I 

116TH CONGRESS 

1ST SESSION H. R. 2166 

To authorize a comprehensive, strategic approach for United States foreign 

assistance to developing countries to strengthen global health security, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 9, 2019 

Mr. CONNOLLY (for himself, Mr. CHABOT, Mr. BERA, Mr. FITZPATRICK, Mr. 

LARSEN of Washington, and Mrs. WAGNER) introduced the following bill; 

which was referred to the Committee on Foreign Affairs, and in addition 

to the Committees on Armed Services, and Intelligence (Permanent Select), for a period to be subsequently determined by the Speaker, in each 

case for consideration of such provisions as fall within the jurisdiction of 

the committee concerned 

A BILL 

To authorize a comprehensive, strategic approach for United 

States foreign assistance to developing countries to 

strengthen global health security, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Global Health Security 

5 Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) In 2005, each of the 196 World Health Or2 ganization member states signed the International 

3 Health Regulations to improve the world’s ability to 

4 prevent, detect, and respond to public health events. 

5 (2) In December 2009, President Obama re6 leased the National Strategy for Countering Biologi7 cal Threats, which listed as one of seven objectives 

8 ‘‘Promote global health security: Increase the avail9 ability of and access to knowledge and products of 

10 the life sciences that can help reduce the impact 

11 from outbreaks of infectious disease whether of nat12 ural, accidental, or deliberate origin’’. 

13 (3) In September 2011, the United States and 

14 the World Health Organization signed a memo15 randum of understanding to help developing coun16 tries strengthen their capabilities to meet the Inter17 national Health Regulations. 

18 (4) In February 2014, the United States and 

19 nearly 30 other nations launched the Global Health 

20 Security Agenda (GHSA) to address several high21 priority, global infectious disease threats. The 

22 GHSA is a multi-faceted, multi-country initiative in23 tended to accelerate partner countries’ measurable 

24 capabilities to achieve specific targets to prevent, de25 tect, and respond to infectious disease threats, 


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1 whether naturally occurring, deliberate, or acci2 dental. 

3 (5) The GHSA was funded with a 

4 $1,000,000,000, one-time, 5-year supplemental ap5 propriation that expires at the end of fiscal year 

6 2019. 

7 (6) As of 2014, approximately 67 percent of na8 tions have not fully implemented the International 

9 Health Regulations and built appropriate core ca10 pacities to detect, assess, report, and respond to 

11 public health emergencies. 

12 (7) In 2015, the United Nations adopted the 

13 Sustainable Development Goals (SDGs), which in14 clude specific reference to the importance of global 

15 health security as part of SDG 3 ‘‘ensure healthy 

16 lives and promote well-being for all at all ages’’ as 

17 follows: ‘‘strengthen the capacity of all countries, in 

18 particular developing countries, for early warning, 

19 risk reduction and management of national and 

20 global health risks’’. 

21 (8) On November 4, 2016, President Obama 

22 signed Executive Order 13747, ‘‘Advancing the 

23 Global Health Security Agenda to Achieve a World 

24 Safe and Secure from Infectious Disease Threats’’. 


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1 (9) In October 2017 at the GHSA Ministerial 

2 Meeting in Uganda, the United States and more 

3 than 40 GHSA member countries supported the 

4 ‘‘Kampala Declaration’’ to extend the GHSA for an 

5 additional 5 years to 2024. 

6 (10) In December 2017, President Trump re7 leased the National Security Strategy, which in8 cludes the priority action: ‘‘Detect and contain bio9 threats at their source: We will work with other 

10 countries to detect and mitigate outbreaks early to 

11 prevent the spread of disease. We will encourage 

12 other countries to invest in basic health care systems 

13 and to strengthen global health security across the 

14 intersection of human and animal health to prevent 

15 infectious disease outbreaks’’. 

16 (11) In February 2018, the Director of Na17 tional Intelligence, Daniel R. Coats, released the 

18 Worldwide Threat Assessment of the U.S. Intel19 ligence Community, which said ‘‘The increase in fre20 quency and diversity of reported disease outbreaks— 

21 such as dengue and Zika—probably will continue 

22 through 2018, including the potential for a severe 

23 global health emergency that could lead to major 

24 economic and societal disruptions, strain governVerDate Sep 11 2014 22:03 Apr 17, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2166.IH H2166

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1 mental and international resources, and increase 

2 calls on the United States for support’’. 

3 (12) In the Consolidated Appropriations Act, 

4 2018 (Public Law 115–141), Congress provided 

5 $172,600,000 for global health security and required 

6 the President to submit a global health security 

7 strategy to Congress not later than 180 days after 

8 the date of the enactment of that Act. 

9 (13) In September 2018, President Trump re10 leased the National Biodefense Strategy, which in11 cludes objectives to ‘‘strengthen global health secu12 rity capacities to prevent local bioincidents from be13 coming epidemics’’, and ‘‘strengthen international 

14 preparedness to support international response and 

15 recovery capabilities’’. 

16 (14) In December 2018, President Trump re17 leased the National Strategy for Countering Weap18 ons of Mass Destruction Terrorism, which states 

19 that ‘‘Although securing dangerous biological agents, 

20 controlled chemical precursors, and nuclear and ra21 diological materials is principally the responsibility 

22 of the states that hold them, it is manifestly in the 

23 United States interest that these states have both 

24 the political will and the ability to discharge this re25 sponsibility. Consequently, we will work with partner 


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1 nations and international organizations to improve 

2 their capacity to secure dangerous materials, in par3 ticular by sharing expertise to establish effective and 

4 sustainable infrastructure, human capital, and regu5 latory frameworks to counter the WMD threat.’’. 

6 SEC. 3. STATEMENT OF POLICY; SENSE OF CONGRESS. 

7 (a) STATEMENT OF POLICY.—It is the policy of the 

8 United States to— 

9 (1) promote global health security as a core na10 tional security interest; 

11 (2) advance the Global Health Security Agenda; 

12 (3) collaborate with other countries to detect 

13 and mitigate outbreaks early to prevent the spread 

14 of disease; 

15 (4) encourage other countries to invest in basic 

16 resilient and sustainable health care systems; and 

17 (5) strengthen global health security across the 

18 intersection of human and animal health to prevent 

19 infectious disease outbreaks and combat the growing 

20 threat of antimicrobial resistance. 

21 (b) SENSE OF CONGRESS.—It is the sense of the 

22 Congress that the President, in providing assistance to im23 plement the strategy required under section 6(a), should— 


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1 (1) coordinate, through a whole-of-government 

2 approach, the efforts of relevant Federal depart3 ments and agencies to implement the strategy; 

4 (2) seek to fully utilize the unique capabilities 

5 of each relevant Federal department and agency 

6 while collaborating with and leveraging the contribu7 tions of other key stakeholders; and 

8 (3) utilize open and streamlined solicitations to 

9 allow for the participation of a wide range of imple10 menting partners through the most appropriate pro11 curement mechanisms, which may include grants, 

12 contracts, cooperative agreements, and other instru13 ments as necessary and appropriate. 

14 SEC. 4. GLOBAL HEALTH SECURITY AGENDA INTERAGENCY 

15 REVIEW COUNCIL. 

16 (a) ESTABLISHMENT.—The President shall establish 

17 a Global Health Security Agenda Interagency Review 

18 Council (in this section referred to as the ‘‘Council’’) to 

19 perform the general responsibilities described in sub20 section (d) and the specific roles and responsibilities de21 scribed in subsection (f). 

22 (b) CHAIR.—The President shall appoint an employee 

23 of the National Security Council, serving at the senior di24 rector level or higher, to serve as Chair for the Council. 


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1 (c) MEETINGS.—The Council shall meet not less than 

2 four times per year to advance its mission and fulfill its 

3 responsibilities. 

4 (d) GENERAL RESPONSIBILITIES.— 

5 (1) IN GENERAL.—The Council shall be respon6 sible for the following activities: 

7 (A) Provide policy-level recommendations 

8 to participating agencies on Global Health Se9 curity Agenda (GHSA) goals, objectives, and 

10 implementation. 

11 (B) Facilitate interagency, multi-sectoral 

12 engagement to carry out GHSA implementa13 tion. 

14 (C) Provide a forum for raising and work15 ing to resolve interagency disagreements con16 cerning the GHSA. 

17 (D)(i) Review the progress toward and 

18 work to resolve challenges in achieving United 

19 States commitments under the GHSA, includ20 ing commitments to assist other countries in 

21 achieving the GHSA targets. 

22 (ii) The Council shall consider, among 

23 other issues, the following: 

24 (I) The status of United States finan25 cial commitments to the GHSA in the conVerDate Sep 11 2014 22:03 Apr 17, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2166.IH H2166

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1 text of commitments by other donors, and 

2 the contributions of partner countries to 

3 achieve the GHSA targets. 

4 (II) The progress toward the mile5 stones outlined in GHSA national plans for 

6 those countries where the United States 

7 Government has committed to assist in im8 plementing the GHSA and in annual work9 plans outlining agency priorities for imple10 menting the GHSA. 

11 (III) The external evaluations of 

12 United States and partner country capa13 bilities to address infectious disease 

14 threats, including the ability to achieve the 

15 targets outlined within the WHO Joint Ex16 ternal Evaluation (JEE) tool, as well as 

17 gaps identified by such external evalua18 tions. 

19 (E) Develop a report on an annual basis 

20 regarding the progress achieved and challenges 

21 concerning the United States Government’s 

22 ability to advance the GHSA across priority 

23 countries. The data included in the report shall 

24 be disaggregated by priority country using indi25 cators that are consistent on a year-to-year 


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1 basis. The report shall include recommendations 

2 to resolve, mitigate, or otherwise address the 

3 challenges identified therein. The report shall 

4 be transmitted to the President and the appro5 priate congressional committees and, to the ex6 tent possible, made publicly available. 

7 (F) Conduct an overall review of the 

8 GHSA for submission to the President and the 

9 appropriate congressional committees by not 

10 later than 180 days after the date of the enact11 ment of this Act. The review should include an 

12 evaluation of the progress achieved during the 

13 first 5 years of this initiative, as well as any 

14 challenges faced. The report should also provide 

15 recommendations on the future direction of the 

16 initiative. 

17 (2) FORM.—The report required under para18 graph (1)(E) and the review required under para19 graph (1)(F) shall be submitted in unclassified form 

20 but may contain a classified annex. 

21 (e) PARTICIPATION.—The Council shall consist of 

22 representatives, serving at the Assistant Secretary level or 

23 higher, from the following agencies: 

24 (1) The Department of State. 

25 (2) The Department of Defense. 


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1 (3) The Department of Justice. 

2 (4) The Department of Agriculture. 

3 (5) The Department of Health and Human 

4 Services. 

5 (6) The Department of Labor. 

6 (7) The Department of Homeland Security. 

7 (8) The Office of Management and Budget. 

8 (9) The United States Agency for International 

9 Development. 

10 (10) The Environmental Protection Agency. 

11 (11) The Centers for Disease Control and Pre12 vention. 

13 (12) The Office of Science and Technology Pol14 icy. 

15 (13) The National Institutes of Health. 

16 (14) The National Institute of Allergy and In17 fectious Diseases. 

18 (15) Such other agencies as the Chair for the 

19 Council determines to be appropriate. 

20 (f) SPECIFIC ROLES AND RESPONSIBILITIES.— 

21 (1) IN GENERAL.—The heads of agencies de22 scribed in subsection (e) shall— 

23 (A) make the GHSA and its implementa24 tion a high priority within their respective agen25 cies, and include GHSA-related activities within 


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1 their respective agencies’ strategic planning and 

2 budget processes; 

3 (B) designate a senior-level official to be 

4 responsible for the implementation of this Act; 

5 (C) designate, in accordance with sub6 section (e), an appropriate representative at the 

7 Assistant Secretary level or higher to partici8 pate on the Council; 

9 (D) keep the Council apprised of GHSA10 related activities undertaken within their re11 spective agencies; 

12 (E) maintain responsibility for agency-re13 lated programmatic functions in coordination 

14 with host governments, country teams, and 

15 GHSA in-country teams, and in conjunction 

16 with other relevant agencies; 

17 (F) coordinate with other agencies that are 

18 identified in this section to satisfy pro19 grammatic goals, and further facilitate coordi20 nation of country teams, implementers, and do21 nors in host countries; and 

22 (G) coordinate across GHSA national 

23 plans and with GHSA partners to which the 

24 United States is providing assistance. 


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1 (2) ADDITIONAL ROLES AND RESPONSIBIL2 ITIES.—In addition to the roles and responsibilities 

3 described in paragraph (1), the heads of agencies de4 scribed in subsection (e) shall carry out their respec5 tive roles and responsibilities described in sub6 sections (b) through (i) of section 3 of Executive 

7 Order 13747 (81 Fed. Reg. 78701; relating to Ad8 vancing the Global Health Security Agenda to 

9 Achieve a World Safe and Secure from Infectious 

10 Disease Threats), as in effect on the day before the 

11 date of the enactment of this Act. 

12 SEC. 5. SPECIAL ADVISOR TO THE PRESIDENT FOR GLOBAL 

13 HEALTH SECURITY. 

14 Section 101 of the National Security Act of 1947 (50 

15 U.S.C. 3021) is amended— 

16 (1) in subsection (b)— 

17 (A) in paragraph (3), by striking ‘‘and’’ at 

18 the end; 

19 (B) in paragraph (4), by striking the pe20 riod and inserting ‘‘; and’’; and 

21 (C) by adding at the end the following new 

22 paragraph: 

23 ‘‘(5) coordinate, without assuming operational 

24 authority, the United States Government response to 

25 global health security emergencies.’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(i) SPECIAL ADVISOR TO THE PRESIDENT FOR

4 GLOBAL HEALTH SECURITY.— 

5 ‘‘(1) IN GENERAL.—The President shall des6 ignate an employee of the National Security Council, 

7 at the level of Deputy Assistant to the President or 

8 higher, to be responsible for the coordination of the 

9 interagency process for responding to global health 

10 security emergencies. 

11 ‘‘(2) CONGRESSIONAL BRIEFING.—Not less fre12 quently than twice each year, the employee des13 ignated under this subsection shall provide to the 

14 appropriate congressional committees a briefing on 

15 the responsibilities and activities of the individual 

16 under this subsection. 

17 ‘‘(3) APPROPRIATE CONGRESSIONAL COMMIT18 TEES DEFINED.—In this subsection, the term ‘ap19 propriate congressional committees’ has the meaning 

20 given such term in section 9 of the Global Health 

21 Security Act of 2019.’’. 

22 SEC. 6. STRATEGY AND REPORTS. 

23 (a) STRATEGY.—The Special Advisor to the Presi24 dent for Global Health Security (designated under sub25 section (i) of section 101 of the National Security Act of 


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1 1947 (50 U.S.C. 3021), as added by section 6 of this Act) 

2 shall coordinate the development and implementation of 

3 a strategy to implement the policy described in section 

4 3(a), which shall— 

5 (1) set specific and measurable goals, bench6 marks, timetables, performance metrics, and moni7 toring and evaluation plans that reflect international 

8 best practices relating to transparency, account9 ability, and global health security; 

10 (2) support and be aligned with country-owned 

11 global health security policy and investment plans 

12 developed with input from key stakeholders, as ap13 propriate; 

14 (3) facilitate communication and collaboration, 

15 as appropriate, among local stakeholders in support 

16 of a multi-sectoral approach to global health secu17 rity; 

18 (4) support the long-term success of programs 

19 by building the capacity of local organizations and 

20 institutions in target countries and communities; 

21 (5) develop community resilience to infectious 

22 disease threats and emergencies; 

23 (6) leverage resources and expertise through 

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1 zations, civil society, nongovernmental organizations, 

2 and health research and academic institutions; and 

3 (7) support collaboration, as appropriate, be4 tween United States universities, and public and pri5 vate institutions in target countries and communities 

6 to promote health security and innovation. 

7 (b) COORDINATION.—The President, acting through 

8 the Special Advisor for Global Health Security, shall co9 ordinate, through a whole-of-government approach, the ef10 forts of relevant Federal departments and agencies in the 

11 implementation of the strategy required under subsection 

12 (a) by— 

13 (1) establishing monitoring and evaluation sys14 tems, coherence, and coordination across relevant 

15 Federal departments and agencies; and 

16 (2) establishing platforms for regular consulta17 tion and collaboration with key stakeholders and the 

18 appropriate congressional committees. 

19 (c) STRATEGY SUBMISSION.— 

20 (1) IN GENERAL.—Not later than 180 days 

21 after the date of the enactment of this Act, the 

22 President, in consultation with the head of each rel23 evant Federal department and agency, shall submit 

24 to the appropriate congressional committees the 

25 strategy required under subsection (a) that provides 


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1 a detailed description of how the United States in2 tends to advance the policy set forth in section 3(a) 

3 and the agency-specific plans described in paragraph 

4 (2). 

5 (2) AGENCY-SPECIFIC PLANS.—The strategy re6 quired under subsection (a) shall include specific im7 plementation plans from each relevant Federal de8 partment and agency that describes— 

9 (A) the anticipated contributions of the de10 partment or agency, including technical, finan11 cial, and in-kind contributions, to implement 

12 the strategy; and 

13 (B) the efforts of the department or agen14 cy to ensure that the activities and programs 

15 carried out pursuant to the strategy are de16 signed to achieve maximum impact and long17 term sustainability. 

18 (d) REPORT.— 

19 (1) IN GENERAL.—Not later than 1 year after 

20 the date on which the strategy required under sub21 section (a) is submitted to the appropriate congres22 sional committees under subsection (c), and not later 

23 than October 1 of each year thereafter, the Presi24 dent shall submit to the appropriate congressional 


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1 committees a report that describes the status of the 

2 implementation of the strategy. 

3 (2) CONTENT.—The report required under 

4 paragraph (1) shall— 

5 (A) identify any substantial changes made 

6 in the strategy during the preceding calendar 

7 year; 

8 (B) describe the progress made in imple9 menting the strategy; 

10 (C) identify the indicators used to establish 

11 benchmarks and measure results over time, as 

12 well as the mechanisms for reporting such re13 sults in an open and transparent manner; 

14 (D) contain a transparent, open, and de15 tailed accounting of expenditures by relevant 

16 Federal departments and agencies to implement 

17 the strategy, including, for each Federal depart18 ment and agency, the statutory source of ex19 penditures, amounts expended, implementing 

20 partners, targeted beneficiaries, and activities 

21 supported; 

22 (E) describe how the strategy leverages 

23 other United States global health and develop24 ment assistance programs; 


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1 (F) assess efforts to coordinate United 

2 States global health security programs, activi3 ties, and initiatives with key stakeholders; and 

4 (G) incorporate a plan for regularly review5 ing and updating strategies, partnerships, and 

6 programs and sharing lessons learned with a 

7 wide range of stakeholders, including key stake8 holders, in an open, transparent manner. 

9 (e) FORM.—The strategy required under subsection 

10 (a) and the report required under subsection (d) shall be 

11 submitted in unclassified form but may contain a classi12 fied annex. 

13 SEC. 7. COMPLIANCE WITH THE FOREIGN AID TRANS14 PARENCY AND ACCOUNTABILITY ACT OF 

15 2016. 

16 Section 2(3) of the Foreign Aid Transparency and 

17 Accountability Act of 2016 (Public Law 114–191; 22 

18 U.S.C. 2394c note) is amended— 

19 (1) in subparagraph (C), by striking ‘‘and’’ at 

20 the end; 

21 (2) in subparagraph (D), by striking the period 

22 at the end and inserting ‘‘; and’’; and 

23 (3) by adding at the end the following: 

24 ‘‘(E) the Global Health Security Act of 

25 2018.’’. 


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1 SEC. 8. DEFINITIONS. 

2 In this Act: 

3 (1) APPROPRIATE CONGRESSIONAL COMMIT4 TEES.—The term ‘‘appropriate congressional com5 mittees’’ means— 

6 (A) the Committee on Foreign Affairs and 

7 the Committee on Appropriations of the House 

8 of Representatives; and 

9 (B) the Committee on Foreign Relations 

10 and the Committee on Appropriations of the 

11 Senate. 

12 (2) GLOBAL HEALTH SECURITY.—The term 

13 ‘‘global health security’’ means activities supporting 

14 epidemic and pandemic preparedness and capabili15 ties at the country and global levels in order to mini16 mize vulnerability to acute public health events that 

17 can endanger the health of populations across geo18 graphical regions and international boundaries. 

19 SEC. 9. SUNSET. 

20 This Act, and the amendments made by this Act 

21 (other than section 5), shall cease to be effective on De22 cember 31, 2024. 

Æ 


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