II 

Calendar No. 287 

116TH CONGRESS 

1ST SESSION S. 1657 

To provide assistance to combat the escalating burden of Lyme disease and 

other tick and vector-borne diseases and disorders. 

IN THE SENATE OF THE UNITED STATES 

MAY 23 (legislative day, MAY 22), 2019 

Ms. COLLINS (for herself, Ms. SMITH, Mr. KING, Mrs. CAPITO, Mr. 

BLUMENTHAL, Mrs. HYDE-SMITH, Mr. MURPHY, Mr. BOOZMAN, Ms. 

HASSAN, Mr. BRAUN, and Mr. SANDERS) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

NOVEMBER 5, 2019 

Reported by Mr. ALEXANDER, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To provide assistance to combat the escalating burden of 

Lyme disease and other tick and vector-borne diseases 

and disorders. 

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 ‘‘Ticks: Identify, Con5 trol, and Knockout Act’’ or the ‘‘TICK Act’’. 


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1 SEC. 2. OFFICE OF OVERSIGHT AND COORDINATION FOR 

2 VECTOR-BORNE DISEASE. 

3 (a) ESTABLISHMENT.—The Secretary of Health and 

4 Human Services (referred to in this Act as the ‘‘Sec5 retary’’) shall establish in the Office of the Secretary an 

6 Office of Oversight and Coordination for Vector-Borne 

7 Diseases (referred to in this Act as the ‘‘Office’’), to be 

8 headed by a director to be appointed by the Secretary. 

9 (b) DUTIES OF THE OFFICE.— 

10 (1) IN GENERAL.—The Director of the Office 

11 shall— 

12 (A) oversee the creation and maintenance 

13 of a national strategy to address Lyme disease, 

14 and other tick and vector-borne diseases as pro15 vided for in paragraph (2); and 

16 (B) oversee and coordinate Lyme disease 

17 and other tick and vector-borne disease and dis18 order programs and activities across the agen19 cies and offices of the Department of Health 

20 and Human Services and other Federal agen21 cies outside of the Department of Health and 

22 Human Services, as appropriate. 

23 (2) NATIONAL STRATEGY.— 

24 (A) IN GENERAL.—The Director of the Of25 fice shall provide for the conduct of an annual 

26 assessment of the progress of the United States 


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1 in preparing for the escalating burden of Lyme 

2 disease and other tick and vector-borne diseases 

3 and disorders, including an assessment of all 

4 Federally funded programs and activities re5 lated to surveillance, diagnosis, treatment, edu6 cation, or prevention, as well as implementation 

7 steps, and recommendations for priority actions, 

8 with appropriate benchmarks to measure 

9 progress, based on the assessment. 

10 (B) NON-FEDERAL PERSPECTIVES.—In de11 veloping the strategy under subparagraph (A), 

12 and maintaining it, the Director shall consult 

13 with non-Federal individuals with appropriate 

14 expertise, which may include— 

15 (i) epidemiologists with experience in 

16 surveillance, treatment, education, or pre17 vention of vector-borne diseases; 

18 (ii) representatives of national patient 

19 advocacy and research organizations that 

20 focus on vector-borne diseases, and those 

21 that focus specifically on tick-borne disease 

22 and have demonstrated experience in re23 search, data collection, or patient access to 

24 care; 


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1 (iii) health information technology ex2 perts or other information management 

3 specialists; 

4 (iv) clinicians, entomologists, vector5 management professionals, integrated pest 

6 management professionals, public health 

7 professionals, and others with expertise in 

8 vector-borne disease, including Lyme dis9 ease or other tick-borne diseases or dis10 orders; and 

11 (v) research scientists with experience 

12 conducting translational research or uti13 lizing surveillance systems for scientific re14 search purposes. 

15 (c) OBJECTIVE OF THE OFFICE.—In carrying out 

16 subsection (b), the Director of the Office shall facilitate 

17 and work to ensure the accomplishment of the following 

18 activities: 

19 (1) Expansion and enhancement of epidemiolog20 ical research and basic, translational, and clinical bi21 ological and biomedical research. 

22 (2) Expansion and improvement of tick surveil23 lance, linking tick surveillance to surveillance of 

24 Lyme disease, and reporting of Lyme disease and 

25 other tick- and vector-borne diseases, including coVerDate Sep 11 2014 21:41 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6401 E:\BILLS\S1657.RS S1657

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1 infections with agents of more than one tick or vec2 tor-borne diseases. 

3 (3) Development of effective diagnostic tests to 

4 accurately and timely diagnose Lyme disease and 

5 other tick- and vector-borne diseases, including di6 rect detention tests. 

7 (4) Development of treatments to cure or im8 prove the lives of those who are infected with Lyme 

9 disease or other tick-and vector-borne diseases or 

10 who suffer from a tick-induced disorder (such as tick 

11 PIM programs). 

12 (5) Address the quality of patient care, treat13 ment affordability, and public awareness of Lyme 

14 disease and other tick or vector-borne diseases. 

15 (6) Design and conduct clinical trials of suffi16 cient size and duration to support clinical rec17 ommendations. 

18 (7) Systematic documentation of the experi19 ences of health care professionals in diagnosing and 

20 treating tick- and vector-borne disease, including di21 agnostic and treatment outcomes. 

22 (8) Development and maintenance of one or 

23 more registries of patients and their experiences re24 lating to exposure to, diagnosis for, and treatment 

25 of tick- and vector-borne disease, including outVerDate Sep 11 2014 21:41 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6401 E:\BILLS\S1657.RS S1657

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1 comes, such that the confidentiality and safety of 

2 patient data is protected. 

3 (9) Access to data and enable emerging tech4 nologies to improve patient care, sharing data with 

5 researchers and care providers. 

6 (10) Coordination with other Federal depart7 ments to address tick- and other vector-borne dis8 eases including the Department of Defense, the De9 partment of Agriculture, the Environmental Protec10 tion Agency, the Department of Interior, and the 

11 Department of Homeland Security. 

12 (11) Coordination with the Tick-Borne Disease 

13 Working Group established under section 2062 of 

14 the 21st Century Cures Act (42 U.S.C. 284s) to de15 velop and implement recommendations. 

16 (12) Coordination with international bodies to 

17 integrate and inform the fight against Lyme disease, 

18 and other tick- and vector-borne diseases globally. 

19 SEC. 3. REGIONAL CENTERS OF EXCELLENCE IN TICK AND 

20 VECTOR-BORNE DISEASES. 

21 (a) IN GENERAL.—The Secretary, in coordination 

22 with the Director of the Centers for Disease Control and 

23 Prevention and the heads of other agencies as appropriate, 

24 shall award grants, contracts, or cooperative agreements 

25 to eligible entities (such as institutions of higher eduVerDate Sep 11 2014 21:41 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6401 E:\BILLS\S1657.RS S1657

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1 cation, State, tribal, and local health departments, asso2 ciations, or other appropriate entities) for the establish3 ment or support of Regional Centers of Excellence in Tick 

4 and Vector-Borne Diseases. Such Regional Centers shall 

5 be designed to address Lyme disease and other tick and 

6 vector-borne diseases by— 

7 (1) building collaboration between academia 

8 and public health agencies for surveillance, preven9 tion and response to Lyme disease and other tick 

10 and vector-borne diseases; 

11 (2) providing training for public health ento12 mologists to deal with Lyme disease and other tick 

13 and vector-borne diseases; and 

14 (3) conducting applied research to develop and 

15 validate prevention and control tools and methods, 

16 and to anticipate and respond to outbreaks of Lyme 

17 disease and other tick and vector-borne diseases. 

18 (b) ELIGIBILITY.—To be eligible to receive a grant, 

19 contract, or cooperative agreement under this section, an 

20 entity shall prepare and submit to the Secretary an appli21 cation at such time, in such manner, and containing such 

22 agreements and information as the Secretary may require, 

23 including a description of how the entity will— 


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1 (1) coordinate, as applicable, with existing Fed2 eral, State, and tribal programs related to Lyme dis3 ease and other vector-borne diseases; 

4 (2) examine, evaluate, and promote evidence5 based interventions for individuals with Lyme dis6 ease and other tick- and vector-borne diseases, in7 cluding those in rural and underserved populations, 

8 and those who provide care for such individuals; and 

9 (3) prioritize activities relating to— 

10 (A) expanding efforts, as appropriate, to 

11 implement evidence-based practices to address 

12 Lyme disease and other tick- and vector-borne 

13 diseases, including through the training of 

14 State, local, and tribal public health officials 

15 and other health professionals on such prac16 tices; 

17 (B) supporting surveillance of vectors, and 

18 early detection and diagnosis of Lyme and 

19 other tick- and vector-borne diseases, including 

20 improving the quality and reliability of diag21 nostic tools at all stages of disease progression, 

22 and developing a Lyme disease test capable of 

23 distinguishing between past and active infec24 tions; 


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1 (C) improving the safety and efficacy of 

2 any new, renewed, or modified human vaccine 

3 for Lyme disease, other tick- and vector-borne 

4 diseases, or a combination of such diseases; 

5 (D) developing a standardized screening 

6 protocol for Lyme disease and other tick- and 

7 vector-borne diseases; 

8 (E) enhancing studies and activities on 

9 tick biology, disease ecology, and surveillance, 

10 and tick management; and 

11 (F) supporting other relevant activities 

12 identified by the Secretary or the Director of 

13 the Centers for Disease Control and Prevention, 

14 as appropriate. 

15 (c) CONSIDERATIONS.—In awarding grants, con16 tracts, and cooperative agreements under this section, the 

17 Secretary shall consider, among other factors, whether the 

18 entity— 

19 (1) provides services to rural areas or other un20 derserved populations; 

21 (2) is able to build on an existing infrastructure 

22 of services and public health research; 

23 (3) is located in an area with a high prevalence, 

24 or in any area predicted to have a high prevalence, 


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1 of Lyme disease or other tick- and vector-borne dis2 eases; and 

3 (4) has experience with conducting research re4 lated to Lyme disease and other tick- and vector5 borne diseases. 

6 (d) AUTHORIZATION OF APPROPRIATIONS.—For the 

7 purpose of carrying out this section, there are authorized 

8 to be appropriated $10,000,000 for each of fiscal years 

9 from 2021 through 2026. Amounts appropriated shall be 

10 allocated under this section to diseases in a manner that 

11 proportionately matches the disease burden of those dis12 eases in the United States, which shall be reassessed and 

13 adjusted annually. 

14 SEC. 4. COOPERATIVE AGREEMENTS WITH THE CENTERS 

15 FOR DISEASE CONTROL AND PREVENTION. 

16 (a) IN GENERAL.—The Secretary, in coordination 

17 with the Director of the Centers for Disease Control and 

18 Prevention and the heads of other agencies, as appro19 priate, shall enter into cooperative agreements between the 

20 Centers for Disease Control and Prevention and health de21 partments of States, political subdivisions of States, and 

22 Indian tribes and tribal organizations, to address Lyme 

23 Disease and other tick- and vector-borne diseases, and to 

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1 based research, interventions, and treatment with respect 

2 to— 

3 (1) educating and informing the public, based 

4 on evidence-based public health research and data, 

5 about Lyme Disease and other vector-borne diseases; 

6 (2) supporting early detection and diagnosis; 

7 (3) supporting prevention; 

8 (4) improving treatment; 

9 (5) supporting care planning and management 

10 for individuals with Lyme disease and other tick11 and vector-borne diseases; and 

12 (6) supporting other relevant activities identi13 fied by the Secretary or the Director of the Centers 

14 for Disease Control and Prevention, as appropriate. 

15 (b) ELIGIBILITY.—To be eligible to enter into a coop16 erative agreement under this section, an entity described 

17 in subsection (a) shall prepare and submit to the Secretary 

18 an application at such time, in such manner, and con19 taining such information as the Secretary may require, in20 cluding a plan that describes— 

21 (1) how the applicant proposes to develop or ex22 pand programs to educate individuals through part23 nership engagement, workforce development, guid24 ance and support for programmatic efforts, and 

25 evaluation with respect to Lyme disease and other 


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1 tick- or vector-borne diseases, and how the applicant 

2 proposes to support other relevant activities identi3 fied by the Secretary or the Director of the Centers 

4 for Disease Control and Prevention, as appropriate; 

5 (2) the manner in which the applicant will co6 ordinate with Federal, tribal, and State programs 

7 related to Lyme Disease and other vector-borne dis8 eases, and appropriate State, tribal, and local agen9 cies, as well as other relevant public and private or10 ganizations or agencies; and 

11 (3) the manner in which the applicant will 

12 evaluate the effectiveness of any program carried out 

13 under the cooperative agreement. 

14 (c) AUTHORIZATION OF APPROPRIATIONS.—For the 

15 purpose of carrying out this section, there are authorized 

16 to be appropriated $20,000,000 for each of fiscal years 

17 from (2021 through 2026). Amounts appropriated shall 

18 be allocated under this section to diseases in a manner 

19 that proportionately matches the disease burden of those 

20 diseases in the United States, which shall be reassessed 

21 and adjusted annually. 

22 SECTION 1. SHORT TITLE. 

23 This Act may be cited as the ‘‘Kay Hagan Tick Act’’. 


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1 SEC. 2. COMBATING VECTOR-BORNE DISEASES. 

2 Title III of the Public Health Service Act is amended 

3 by inserting after section 317T (42 U.S.C. 247b–22) the fol4 lowing: 

5 ‘‘SEC. 317U. NATIONAL STRATEGY AND REGIONAL CENTERS 

6 OF EXCELLENCE IN VECTOR-BORNE DIS7 EASES. 

8 ‘‘(a) IN GENERAL.—The Secretary, acting through the 

9 Assistant Secretary for Health, shall— 

10 ‘‘(1) ensure the development and implementation 

11 of a national strategy to address vector-borne diseases, 

12 including tick-borne diseases, consistent with sub13 section (b); and 

14 ‘‘(2) coordinate programs and activities, includ15 ing related to data collection, research, and the devel16 opment of diagnostics, treatments, vaccines, and other 

17 related activities, to address vector-borne diseases, in18 cluding tick-borne diseases, across the Department of 

19 Health and Human Services and with other Federal 

20 agencies or departments, as appropriate. 

21 ‘‘(b) STRATEGY.— 

22 ‘‘(1) IN GENERAL.—The Secretary, in coordina23 tion with the Secretary of Defense, the Secretary of 

24 Agriculture, the Administrator of the Environmental 

25 Protection Agency, the Secretary of the Interior, the 

26 Secretary of Veterans Affairs, the Secretary of HomeVerDate Sep 11 2014 21:41 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6203 E:\BILLS\S1657.RS S1657

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1 land Security, and others, as appropriate, shall de2 velop a strategy to address gaps in Federal programs, 

3 and assess the progress of the United States in, ad4 dressing vector-borne diseases, including tick-borne 

5 diseases. Such strategy shall— 

6 ‘‘(A) assess gaps and unnecessary duplica7 tion in federally funded programs and activities 

8 related to surveillance, diagnosis, treatment, edu9 cation, pathogenesis, or prevention of vector10 borne diseases, including tick-borne diseases, 

11 which may include taking into consideration rel12 evant strategic plans made by other agencies; 

13 ‘‘(B) identify gaps and unnecessary dupli14 cation with respect to— 

15 ‘‘(i) epidemiological, basic, 

16 translational, and clinical research on vec17 tor-borne diseases, including tick-borne dis18 eases; and 

19 ‘‘(ii) vector surveillance, registries, and 

20 disease monitoring, including coinfections 

21 with agents of more than one vector-borne 

22 disease; 

23 ‘‘(C) identify strategic goals related to ad24 dressing vector-borne diseases, including tick25 borne diseases, including goals related to the deVerDate Sep 11 2014 21:41 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6203 E:\BILLS\S1657.RS S1657

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1 velopment of diagnostics, treatments, vaccines, 

2 and other related measures, as appropriate, and 

3 benchmarks to measure progress; 

4 ‘‘(D) identify ways to improve the care and 

5 treatment of individuals with vector-borne dis6 eases, including tick-borne diseases, and to im7 prove public awareness of such diseases; and 

8 ‘‘(E) update such strategy biennially. 

9 ‘‘(2) NON-FEDERAL PERSPECTIVES.—In devel10 oping and updating, as applicable, the strategy under 

11 paragraph (1), the Secretary shall— 

12 ‘‘(A) coordinate with the Tick-Borne Dis13 ease Working Group established under section 

14 2062 of the 21st Century Cures Act (42 U.S.C. 

15 284s), as appropriate; and 

16 ‘‘(B) consult with non-Federal individuals 

17 with appropriate expertise, which may include— 

18 ‘‘(i) epidemiologists with experience in 

19 vector-borne diseases, including tick-borne 

20 diseases; 

21 ‘‘(ii) representatives of patient advo22 cacy and research organizations that focus 

23 on vector-borne diseases, including those 

24 that focus specifically on tick-borne diseases 

25 and have demonstrated experience in related 


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1 research, public health, data collection, or 

2 patient access to care; 

3 ‘‘(iii) health information technology ex4 perts or other information management spe5 cialists; 

6 ‘‘(iv) clinicians, entomologists, vector 

7 management professionals, public health 

8 professionals, and others with expertise in 

9 vector-borne diseases, including tick-borne 

10 diseases; and 

11 ‘‘(v) researchers, including researchers 

12 with experience conducting translational re13 search. 

14 ‘‘(c) CENTERS OF EXCELLENCE.—The Secretary, in 

15 coordination with the Director of the Centers for Disease 

16 Control and Prevention and the heads of other agencies, as 

17 appropriate, shall award grants, contracts, or cooperative 

18 agreements to institutions of higher education for the estab19 lishment or continued support of regional centers of excel20 lence in vector-borne diseases to address vector-borne dis21 eases, including tick-borne diseases, by— 

22 ‘‘(1) facilitating collaboration between academia 

23 and public health organizations for public health sur24 veillance, prevention, and response activities related 

25 to vector-borne diseases, including tick-borne diseases; 


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1 ‘‘(2) providing training for public health ento2 mologists and other health care professionals, as ap3 propriate, to address vector-borne diseases, including 

4 tick-borne diseases; 

5 ‘‘(3) conducting research to develop and validate 

6 prevention and control tools and methods, including 

7 evidence-based and innovative, evidence-informed 

8 tools and methods to anticipate and respond to dis9 ease outbreaks; or 

10 ‘‘(4) preparing for and responding to outbreaks 

11 of vector-borne diseases, including tick-borne diseases. 

12 ‘‘(d) ELIGIBILITY.—To be eligible to receive a grant, 

13 contract, or cooperative agreement under subsection (c), an 

14 entity shall submit to the Secretary an application at such 

15 time, in such manner, and containing such information as 

16 the Secretary may require, including a description of how 

17 the entity will conduct the activities described in such sub18 section. 

19 ‘‘(e) REPORTS.— 

20 ‘‘(1) PROGRAM SUMMARY.—An entity receiving 

21 an award under subsection (c) shall, not later than 

22 one year after receiving such award, and annually 

23 thereafter, submit to the Secretary a summary of pro24 grams and activities funded under the award. 


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1 ‘‘(2) PROGRESS REPORT.—Not later than 4 years 

2 after the date of enactment of this section, the Sec3 retary shall submit to the Committee on Health, Edu4 cation, Labor, and Pensions of the Senate and the 

5 Committee on Energy and Commerce of the House of 

6 Representatives, a report on the progress made in ad7 dressing vector-borne diseases, including tick-borne 

8 diseases, through activities carried out under this sec9 tion. 

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the 

11 purpose of carrying out this section, there are authorized 

12 to be appropriated $10,000,000 for each of fiscal years 2021 

13 through 2025.’’. 

14 SEC. 3. ENHANCING CAPACITY TO ADDRESS VECTOR15 BORNE DISEASES. 

16 (a) ENHANCED SUPPORT.—Subtitle C of title XXVIII 

17 of the Public Health Service Act (42 U.S.C. 300hh-31 et 

18 seq.) is amended by adding at the end the following: 

19 ‘‘SEC. 2822. ENHANCED SUPPORT TO ASSIST HEALTH DE20 PARTMENTS IN ADDRESSING VECTOR-BORNE 

21 DISEASES. 

22 ‘‘(a) IN GENERAL.—The Secretary, acting through the 

23 Director of the Centers for Disease Control and Prevention, 

24 may enter into cooperative agreements with health depart25 ments of States, political subdivisions of States, and Indian 


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1 Tribes and Tribal organizations in areas at high risk of 

2 vector-borne diseases in order to increase capacity to iden3 tify, report, prevent, and respond to such diseases and re4 lated outbreaks. 

5 ‘‘(b) ELIGIBILITY.—To be eligible to enter into a coop6 erative agreement under this section, an entity described in 

7 subsection (a) shall prepare and submit to the Secretary 

8 an application at such time, in such manner, and con9 taining such information as the Secretary may require, in10 cluding a plan that describes— 

11 ‘‘(1) how the applicant proposes to develop or ex12 pand programs to address vector-borne diseases risks, 

13 including through— 

14 ‘‘(A) related training and workforce devel15 opment; 

16 ‘‘(B) programmatic efforts to improve ca17 pacity to identify, report, prevent, and respond 

18 to such disease and related outbreaks; and 

19 ‘‘(C) other relevant activities identified by 

20 the Director of the Centers for Disease Control 

21 and Prevention, as appropriate; 

22 ‘‘(2) the manner in which the applicant will co23 ordinate with other Federal, Tribal, and State agen24 cies and programs, as applicable, related to vectorVerDate Sep 11 2014 21:41 Nov 05, 2019 Jkt 099200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6203 E:\BILLS\S1657.RS S1657

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1 borne diseases, as well as other relevant public and 

2 private organizations or agencies; and 

3 ‘‘(3) the manner in which the applicant will 

4 evaluate the effectiveness of any program carried out 

5 under the cooperative agreement. 

6 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 

7 purposes of carrying out this section, there are authorized 

8 to be appropriated $20,000,000 for each of fiscal years 2021 

9 through 2025.’’. 


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Calendar No. 287 

116TH CONGRESS 

1ST SESSION S. 1657 

A BILL 

To provide assistance to combat the escalating burborne diseases and disorders. den of Lyme disease and other tick and vectorNOVEMBER 5, 2019 

Reported with an amendment 


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