99–010

Calendar No. 388

107TH CONGRESS REPORT

2d Session " ! SENATE 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

REPORT

[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
2

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 epidemio-
3

1General Accounting Office. ‘‘Global Health: Challenges in Improving Infectious Disease Surveillance Systems.’’ P. 3. August 2001.

logical 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

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
4

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 underreported 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 contain-
5

ment 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
6

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
7

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
8

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 wellestablished 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 Glob-
9

al 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.
10

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.
11

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;
12

• 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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