even prior to the anthrax attacks, the threat of biological 
terrorism was receiving increasing public attention from health 
officials, security experts, and government officials. In 
January 2000, the National Intelligence Council released a 
National Intelligence Estimate (NIE) entitled, The Global 
Infectious Disease Threat and Its Implications for the United 
States. According to the NIE, the probability of a bioterrorist 
attack against U.S. civilians and military personnel will 
continue to grow as states and terrorist groups develop a 
biological warfare capability. Moreover, the NIE warned that 
emerging and re-emerging infectious diseases overseas could 
threaten U.S. national security by causing high mortality rates 
for Americans in the event of an epidemic or by infecting U.S. 
military personnel participating in humanitarian and 
peacekeeping operations in developing countries.
    In January 2001, the National Intelligence Council released 
a NIE entitled, The Biological Warfare Threat. The 2001 NIE not 
only points to the growing biological warfare capabilities of 
state and nonstate actors but, more importantly, validates 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 versus a natural disease 
outbreak. Furthermore, both are potentially devastating to 
human, animal, and plant life, as well as economically costly. 
Accordingly, epidemiologists and public health experts rely on 
similar tools to help prevent, detect, and contain both 
intentional and naturally occurring disease outbreaks.
    The Committee held a hearing to examine the threat of 
bioterrorism and the spread of infectious diseases on September 
5, 2001. The Committee heard from a range of experts including 
former Senator Sam Nunn, former Director of Central 
Intelligence R. James Woolsey, Jr., and Dr. Donald A. 
Henderson, who led the World Health Organization's smallpox 
eradication campaign. The witnesses presented the potentially 
grim consequences of a bioterrorist attack or a naturally 
occurring disease epidemic, consequences that, in their 
opinions, would likely be exacerbated by delays in the 
recognition of an epidemic and identification of the specific 
pathogen involved. According to Dr. Henderson, ``In cooperation 
with WHO and other countries, we need to strengthen greatly our 
intelligence gathering capability. A focus on international 
surveillance and on scientist-to-scientist communication will 
be necessary if we are to have an early warning about the 
possible development and production of biological weapons by 
rogue nations or groups.'' Dr. David L. Heymann, Executive 
Director for Communicable Diseases at the World Health 
Organization, asserted, ``National surveillance systems need to 
be in place well in advance of a possible attack, as adequate 
data on the prevalence of background diseases are needed to aid 
recognition or an unusual and possibly deliberately caused 
disease. Moreover, the epidemiological techniques needed to 
investigate deliberate and natural outbreaks are the same.'' 
Finally, Frank Cilluffo, then with the Center for Strategic and 
International Studies, declared, ``Core public health 
functions, disease surveillance and lab capability will be the 
foundation of detection, investigation and response for 
bioterrorist attacks.''
    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 alone in an age of unprecedented air travel and 
international trade, as infectious pathogens are transported 
across borders each day. 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. Thus, the United States 
must enhance its participation in combating global infectious 
disease threats.
    Developing nations represent one of the weak links in a 
comprehensive global surveillance and monitoring network. 
According to an August 2001 report by the General Accounting 
Office on ``Challenges in Improving Infectious Disease 
Surveillance Systems'',

        Surveillance in developing countries is often impaired 
        by shortages of human and material resources. Key 
        positions in laboratories and clinics often are filled 
        by people who do not possess the necessary 
        qualifications. According to WHO, staff in over 90 
        percent of developing country laboratories are not 
        familiar with quality assurance principles, and more 
        than 60 percent of laboratory equipment is outdated or 
        not functioning . . . In addition, poor roads and 
        communications make it difficult for health care 
        workers to alert higher authorities about outbreaks or 
        quickly transport specimens to laboratories . . . These 
        weaknesses limit the effectiveness of even the most 
        widely supported international disease control 
        programs.\1\
---------------------------------------------------------------------------
    \1\ General Accounting Office. ``Global Health: Challenges in 
Improving Infectious Disease Surveillance Systems.'' P. 3. August 2001.

    Naturally occurring disease outbreaks are most likely to 
occur in the developing world, 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, where there is 
documented interest in biological agents.
    Accordingly, the Global Pathogen Surveillance Act of 2002 
seeks to identify and 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. Several 
provisions are intended to address shortfalls in public health 
education and training, including in laboratory techniques and 
syndrome surveillance, for eligible nationals from developing 
countries. We must enable public health officials to better 
detect, diagnose, and contain infectious disease outbreaks. The 
Global Pathogen Surveillance Act of 2002 includes sections that 
authorize the President to provide assistance for the purchase 
of laboratory and communications equipment. The President is 
authorized to provide assistance for the purpose of enhancing 
the surveillance and reporting capabilities for the World 
Health Organization and existing regional health networks. The 
heads of appropriate Federal agencies are authorized to make 
available greater numbers of United States Government public 
health personnel to international health organizations, 
regional health networks, and United States diplomatic missions 
where appropriate.
    The Committee's intent in approving the Global Pathogen 
Surveillance Act of 2002 is to improve the world's anti-
terrorism capabilities, and the training that is provided 
pursuant to this bill must include information on pathogens 
that have been identified as possible biological warfare 
agents. Witnesses at the Committee's September 5, 2001, hearing 
made clear, however, that the training and equipment needed to 
meet anti-terrorism concerns will also assist in the detection, 
identification and containment of naturally occurring disease 
outbreaks.
    The primary authority for implementation of the bill's 
provisions is vested in the Department of State, but the 
Committee expects that the Department of Health and Human 
Services will also play a critical role, including consultation 
to the greatest extent possible.

                    III. Section-by-Section Analysis

Section 1. Short Title.

    This Act is called the ``Global Pathogen Surveillance Act 
of 2002.''

Section 2. Findings; Purpose.

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

Section 3. Definitions.

    This section defines five terms of art and sets forth two 
routine definitions.

Section 4. Priority for Certain Countries.

    According to the previously cited 2000 NIE, ``disease 
incidence in developing countries, in particular, is either 
unreported or under-reported due to a lack of adequate medical 
and administrative personnel, the stigma associated with many 
diseases, or the reluctance of countries to incur the trade, 
tourism, and other losses that such revelations might 
produce.'' This reporting gap is of particular concern in a 
world where an unreported disease could become, or even be 
caused by, a novel biological warfare agent.
    Section 4 therefore requires that priority in allocating 
assistance under the provisions of this bill be given 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. In particular, the Committee 
expects that recipient nations will adhere to the terms of the 
International Health Regulations regarding prompt notification 
of disease outbreaks, cooperation with WHO investigations, and 
speedy implementation of containment strategies. Such adherence 
will serve the interests of public health and anti-terrorism 
alike.

Section 5. Restriction.

    Access to biological agents should be carefully regulated 
and appropriate accounting procedures should be followed when 
handling potentially deadly pathogens. Accordingly, section 5 
restricts access that foreign nationals participating in 
programs authorized under this Act may gain to select agents 
that may be used as, or in, a biological weapon, except in a 
supervised and controlled setting. The Committee believes that 
there is no compelling reason for participants to have 
unlimited access to such select agents. 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.

Section 6. Fellowship Program.

    A major obstacle to effective global pathogen surveillance 
and response will continue to be a lack of adequately trained 
public health officials in developing countries who can 
properly identify and diagnose an infectious disease outbreak. 
Many developing countries not only have a paucity of properly 
trained public health personnel, but also lack the capacity to 
train these individuals. The Committee believes that public 
health officials, properly trained in epidemiology and in 
diagnosing possible bioterrorism agents, are essential to the 
implementation of a strong and effective global surveillance 
system.
    To this end, Section 6 authorizes the Secretary of State to 
award fellowships to eligible nationals of developing countries 
to pursue a master of public health degree or advanced public 
health training in epidemiology. 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. So that this education and training 
pays dividends in global pathogen surveillance efforts and, in 
particular, benefits public health and surveillance efforts in 
developing countries, the Secretary of State shall require the 
recipient to enter into an agreement under which the recipient, 
upon completing said education or training, will return to the 
recipient's 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 nongovernmental, not-for-profit entity 
in that country. If the recipient is unable to meet these 
requirements, the recipient will be required to reimburse the 
U.S. government for the value of the assistance provided. The 
Secretary of State is authorized to enter into an agreement 
with any eligible developing country in order to establish the 
procedures for implementing the program.
    While the fellowship program is intended to benefit 
eligible nationals from eligible developing countries to 
receive education and training, subsection (e) allows for the 
participation of United States citizens, on a case-by-case 
basis, if the Secretary determines that it is in the national 
interest of the United States to do so. 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 the World Health 
Organization.

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

    Global pathogen disease surveillance requires a 
comprehensive strategy, including both laboratory-based and 
clinic-based surveillance efforts. Laboratory-based 
surveillance is critical to accurate diagnoses. Section 7 
supports short-term training courses, outside the United 
States, in laboratory techniques for laboratory technicians and 
public health officials. Such training courses offer the 
opportunity for public health personnel to train in their 
indigenous environment, utilizing the available technology. 
Subsection 7(a) complements the assistance authorized in 
Section 8 for the purchase and maintenance of public health 
laboratory equipment.
    While traditional disease surveillance and identification 
methods are irreplaceable, the need for rapid surveillance that 
does not depend on confirmed laboratory diagnosis is growing. 
Infectious disease outbreaks, particularly those perpetrated by 
biological terrorism, often present themselves as ill-defined 
or unexplained syndromes and/or deaths. While there can be no 
substitute for laboratory identification of pathogens, and 
astute diagnosis of disease by public health officials, it is 
possible to recognize suspicious patterns at the local level 
before individual patient data (signs and symptoms) raise alarm 
and/or are sent to a laboratory for diagnosis.
    Subsection 7(b) supports training in syndrome surveillance 
techniques. Syndrome surveillance systems provide the means for 
early detection and recognition, limit infection and mortality 
rates, and help to more efficiently focus limited public health 
resources. Utilizing simple desktop computer technology, a 
syndrome surveillance system at the fingertips of doctors and 
clinicians can transmit and track information in real-time 
using simple geographic locators to detect suspicious patterns 
of disease outbreak and to alert regional, national or 
international public health agencies. During a March 19, 2002 
hearing before the Senate Foreign Relations Committee, Dr. Alan 
P. Zelicoff, Senior Scientist, Sandia National Laboratories 
testified that the most critical aspect of our bioterrorism 
prevention efforts is ``enhanced disease surveillance 
accomplished through an inexpensive, international, secure, 
Internet-based system located in primary care clinics and some 
hospital emergency wards. . . .''
    The Committee does not intend that this program will take 
away from any existing programs or authorities. Rather, it is 
intended to be a very specific addition to the surveillance 
tool kit.

Sections 8 and 9. Assistance for the Purchase and Maintenance of Public 
        Health Laboratory Equipment and Assistance for Improved 
        Communication of Public Health Information.

    Equipment shortages are widespread in developing countries 
and severely impair pathogen surveillance efforts. The WHO 
reports that more than sixty percent of laboratory equipment in 
developing countries is outdated or defunct. According to the 
previously cited GAO report, ``The ability of developing 
country health officials to provide accurate disease 
information is further compromised by their frequent lack of 
clear and accurate diagnostic tests that they can perform 
themselves or ready access to functioning laboratories.''
    At the same time, in order to establish a truly global 
surveillance systems, local and regional health networks must 
have the ability to communicate with one another, both intra-
state and inter-state. In doing so, the Committee recognizes 
the need to strengthen the telecommunications capacities of 
different networks and to employ common software tools and 
compatible reporting requirements. Without modern and 
interoperable communications equipment and information 
technology, developing countries cannot employ effective 
disease surveillance and reporting systems. The Committee 
believes that improved communications equipment will result in 
the more timely and accurate dissemination of information 
throughout regional health networks, in circumstances in which 
time can mean the difference between low or high rates of 
infection or mortality from disease outbreaks.
    Sections 8 and 9 authorizes the President to provide 
assistance, subject to the availability of appropriations, to 
eligible developing countries to purchase and maintain (1) 
public health laboratory equipment necessary for the 
collection, analysis, and identification of pathogens which may 
cause disease outbreaks or be used as biological weapons and 
(2) communications equipment and information technology, along 
with supporting equipment, necessary to effectively collect, 
analyze, and transmit public health information. The equipment 
should be appropriate for ready use in the intended 
geographical area and compatible with general standards 
established by the WHO and, as appropriate, the CDC to ensure 
interoperability with regional and international networks. 
Recipient countries are expected to commit the necessary 
resources, infrastructure, and other assets to maintain and 
support use of this equipment.
    Subsections (c) and (d) in both sections reflect the 
Committee's belief that equipment purchased with assistance 
provided under these sections should be in compliance with the 
Export Administration Act of 1979 and that no funds should be 
made available for the purchase from a foreign country of 
equipment that, if made in the United States, would be subject 
to the Arms Export Control Act. Subsection (e) in both sections 
reflects the Committee's preference that equipment purchased 
with this assistance be of U.S. manufacture and that the 
amounts appropriated to carry out this section shall be subject 
to section 604 of the Foreign Assistance Act of 1961.
    The Committee favors standardizing the reporting of public 
health information between and among developing countries and 
international health organizations. Standardized reporting 
requirements will enable information to be more easily 
transmitted and understood. Thus, the President is authorized 
under subsection (f) of Section 9 to provide assistance for 
this purpose.
    It is the belief of this Committee that financial 
assistance must be accompanied by a requisite commitment, on 
the part of the recipient country, to the overall goals of 
global pathogen surveillance. The United States cannot 
undertake full support for the establishment of surveillance 
systems in developing countries. Thus, in order to make use of 
this assistance, Sections 8 and 9 direct that the recipient 
country must agree to provide the resources, infrastructure, 
and other assets required to house, support, maintain, secure, 
and maximize use of this equipment and appropriate technical 
personnel.

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. These details, intended to be flexible in 
nature, should be for the purpose of enhancing disease and 
pathogen surveillance efforts in developing countries. The 
Secretary of State must concur with any such detail. This 
section also provides for the appropriate reimbursement of the 
home department or agency for the loss of personnel, subject to 
the availability of appropriations.
    The Committee envisions use of this provision, among other 
examples, to enable the posting of Epidemiological Intelligence 
Service Officers at U.S. embassies and consulates overseas and 
the detail of additional U.S. personnel to the WHO.

Section 11. Laboratory-to-Laboratory Exchange Program.

    An important element of training for personnel from 
developing countries involves educational exchanges. Such types 
of exchanges allow U.S. personnel to spend time in developing 
countries and foreign personnel to observe disease surveillance 
techniques in U.S. laboratories.
    Section 11 authorizes the head of a federal department or 
agency, with the concurrence of the Secretary of State, to 
provide for such exchanges, subject to the availability of 
appropriations. The section defines ``approved public health 
and research laboratories'' as those overseas non-U.S. 
government laboratories which are well-established and have a 
demonstrated record of excellence, as determined by the 
Secretary.
    The Committee intends that such exchanges provide U.S. 
personnel the opportunity to share their knowledge and skills 
with public health officials in developing countries and, in 
doing so, contribute to the development of a robust global 
surveillance system. Similarly, foreign public health personnel 
are provided the opportunity to work alongside distinguished 
public health practitioners and to hone their skills on state-
of-the-art equipment.

Section 12. Expansion of Certain United States Governmental 
        Laboratories Abroad.

    Section 12, subject to the availability of appropriations, 
authorizes the expansion of the overseas laboratories and other 
related facilities of the Centers for Disease Control and the 
Department of Defense, as appropriate, to further the goals of 
global pathogen surveillance and monitoring. This expansion 
applies to both numbers of personnel and the scope of 
operations.
    Overseas CDC and DoD facilities, working with host 
governments, play a crucial role in enhancing the capability of 
developing countries to monitor disease outbreaks and suspected 
biological weapons attacks. For example, the Pentagon 
administers the Global Emerging Infections Surveillance and 
Response System (GEIS), a program established in 1997 to 
address the challenges of identifying, reporting, and 
responding to emerging infectious disease threats. The 
continued success of the GEIS program is predicated upon the 
availability of resources at overseas laboratories. Recently, 
this program received positive marks in a study by the 
Institute of Medicine. The Committee believes expanded funding 
will allow the GEIS program and overseas CDC facilities to 
foster greater international efforts on pathogen surveillance.

Section 13. Assistance for Regional Health Networks and Expansion of 
        Foreign Epidemiology Training Programs.

    The Committee notes the invaluable contributions of the 
World Heath Organization to the development of a global 
pathogen surveillance system. The World Health Organization, 
responsible for initiating the Global Alert and Response 
Network in April 2000, has been at the forefront of the 
creation of a global surveillance system, engineering links 
between a series of local, regional, and national health 
networks. Furthermore, the Committee believes that by making a 
commitment to expand the number, geographic scope, and quality 
of regional health networks, we move closer to our goal of a 
truly global pathogen surveillance system. A global 
surveillance system will not materialize overnight nor will it 
become a reality without a series of interconnected regional 
and disease specific surveillance networks.
    The Committee believes that still more can and should be 
done to increase the capacities of the World Health 
Organization and regional health networks to ensure early 
warning of potential bioterrorist attacks and emerging or 
reemerging infectious disease threats. Section 13 therefore 
authorizes the President to provide assistance for the purposes 
of enhancing the surveillance and reporting capabilities of the 
World Health Organization and existing regional networks. The 
President is also authorized to provide funding for the 
development of new regional health networks, as a means of 
continuing to expand the reach of a global surveillance 
network.
    Additionally, subsection (b) authorizes the Secretary of 
Health and Human Services to establish new country or regional 
Foreign Epidemiology Training Programs in eligible developing 
countries. The FETP program offers 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 in approximately twenty countries.

Section 14. Authorization of Appropriations.

    Section 14 authorizes appropriations for carrying out the 
provisions of this bill for Fiscal Years 2003 and 2004. The 
section authorizes $150 million in total, $70 million for FY 
2003 and $80 million for FY 2004. Of these amounts, $50 million 
is authorized each year to carry out Sections 6, 7, 8, and 9; 
$5 million each year to carry out Section 10; $2 million each 
year to carry out Section 11; $8 million in FY 2003 and $18 
million in FY 2004 to carry out Section 12; and $5 million each 
year to carry out Section 13. All of these authorization levels 
are subject to the availability of appropriations.
    In providing the training and tools for developing 
countries to establish an indigenous capability to participate 
in a global disease surveillance network, the Committee 
recognizes that the level of required assistance will be modest 
in comparison to other foreign assistance efforts. Targeted 
U.S. assistance can leverage other international assistance 
and, more importantly, establish benchmarks for public health 
programs in developing countries to strive for in sustaining 
and expanding pathogen surveillance efforts. Global 
surveillance does not command large-scale investments nor does 
it require high-tech equipment. Simple desktop computers or 
even telephone lines can serve as effective reporting 
mechanisms depending upon the particular geographic 
circumstances. However, the Committee does expect developing 
countries receiving assistance under this Act to make an 
unwavering commitment to improving their pathogen surveillance 
and monitoring efforts.
    The Committee hopes that U.S. allies and partners will 
contribute a proportionate share in funding these types of 
efforts to develop a comprehensive global surveillance network. 
The absence of authorized funding beyond FY 2005 does not 
indicate the need for a re-authorization of these programs.

                  IV. Evaluation of Regulatory Impact

    In accordance with Rule XXVI, paragraph 11(b) of the 
Standing Rules of the Senate, the Committee has concluded that 
there is no regulatory impact from this legislation.

                            V. Cost Estimate

    In accordance with Rule XXVI, paragraph 11(a) of the 
Standing Rules of the Senate, the Committee provides the 
following estimate of the cost of this legislation prepared by 
the Congressional Budget Office:
                       Congressional Budget Office,
                             U.S. Congress, Washington, DC.
                                                     June 11, 2002.
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. 2487, the Global 
Pathogen Surveillance Act of 2002.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
        Sincerely,
                                            Dan L. Crippen,
                                                          Director.
Enclosure:

cc: Hon. Jesse Helms, Ranking Minority Member.

               Congressional Budget Office Cost Estimate

           S. 2487--GLOBAL PATHOGEN SURVEILLANCE ACT OF 2002

Summary

    S. 2487 would authorize appropriations of $70 million in 
2003 and $80 million in 2004 to establish a worldwide 
monitoring and response system against bioterrorism and 
outbreaks of infectious disease. CBO estimates that 
implementing S. 2487 would cost $20 million in 2003 and $145 
million over the 2003-2007 period, assuming appropriation of 
the authorized amounts. Because the bill would not affect 
direct spending or receipts, pay-as-you-go procedures would not 
apply.
    S. 2487 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.

Estimated Cost to the Federal Government

    The estimated budgetary impact of S. 2487 is shown in the 
following table. This estimate assumes that the amounts 
authorized will be appropriated by the start of each fiscal 
year and that outlays would follow historical spending 
patterns. The costs of this legislation fall within budget 
functions 050 (defense), 150 (international affairs), and 550 
(health).

                             Spending for Global Pathogen Surveillance Under S. 2487
             (By Fiscal Year, in Millions of Dollars--Changes in Spending Subject to Appropriation)
----------------------------------------------------------------------------------------------------------------
                                                     2003         2004         2005         2006         2007
----------------------------------------------------------------------------------------------------------------
Authorization Level............................          70           80            0            0            0
Estimated Outlays..............................          20           56           46           16            7
----------------------------------------------------------------------------------------------------------------

Basis of Estimate

    S. 2487 would establish a worldwide monitoring and response 
system against bioterrorism and outbreaks of infectious 
disease. It would authorize appropriations of $70 million in 
2003 and $80 million in 2004 for the U.S. Agency for 
International Development, the Department of State, the Centers 
for Disease Control and Prevention, the Department of Defense, 
and other federal agencies. Assuming appropriation of the 
authorized amounts, CBO estimates that implementing the bill 
would cost $20 million in 2003 and $145 million over the 2003-
2007 period.
    Some of the specific programs authorized by the bill 
include:

   Educational exchange programs;

   Fellowships and training courses for health 
        personnel in developing countries;

   Development assistance for developing countries to 
        purchase and maintain laboratory equipment, information 
        technology, and communications equipment;

   Assigning public health personnel to U.S. missions 
        and international organizations;

   Expansion of personnel, operations, and training 
        activities of U.S. government laboratories abroad;

   Development assistance to improve the surveillance 
        and reporting mechanisms of the World Health 
        Organization and regional health networks; and

   Establishing and expanding epidemiology training 
        programs in developing countries.

Pay-As-You-Go Considerations

    None.

Intergovernmental and Private-Sector Impact

    S. 2487 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would not affect the budgets of 
state, local, or tribal governments.

Estimate Prepared By

Federal Costs:

    Education and Exchange Programs: Sunita D'Monte.

    Foreign Assistance: Joseph C. Whitehill.

    Department of Defense: Sam Papenfuss.

    Centers for Disease Control and Prevention: Jeanne De Sa.

Impact on State, Local, and Tribal Governments: Elyse Goldman.

Impact on the Private Sector: Paige Piper/Bach.

Estimate Approved By

    Peter H. Fontaine, Deputy Assistant Director for Budget 
Analysis.

                      VI. 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 are made by this bill.
                                  
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