II 

111TH CONGRESS 

1ST SESSION S. 1028 

To amend the Public Health Service Act to improve the Nation’s surveillance 

and reporting for diseases and conditions, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 13, 2009 

Mr. BINGAMAN introduced the following bill; which was read twice and 

referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to improve the 

Nation’s surveillance and reporting for diseases and conditions, 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 ‘‘Strengthening Amer5 ica’s Public Health System Act’’. 

6 SEC. 2. PURPOSES. 

7 The purpose of the programs authorized under this 

8 Act is to strengthen public health surveillance systems and 

9 disease reporting by— 


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1 (1) delineating existing grant mechanisms at 

2 the Centers for Disease Control and Prevention de3 signed to enhance disease surveillance and reporting 

4 by improving and modernizing capacity at the State 

5 and local level— 

6 (A) to identify and monitor the occurrence 

7 of infectious diseases and other conditions of 

8 public health importance; 

9 (B) to detect new and emerging infectious 

10 disease threats; and 

11 (C) to identify and respond to disease out12 breaks; 

13 (2) expanding eligibility for grantees; 

14 (3) increasing funding to ensure all States and 

15 jurisdictions have appropriate surveillance and re16 porting capacity and can provide comprehensive elec17 tronic reporting, including laboratory reporting; 

18 (4) delineating existing applied epidemiology, 

19 laboratory science, and informatics fellowship pro20 grams designed to reduce documented workforce 

21 shortages for these essential public health profes22 sionals at the State and local level and increasing 

23 funding for these programs; 

24 (5) expanding the Epidemic Intelligence Serv25 ice; 


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1 (6) delineating a refined process for estab2 lishing a list of nationally notifiable diseases and 

3 conditions; 

4 (7) improving binational surveillance of diseases 

5 in the United States and Mexico border region, in6 cluding developing improved standards and protocols 

7 for binational epidemiology, surveillance, laboratory 

8 analyses, and control of infectious diseases between 

9 the two nations; and 

10 (8) establishing a forum to permit review and 

11 identification of best surveillance practices with a 

12 particular focus on improving coordination of ani13 mal-human disease surveillance. 

14 SEC. 3. STRENGTHENING PUBLIC HEALTH SURVEILLANCE 

15 SYSTEMS. 

16 Title XXVIII of the Public Health Service Act (42 

17 U.S.C. 300hh et seq.) is amended by adding at the end 

18 the following: 

19 ‘‘Subtitle C—Strengthening Public 

20 Health Surveillance Systems 

21 ‘‘SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY 

22 GRANTS. 

23 ‘‘(a) IN GENERAL.—Subject to the availability of ap24 propriations, the Secretary, acting through the Director 

25 of the Centers for Disease Control and Prevention, shall 


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1 establish an Epidemiology and Laboratory Capacity Grant 

2 Program to award grants to eligible entities to assist pub3 lic health agencies in improving surveillance for, and re4 sponse to, infectious diseases and other conditions of pub5 lic health importance by— 

6 ‘‘(1) strengthening epidemiologic capacity; 

7 ‘‘(2) enhancing laboratory practice; 

8 ‘‘(3) improving information systems; and 

9 ‘‘(4) developing and implementing prevention 

10 and control strategies. 

11 ‘‘(b) ELIGIBLE ENTITIES.—In this section, the term 

12 ‘eligible entity’ means an entity that— 

13 ‘‘(1) is— 

14 ‘‘(A) a State health department; 

15 ‘‘(B) a local health department that meets 

16 such criteria as the Director of the Centers for 

17 Diseases Control and Prevention determines for 

18 purposes of this section; 

19 ‘‘(C) a tribal jurisdiction that meets such 

20 criteria as the Director of the Centers for Dis21 ease Control and Prevention determines for 

22 purposes of this section; or 

23 ‘‘(D) a partnership established for pur24 poses of this section between one or more eligiVerDate Nov 24 2008 21:10 May 15, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1028.IS S1028

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1 ble entities described in subparagraph (A), (B), 

2 or (C) and an academic center; and 

3 ‘‘(2) submits to the Secretary an application at 

4 such time, in such manner, and containing such in5 formation as the Secretary may require. 

6 ‘‘(c) USE OF FUNDS.— 

7 ‘‘(1) IN GENERAL.—An eligible entity shall use 

8 amounts received under a grant under this section 

9 for core functions described in this subsection in10 cluding— 

11 ‘‘(A) building public health capacity to 

12 identify and monitor the occurrence of infec13 tious diseases and other conditions of public 

14 health importance; 

15 ‘‘(B) detecting new and emerging infec16 tious disease threats, including laboratory ca17 pacity to detect antimicrobial resistant infec18 tions; 

19 ‘‘(C) identifying and responding to disease 

20 outbreaks; 

21 ‘‘(D) hiring necessary staff; 

22 ‘‘(E) conducting needed staff training and 

23 educational development; and 


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1 ‘‘(F) other activities that improve surveil2 lance as determined by the Director of the Cen3 ters for Disease Control and Prevention. 

4 ‘‘(2) DEVELOPMENT AND MAINTENANCE OF IN5 FORMATION EXCHANGE.— 

6 ‘‘(A) NATIONAL STANDARDS.—Not later 

7 than 180 days after the date of the enactment 

8 of this subtitle, the Secretary, acting through 

9 the Director of the Centers for Disease Control 

10 and Prevention, and in consultation with the 

11 National Coordinator for Health Information 

12 Technology, shall issue guidelines for public 

13 health entities that— 

14 ‘‘(i) are designed to ensure that all 

15 State and local health departments and 

16 public health laboratories have access to 

17 information systems to receive, monitor, 

18 and report infectious diseases and other 

19 urgent conditions of public health impor20 tance; and 

21 ‘‘(ii) are consistent with standards 

22 and recommendations for health informa23 tion technology by the National Coordi24 nator for Health Information Technology, 


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1 and by the American Health Information 

2 Community (AHIC) and its successors. 

3 ‘‘(B) SECURE INFORMATION SYSTEMS.— 

4 An eligible entity shall use amounts received 

5 through a grant under this section to ensure 

6 that the entity has access to a web-based, se7 cure information system that complies with the 

8 guidelines developed under subparagraph (A). 

9 Such a system shall be designed— 

10 ‘‘(i) to receive automated case reports 

11 of State and national reportable conditions 

12 from clinical systems and health care of13 fices that use electronic health records and 

14 from clinical and public health labora15 tories, and to submit reports of nationally 

16 reportable conditions to the Director of the 

17 Centers for Disease Control and Preven18 tion; 

19 ‘‘(ii) to receive and analyze, within 24 

20 hours, de-identified electronic clinical data 

21 for situational awareness and to forward 

22 such reports immediately to the Centers 

23 for Disease Control and Prevention at the 

24 time of receipt; 


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1 ‘‘(iii) to manage, link, and process dif2 ferent types of data, including information 

3 on newly reported cases, exposed contacts, 

4 laboratory results, number of people vac5 cinated or given prophylactic medications, 

6 adverse events monitoring and follow-up, in 

7 an integrated outbreak management sys8 tem; 

9 ‘‘(iv) to geocode analyze, display, re10 port, and map, using Geographic Informa11 tion System technology, accumulated data 

12 and to share data with other local health 

13 departments, State health departments, 

14 and the Centers for Disease Control and 

15 Prevention; 

16 ‘‘(v) to receive, manage, and dissemi17 nate alerts, protocols, and other informa18 tion, including Health Alert Network and 

19 Epi-X information, as appropriate, for 

20 public health workers, health care pro21 viders, and public health partners in emer22 gency response within each health depart23 ment’s jurisdiction and to automate the ex24 change and cascading of such information 


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1 with external partners using national 

2 standards; 

3 ‘‘(vi) to have information technology 

4 security and critical infrastructure protec5 tion as appropriate to protect public health 

6 information; 

7 ‘‘(vii) to have the technical infrastruc8 ture needed to ensure availability, backup, 

9 and disaster recovery of data, application 

10 services, and communications systems dur11 ing natural disasters such as floods, tor12 nados, hurricanes, and power outages; and 

13 ‘‘(viii) to provide for other capabilities 

14 as the Secretary determines appropriate. 

15 ‘‘(C) LABORATORY SYSTEMS.—An eligible 

16 entity shall use amounts received under a grant 

17 under this section to ensure that State or local 

18 public health laboratories are utilizing web19 based, secure systems that are in compliance 

20 with the guidelines developed by the Secretary 

21 under subparagraph (A) and that— 

22 ‘‘(i) are fully integrated laboratory in23 formation systems; 

24 ‘‘(ii) provide for the reporting of elec25 tronic test results to the appropriate local 


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1 and State health departments using cur2 rently existing national format and coding 

3 standards; 

4 ‘‘(iii) have information technology se5 curity and critical infrastructure protection 

6 to protect public health information (as de7 termined by the Secretary); 

8 ‘‘(iv) have the technical infrastructure 

9 needed to ensure availability, backup, and 

10 disaster recovery of data, application serv11 ices, and communications systems during 

12 natural disasters including floods, torna13 does, hurricanes, and power outages; and 

14 ‘‘(v) address other capabilities as the 

15 Secretary determines appropriate. 

16 ‘‘(D) OTHER USES.—In addition to the ac17 tivities described in subparagraphs (B) and (C), 

18 an eligible entity (including the entity’s public 

19 health laboratory) may use amounts received 

20 under a grant under this section for systems 

21 development and maintenance, hiring necessary 

22 staff, and staff technical training. Grantees 

23 under this section may elect to develop their 

24 own systems or use federally developed systems 

25 in carrying out activities under this paragraph. 


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1 ‘‘(d) PRIORITY.—In allocating funds under sub2 section (f)(2) for activities under subsection (c)(2)(B) (re3 lating to secure information systems), the Secretary shall 

4 give priority to eligible entities that demonstrate need. 

5 ‘‘(e) REPORTS.—Not later than September 30, 2011, 

6 and each September 30 thereafter, the Secretary shall 

7 submit to Congress an annual report on the activities car8 ried out under this section by recipients of assistance 

9 under this section. 

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated to carry out this section 

12 $190,000,000 for each of fiscal years 2010 through 2013, 

13 of which— 

14 ‘‘(1) not less than $95,000,000 shall be made 

15 available each such fiscal year for activities under 

16 subsection (c)(1); 

17 ‘‘(2) not less than $60,000,000 shall be made 

18 available each such fiscal year for activities under 

19 subsection (c)(2)(B); and 

20 ‘‘(3) not less than $32,000,000 shall be made 

21 available each such fiscal year for activities under 

22 subsection (c)(2)(C). 


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1 ‘‘SEC. 2822. FELLOWSHIP TRAINING IN APPLIED PUBLIC 

2 HEALTH EPIDEMIOLOGY, PUBLIC HEALTH 

3 LABORATORY SCIENCE, PUBLIC HEALTH 

4 INFORMATICS, AND EXPANSION OF THE EPI5 DEMIC INTELLIGENCE SERVICE. 

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

7 the Director of the Centers for Disease Control and Pre8 vention, may carry out activities to address documented 

9 workforce shortages in State and local health departments 

10 in the critical areas of applied public health epidemiology 

11 and public health laboratory science and informatics and 

12 may expand the Epidemic Intelligence Service. 

13 ‘‘(b) SPECIFIC USES.—In carrying out subsection 

14 (a), the Secretary, acting through the Director of the Cen15 ters for Disease Control and Prevention, shall provide for 

16 the expansion of existing fellowship programs operated 

17 through the Centers for Disease Control and Prevention 

18 in a manner that is designed to alleviate shortages of the 

19 type described in subsection (a). 

20 ‘‘(c) OTHER PROGRAMS.—The Secretary, acting 

21 through the Director of the Centers for Disease Control 

22 and Prevention, may provide for the expansion of other 

23 applied epidemiology training programs that meet objec24 tives similar to the objectives of the programs described 

25 in subsection (b). 


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1 ‘‘(d) WORK OBLIGATION.—Participation in fellow2 ship training programs under this section shall be deemed 

3 to be service for purposes of satisfying work obligations 

4 stipulated in contracts under section 338I(j). 

5 ‘‘(e) GENERAL SUPPORT.—Amounts may be used 

6 from grants awarded under this section to expand the 

7 Public Health Informatics Fellowship Program at the 

8 Centers for Disease Control and Prevention to better sup9 port all public health systems at all levels of government. 

10 ‘‘(f) AUTHORIZATIONS OF APPROPRIATIONS.—There 

11 are authorized to be appropriated to carry out this section 

12 $39,500,000 for each of fiscal years 2010 through 2013, 

13 of which— 

14 ‘‘(1) $5,000,000 shall be made available in each 

15 such fiscal year for epidemiology fellowship training 

16 program activities under subsections (b) and (c); 

17 ‘‘(2) $5,000,000 shall be made available in each 

18 such fiscal year for laboratory fellowship training 

19 programs under subsection (b); 

20 ‘‘(3) $5,000,000 shall be made available in each 

21 such fiscal year for the Public Health Informatics 

22 Fellowship Program under subsection (e); and 

23 ‘‘(4) $24,500,000 shall be made available for 

24 expanding the Epidemic Intelligence Service under 

25 subsection (a). 


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1 ‘‘SEC. 2823. NATIONALLY NOTIFIABLE DISEASES AND CON2 DITIONS. 

3 ‘‘(a) IN GENERAL.—At the request of the Council of 

4 State and Territorial Epidemiologists, the Director of the 

5 Centers for Disease Control and Prevention shall assist 

6 the Council in developing or improving a process for 

7 States to conduct surveillance and submit reports to the 

8 Director on nationally notifiable diseases and conditions. 

9 ‘‘(b) LIST OF NATIONALLY NOTIFIABLE DISEASES

10 AND CONDITIONS.—The process under subsection (a) 

11 shall include a list of nationally notifiable diseases and 

12 conditions as follows: 

13 ‘‘(1) The Council of State and Territorial Epi14 demiologists and the Director of the Centers for Dis15 ease Control and Prevention will jointly develop— 

16 ‘‘(A) not later than 1 year after the date 

17 of the enactment of the Strengthening Amer18 ica’s Public Health System Act, a list of nation19 ally notifiable diseases and conditions; and 

20 ‘‘(B) a process for reviewing the list on an 

21 annual basis and, as appropriate, modifying the 

22 list, taking into account newly recognized dis23 eases and conditions of public health impor24 tance and advances in diagnostic technology. 


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1 ‘‘(2) A disease or condition will be included on 

2 the list only if a majority of the States represented 

3 on the Council approve such inclusion. 

4 ‘‘(3) The list will include standard definitions 

5 for confirmed, probable, and suspect cases for each 

6 nationally notifiable disease or condition. 

7 ‘‘(4) The list will distinguish between— 

8 ‘‘(A) diseases and conditions of urgent 

9 public health importance for which immediate 

10 action may be needed; and 

11 ‘‘(B) diseases and conditions for which re12 porting is less urgent and mainly for the pur13 pose of monitoring trends and evaluating public 

14 health intervention programs. 

15 ‘‘(c) NOTIFICATIONS TO CDC.—The process under 

16 subsection (a) shall provide for reporting to the Director 

17 of the Centers for Disease Control and Prevention as fol18 lows: 

19 ‘‘(1) For diseases and conditions described in 

20 subsection (b)(4)(A), reporting will occur— 

21 ‘‘(A) by telephone or by using a system de22 scribed in section 2821(c)(2)(B); and 

23 ‘‘(B) within 24 hours of the State making 

24 a determination that a disease or condition 


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1 meets the criteria for national reporting for 

2 that disease or condition. 

3 ‘‘(2) For diseases and conditions described in 

4 subsection (b)(4)(B), reporting will occur— 

5 ‘‘(A) by using a system described in sec6 tion 2821(c)(2)(B); and 

7 ‘‘(B) only if funding is sufficient for the 

8 State to conduct individual case surveillance 

9 and to have the necessary systems to support 

10 electronic reporting. 

11 ‘‘(d) DEFINITIONS.—In this section, the term ‘na12 tionally notifiable’, with respect to a disease or condition, 

13 means included on the list developed pursuant to sub14 section (b). 

15 ‘‘SEC. 2824. IMPROVING BINATIONAL SURVEILLANCE AND 

16 NOTIFICATION. 

17 ‘‘(a) FINDINGS.—The Congress finds as follows: 

18 ‘‘(1) Nearly 1,000,000 people cross the inter19 national border between the United States and Mex20 ico on a daily basis, and this transmobility of popu21 lation presents actual cases and the potential risk of 

22 transmission of infectious diseases and disease 

23 agents between these countries. 

24 ‘‘(2) Numerous infectious disease cases in the 

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1 ing improved epidemiology, surveillance, follow-up 

2 investigations, and disease case management along 

3 the United States and Mexico border. 

4 ‘‘(b) GUIDELINES FOR BINATIONAL COOPERA5 TION.—Not later than 1 year after the date of the enact6 ment of this subtitle, the Director of the Centers for Dis7 ease Control and Prevention shall— 

8 ‘‘(1) develop an expedited review and approval 

9 process and adopt the resultant version of the 

10 ‘Guidelines for U.S.-Mexico Coordination on Epide11 miological Events of Mutual Interest’, which have 

12 been developed with input from United States and 

13 Mexican State health agencies, including the Mexi14 can Federal Health Secretariat, the United States 

15 Department of Health and Human Services, and the 

16 Centers for Disease Control and Prevention; and 

17 ‘‘(2) use these guidelines as the basis for devel18 oping improved standards and protocols for bina19 tional epidemiology, surveillance, laboratory anal20 yses, and control of infectious diseases between the 

21 United States and Mexico. 

22 ‘‘(c) DEFINITION.—In this section, the term ‘bina23 tional’ refers to both sides of the United States-Mexico 

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1 tries, a phenomenon (for example, a disease outbreak or 

2 health emergency) affecting a population or geographic 

3 area in both countries, or a disease case that originated 

4 on one side of the border and was transmitted to the other. 

5 ‘‘SEC. 2825. EVALUATION OF BEST PRACTICES IN PUBLIC 

6 HEALTH SURVEILLANCE. 

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

8 the Director of the Centers for Disease Control and Pre9 vention, shall establish a committee— 

10 ‘‘(1) to evaluate best practices in public health 

11 surveillance, including human and animal disease 

12 surveillance and environmental health monitoring of 

13 harmful exposures through air, water, soil, or other 

14 means; and 

15 ‘‘(2) to assess systems needed for improving co16 ordination among public health surveillance and 

17 monitoring systems. 

18 ‘‘(b) COMPOSITION.—The committee established 

19 under subsection (a) shall be composed of— 

20 ‘‘(1) an epidemiologist employed and designated 

21 by the Director of the Centers for Disease Control 

22 and Prevention; 

23 ‘‘(2) an informatics specialist designated by the 

24 Director of the Centers for Disease Control and Pre25 vention; 


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1 ‘‘(3) an epidemiologist designated by the Direc2 tor of the Centers for Disease Control and Preven3 tion to represent the National Center for Environ4 mental Health and the Agency for Toxic Substances 

5 and Disease Registry; 

6 ‘‘(4) a representative of an academic center or 

7 professional, scientific association designated by the 

8 American Society for Microbiology; 

9 ‘‘(5) a food scientist designated by the Commis10 sioner of Food and Drugs; 

11 ‘‘(6) an individual designated by the Secretary 

12 of Agriculture from the Division of Veterinary Serv13 ices; 

14 ‘‘(7) a wildlife disease specialist designated by 

15 the Secretary of Agriculture; 

16 ‘‘(8) an epidemiologist employed by a State and 

17 designated by the Council of State and Territorial 

18 Epidemiologists; 

19 ‘‘(9) a public health laboratorian employed by a 

20 State and designated by the Association of Public 

21 Health Laboratories; 

22 ‘‘(10) a public health veterinarian employed by 

23 a State and designated by the National Association 

24 of State Public Health Veterinarians; 


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1 ‘‘(11) a laboratorian designated by the Amer2 ican Association of Veterinary Laboratory Diagnosti3 cians; 

4 ‘‘(12) a State health official designated by the 

5 Association of State and Territorial Health Officials; 

6 ‘‘(13) a local health official designated by the 

7 National Association of County and City Health Of8 ficials; 

9 ‘‘(14) an environmental health scientist em10 ployed and designated by the Administrator of the 

11 Environmental Protection Agency; and 

12 ‘‘(15) a representative with expertise in the De13 partment of Veterans Affairs’ disease monitoring 

14 systems. 

15 ‘‘(c) FUNCTIONS.—The committee established under 

16 subsection (a) shall— 

17 ‘‘(1) review innovative approaches adopted by 

18 State and local agencies to improve disease detec19 tion; 

20 ‘‘(2) evaluate best practices in public health 

21 surveillance; 

22 ‘‘(3) develop model data sharing agreements 

23 among local, State, and Federal health agencies; 

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1 ommendations for the improvement of such surveil2 lance; and 

3 ‘‘(5) disseminate findings and recommendations 

4 to relevant local, State and Federal agencies. 

5 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

6 is authorized to be appropriated to carry out this section, 

7 $750,000 for each of fiscal years 2010 through 2011.’’. 

Æ 


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