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 Se-
lect), 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Global Health Security 
Act of 2019’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) In 2005, each of the 196 World Health Or-
ganization member states signed the International 
Health Regulations to improve the world’s ability to 
prevent, detect, and respond to public health events. 
(2) In December 2009, President Obama re-
leased the National Strategy for Countering Biologi-
cal Threats, which listed as one of seven objectives 
‘‘Promote global health security: Increase the avail-
ability of and access to knowledge and products of 
the life sciences that can help reduce the impact 
from outbreaks of infectious disease whether of nat-
ural, accidental, or deliberate origin’’. 
(3) In September 2011, the United States and 
the World Health Organization signed a memo-
randum of understanding to help developing coun-
tries strengthen their capabilities to meet the Inter-
national Health Regulations. 
(4) In February 2014, the United States and 
nearly 30 other nations launched the Global Health 
Security Agenda (GHSA) to address several high- 
priority, global infectious disease threats. The 
GHSA is a multi-faceted, multi-country initiative in-
tended to accelerate partner countries’ measurable 
capabilities to achieve specific targets to prevent, de-
tect, and respond to infectious disease threats, 
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whether naturally occurring, deliberate, or acci-
dental. 
(5) 
The 
GHSA 
was 
funded 
with 
a 
$1,000,000,000, one-time, 5-year supplemental ap-
propriation that expires at the end of fiscal year 
2019. 
(6) As of 2014, approximately 67 percent of na-
tions have not fully implemented the International 
Health Regulations and built appropriate core ca-
pacities to detect, assess, report, and respond to 
public health emergencies. 
(7) In 2015, the United Nations adopted the 
Sustainable Development Goals (SDGs), which in-
clude specific reference to the importance of global 
health security as part of SDG 3 ‘‘ensure healthy 
lives and promote well-being for all at all ages’’ as 
follows: ‘‘strengthen the capacity of all countries, in 
particular developing countries, for early warning, 
risk reduction and management of national and 
global health risks’’. 
(8) On November 4, 2016, President Obama 
signed Executive Order 13747, ‘‘Advancing the 
Global Health Security Agenda to Achieve a World 
Safe and Secure from Infectious Disease Threats’’. 
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(9) In October 2017 at the GHSA Ministerial 
Meeting in Uganda, the United States and more 
than 40 GHSA member countries supported the 
‘‘Kampala Declaration’’ to extend the GHSA for an 
additional 5 years to 2024. 
(10) In December 2017, President Trump re-
leased the National Security Strategy, which in-
cludes the priority action: ‘‘Detect and contain bio-
threats at their source: We will work with other 
countries to detect and mitigate outbreaks early to 
prevent the spread of disease. We will encourage 
other countries to invest in basic health care systems 
and to strengthen global health security across the 
intersection of human and animal health to prevent 
infectious disease outbreaks’’. 
(11) In February 2018, the Director of Na-
tional Intelligence, Daniel R. Coats, released the 
Worldwide Threat Assessment of the U.S. Intel-
ligence Community, which said ‘‘The increase in fre-
quency and diversity of reported disease outbreaks— 
such as dengue and Zika—probably will continue 
through 2018, including the potential for a severe 
global health emergency that could lead to major 
economic and societal disruptions, strain govern-
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mental and international resources, and increase 
calls on the United States for support’’. 
(12) In the Consolidated Appropriations Act, 
2018 (Public Law 115–141), Congress provided 
$172,600,000 for global health security and required 
the President to submit a global health security 
strategy to Congress not later than 180 days after 
the date of the enactment of that Act. 
(13) In September 2018, President Trump re-
leased the National Biodefense Strategy, which in-
cludes objectives to ‘‘strengthen global health secu-
rity capacities to prevent local bioincidents from be-
coming epidemics’’, and ‘‘strengthen international 
preparedness to support international response and 
recovery capabilities’’. 
(14) In December 2018, President Trump re-
leased the National Strategy for Countering Weap-
ons of Mass Destruction Terrorism, which states 
that ‘‘Although securing dangerous biological agents, 
controlled chemical precursors, and nuclear and ra-
diological materials is principally the responsibility 
of the states that hold them, it is manifestly in the 
United States interest that these states have both 
the political will and the ability to discharge this re-
sponsibility. Consequently, we will work with partner 
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nations and international organizations to improve 
their capacity to secure dangerous materials, in par-
ticular by sharing expertise to establish effective and 
sustainable infrastructure, human capital, and regu-
latory frameworks to counter the WMD threat.’’. 
SEC. 3. STATEMENT OF POLICY; SENSE OF CONGRESS. 
(a) STATEMENT OF POLICY.—It is the policy of the 
United States to— 
(1) promote global health security as a core na-
tional security interest; 
(2) advance the Global Health Security Agenda; 
(3) collaborate with other countries to detect 
and mitigate outbreaks early to prevent the spread 
of disease; 
(4) encourage other countries to invest in basic 
resilient and sustainable health care systems; and 
(5) strengthen global health security across the 
intersection of human and animal health to prevent 
infectious disease outbreaks and combat the growing 
threat of antimicrobial resistance. 
(b) SENSE OF CONGRESS.—It is the sense of the 
Congress that the President, in providing assistance to im-
plement the strategy required under section 6(a), should— 
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(1) coordinate, through a whole-of-government 
approach, the efforts of relevant Federal depart-
ments and agencies to implement the strategy; 
(2) seek to fully utilize the unique capabilities 
of each relevant Federal department and agency 
while collaborating with and leveraging the contribu-
tions of other key stakeholders; and 
(3) utilize open and streamlined solicitations to 
allow for the participation of a wide range of imple-
menting partners through the most appropriate pro-
curement mechanisms, which may include grants, 
contracts, cooperative agreements, and other instru-
ments as necessary and appropriate. 
SEC. 4. GLOBAL HEALTH SECURITY AGENDA INTERAGENCY 
REVIEW COUNCIL. 
(a) ESTABLISHMENT.—The President shall establish 
a Global Health Security Agenda Interagency Review 
Council (in this section referred to as the ‘‘Council’’) to 
perform the general responsibilities described in sub-
section (d) and the specific roles and responsibilities de-
scribed in subsection (f). 
(b) CHAIR.—The President shall appoint an employee 
of the National Security Council, serving at the senior di-
rector level or higher, to serve as Chair for the Council. 
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(c) MEETINGS.—The Council shall meet not less than 
four times per year to advance its mission and fulfill its 
responsibilities. 
(d) GENERAL RESPONSIBILITIES.— 
(1) IN GENERAL.—The Council shall be respon-
sible for the following activities: 
(A) Provide policy-level recommendations 
to participating agencies on Global Health Se-
curity Agenda (GHSA) goals, objectives, and 
implementation. 
(B) Facilitate interagency, multi-sectoral 
engagement to carry out GHSA implementa-
tion. 
(C) Provide a forum for raising and work-
ing to resolve interagency disagreements con-
cerning the GHSA. 
(D)(i) Review the progress toward and 
work to resolve challenges in achieving United 
States commitments under the GHSA, includ-
ing commitments to assist other countries in 
achieving the GHSA targets. 
(ii) The Council shall consider, among 
other issues, the following: 
(I) The status of United States finan-
cial commitments to the GHSA in the con-
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text of commitments by other donors, and 
the contributions of partner countries to 
achieve the GHSA targets. 
(II) The progress toward the mile-
stones outlined in GHSA national plans for 
those countries where the United States 
Government has committed to assist in im-
plementing the GHSA and in annual work- 
plans outlining agency priorities for imple-
menting the GHSA. 
(III) The external evaluations of 
United States and partner country capa-
bilities 
to 
address 
infectious 
disease 
threats, including the ability to achieve the 
targets outlined within the WHO Joint Ex-
ternal Evaluation (JEE) tool, as well as 
gaps identified by such external evalua-
tions. 
(E) Develop a report on an annual basis 
regarding the progress achieved and challenges 
concerning the United States Government’s 
ability to advance the GHSA across priority 
countries. The data included in the report shall 
be disaggregated by priority country using indi-
cators that are consistent on a year-to-year 
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basis. The report shall include recommendations 
to resolve, mitigate, or otherwise address the 
challenges identified therein. The report shall 
be transmitted to the President and the appro-
priate congressional committees and, to the ex-
tent possible, made publicly available. 
(F) Conduct an overall review of the 
GHSA for submission to the President and the 
appropriate congressional committees by not 
later than 180 days after the date of the enact-
ment of this Act. The review should include an 
evaluation of the progress achieved during the 
first 5 years of this initiative, as well as any 
challenges faced. The report should also provide 
recommendations on the future direction of the 
initiative. 
(2) FORM.—The report required under para-
graph (1)(E) and the review required under para-
graph (1)(F) shall be submitted in unclassified form 
but may contain a classified annex. 
(e) PARTICIPATION.—The Council shall consist of 
representatives, serving at the Assistant Secretary level or 
higher, from the following agencies: 
(1) The Department of State. 
(2) The Department of Defense. 
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(3) The Department of Justice. 
(4) The Department of Agriculture. 
(5) The Department of Health and Human 
Services. 
(6) The Department of Labor. 
(7) The Department of Homeland Security. 
(8) The Office of Management and Budget. 
(9) The United States Agency for International 
Development. 
(10) The Environmental Protection Agency. 
(11) The Centers for Disease Control and Pre-
vention. 
(12) The Office of Science and Technology Pol-
icy. 
(13) The National Institutes of Health. 
(14) The National Institute of Allergy and In-
fectious Diseases. 
(15) Such other agencies as the Chair for the 
Council determines to be appropriate. 
(f) SPECIFIC ROLES AND RESPONSIBILITIES.— 
(1) IN GENERAL.—The heads of agencies de-
scribed in subsection (e) shall— 
(A) make the GHSA and its implementa-
tion a high priority within their respective agen-
cies, and include GHSA-related activities within 
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their respective agencies’ strategic planning and 
budget processes; 
(B) designate a senior-level official to be 
responsible for the implementation of this Act; 
(C) designate, in accordance with sub-
section (e), an appropriate representative at the 
Assistant Secretary level or higher to partici-
pate on the Council; 
(D) keep the Council apprised of GHSA- 
related activities undertaken within their re-
spective agencies; 
(E) maintain responsibility for agency-re-
lated programmatic functions in coordination 
with host governments, country teams, and 
GHSA in-country teams, and in conjunction 
with other relevant agencies; 
(F) coordinate with other agencies that are 
identified in this section to satisfy pro-
grammatic goals, and further facilitate coordi-
nation of country teams, implementers, and do-
nors in host countries; and 
(G) coordinate across GHSA national 
plans and with GHSA partners to which the 
United States is providing assistance. 
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(2) ADDITIONAL
ROLES
AND
RESPONSIBIL-
ITIES.—In addition to the roles and responsibilities 
described in paragraph (1), the heads of agencies de-
scribed in subsection (e) shall carry out their respec-
tive roles and responsibilities described in sub-
sections (b) through (i) of section 3 of Executive 
Order 13747 (81 Fed. Reg. 78701; relating to Ad-
vancing the Global Health Security Agenda to 
Achieve a World Safe and Secure from Infectious 
Disease Threats), as in effect on the day before the 
date of the enactment of this Act. 
SEC. 5. SPECIAL ADVISOR TO THE PRESIDENT FOR GLOBAL 
HEALTH SECURITY. 
Section 101 of the National Security Act of 1947 (50 
U.S.C. 3021) is amended— 
(1) in subsection (b)— 
(A) in paragraph (3), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (4), by striking the pe-
riod and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(5) coordinate, without assuming operational 
authority, the United States Government response to 
global health security emergencies.’’; and 
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(2) by adding at the end the following new sub-
section: 
‘‘(i) SPECIAL ADVISOR
TO
THE PRESIDENT
FOR 
GLOBAL HEALTH SECURITY.— 
‘‘(1) IN GENERAL.—The President shall des-
ignate an employee of the National Security Council, 
at the level of Deputy Assistant to the President or 
higher, to be responsible for the coordination of the 
interagency process for responding to global health 
security emergencies. 
‘‘(2) CONGRESSIONAL BRIEFING.—Not less fre-
quently than twice each year, the employee des-
ignated under this subsection shall provide to the 
appropriate congressional committees a briefing on 
the responsibilities and activities of the individual 
under this subsection. 
‘‘(3) APPROPRIATE
CONGRESSIONAL
COMMIT-
TEES DEFINED.—In this subsection, the term ‘ap-
propriate congressional committees’ has the meaning 
given such term in section 9 of the Global Health 
Security Act of 2019.’’. 
SEC. 6. STRATEGY AND REPORTS. 
(a) STRATEGY.—The Special Advisor to the Presi-
dent for Global Health Security (designated under sub-
section (i) of section 101 of the National Security Act of 
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1947 (50 U.S.C. 3021), as added by section 6 of this Act) 
shall coordinate the development and implementation of 
a strategy to implement the policy described in section 
3(a), which shall— 
(1) set specific and measurable goals, bench-
marks, timetables, performance metrics, and moni-
toring and evaluation plans that reflect international 
best practices relating to transparency, account-
ability, and global health security; 
(2) support and be aligned with country-owned 
global health security policy and investment plans 
developed with input from key stakeholders, as ap-
propriate; 
(3) facilitate communication and collaboration, 
as appropriate, among local stakeholders in support 
of a multi-sectoral approach to global health secu-
rity; 
(4) support the long-term success of programs 
by building the capacity of local organizations and 
institutions in target countries and communities; 
(5) develop community resilience to infectious 
disease threats and emergencies; 
(6) leverage resources and expertise through 
partnerships with the private sector, health organi-
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zations, civil society, nongovernmental organizations, 
and health research and academic institutions; and 
(7) support collaboration, as appropriate, be-
tween United States universities, and public and pri-
vate institutions in target countries and communities 
to promote health security and innovation. 
(b) COORDINATION.—The President, acting through 
the Special Advisor for Global Health Security, shall co-
ordinate, through a whole-of-government approach, the ef-
forts of relevant Federal departments and agencies in the 
implementation of the strategy required under subsection 
(a) by— 
(1) establishing monitoring and evaluation sys-
tems, coherence, and coordination across relevant 
Federal departments and agencies; and 
(2) establishing platforms for regular consulta-
tion and collaboration with key stakeholders and the 
appropriate congressional committees. 
(c) STRATEGY SUBMISSION.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, the 
President, in consultation with the head of each rel-
evant Federal department and agency, shall submit 
to the appropriate congressional committees the 
strategy required under subsection (a) that provides 
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a detailed description of how the United States in-
tends to advance the policy set forth in section 3(a) 
and the agency-specific plans described in paragraph 
(2). 
(2) AGENCY-SPECIFIC PLANS.—The strategy re-
quired under subsection (a) shall include specific im-
plementation plans from each relevant Federal de-
partment and agency that describes— 
(A) the anticipated contributions of the de-
partment or agency, including technical, finan-
cial, and in-kind contributions, to implement 
the strategy; and 
(B) the efforts of the department or agen-
cy to ensure that the activities and programs 
carried out pursuant to the strategy are de-
signed to achieve maximum impact and long- 
term sustainability. 
(d) REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date on which the strategy required under sub-
section (a) is submitted to the appropriate congres-
sional committees under subsection (c), and not later 
than October 1 of each year thereafter, the Presi-
dent shall submit to the appropriate congressional 
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committees a report that describes the status of the 
implementation of the strategy. 
(2) CONTENT.—The report required under 
paragraph (1) shall— 
(A) identify any substantial changes made 
in the strategy during the preceding calendar 
year; 
(B) describe the progress made in imple-
menting the strategy; 
(C) identify the indicators used to establish 
benchmarks and measure results over time, as 
well as the mechanisms for reporting such re-
sults in an open and transparent manner; 
(D) contain a transparent, open, and de-
tailed accounting of expenditures by relevant 
Federal departments and agencies to implement 
the strategy, including, for each Federal depart-
ment and agency, the statutory source of ex-
penditures, amounts expended, implementing 
partners, targeted beneficiaries, and activities 
supported; 
(E) describe how the strategy leverages 
other United States global health and develop-
ment assistance programs; 
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