IIB 
117TH CONGRESS 
1ST SESSION 
H. R. 391 
IN THE SENATE OF THE UNITED STATES 
JULY 12, 2021 
Received; read twice and referred to the Committee on Foreign Relations 
AN ACT 
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, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Global Health Security 
Act of 2021’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) 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’’. 
(2) 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, 
whether naturally occurring, deliberate, or acci-
dental. 
(3) In 2015, the United Nations adopted the 
Sustainable Development Goals (SDGs), which in-
clude specific reference to the importance of global 
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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’’. 
(4) On November 4, 2016, President Obama 
signed Executive Order No. 13747, ‘‘Advancing the 
Global Health Security Agenda to Achieve a World 
Safe and Secure from Infectious Disease Threats’’. 
(5) 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. 
(6) 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’’. 
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(7) 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’’. 
(8) In January 2021, President Biden issued 
Executive Order 13987 (86 Fed. Reg. 7019; relating 
to Organizing and Mobilizing the United States Gov-
ernment to Provide a Unified and Effective Re-
sponse to Combat COVID–19 and to Provide United 
States Leadership on Global Health and Security), 
as well as National Security Memorandum on 
United States Global Leadership to Strengthen the 
International COVID–19 Response and to Advance 
Global Health Security and Biological Preparedness, 
which include objectives to strengthen and reform 
the World Health Organization, increase United 
States leadership in the global response to COVID– 
19, and to finance and advance global health secu-
rity and pandemic preparedness. 
SEC. 3. STATEMENT OF POLICY. 
It is the policy of the United States to— 
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(1) promote and invest in global health security 
and pandemic preparedness as a core national secu-
rity interest; 
(2) advance the aims of the Global Health Se-
curity Agenda; 
(3) collaborate with other countries to detect 
and mitigate outbreaks early to prevent the spread 
of disease; 
(4) encourage and support other countries to 
advance pandemic preparedness by investing in basic 
resilient and sustainable health care systems; and 
(5) strengthen global health security across the 
intersection of human and animal health to prepare 
for and prevent infectious disease outbreaks and 
combat the growing threat of antimicrobial resist-
ance. 
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 (c) and the specific roles and responsibilities de-
scribed in subsection (e). 
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(b) MEETINGS.—The Council shall meet not less than 
four times per year to advance its mission and fulfill its 
responsibilities. 
(c) GENERAL RESPONSIBILITIES.—The Council shall 
be responsible for the following activities: 
(1) Provide policy-level recommendations to 
participating agencies on Global Health Security 
Agenda (GHSA) goals, objectives, and implementa-
tion, and other international efforts to strengthen 
pandemic preparedness and response. 
(2) Facilitate interagency, multi-sectoral en-
gagement to carry out GHSA implementation. 
(3) Provide a forum for raising and working to 
resolve interagency disagreements concerning the 
GHSA, and other international efforts to strengthen 
pandemic preparedness and response. 
(4)(A) Review the progress toward and work to 
resolve challenges in achieving United States com-
mitments under the GHSA, including commitments 
to assist other countries in achieving the GHSA tar-
gets. 
(B) The Council shall consider, among other 
issues, the following: 
(i) The status of United States financial 
commitments to the GHSA in the context of 
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commitments by other donors, and the con-
tributions of partner countries to achieve the 
GHSA targets. 
(ii) The progress toward the milestones 
outlined in GHSA national plans for those 
countries where the United States Government 
has committed to assist in implementing the 
GHSA and in annual work-plans outlining 
agency priorities for implementing the GHSA. 
(iii) The external evaluations of United 
States and partner country capabilities to ad-
dress infectious disease threats, including the 
ability to achieve the targets outlined within the 
WHO Joint External Evaluation tool, as well as 
gaps identified by such external evaluations. 
(d) PARTICIPATION.—The Council shall be headed by 
the Assistant to the President for National Security Af-
fairs, in coordination with the heads of relevant Federal 
agencies. The Council shall consist of representatives from 
the following agencies: 
(1) The Department of State. 
(2) The Department of Defense. 
(3) The Department of Justice. 
(4) The Department of Agriculture. 
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(5) The Department of Health and Human 
Services. 
(6) The Department of the Treasury. 
(7) The Department of Labor. 
(8) The Department of Homeland Security. 
(9) The Office of Management and Budget. 
(10) The Office of the Director of National In-
telligence. 
(11) The United States Agency for Inter-
national Development. 
(12) The Environmental Protection Agency. 
(13) The Centers for Disease Control and Pre-
vention. 
(14) The Office of Science and Technology Pol-
icy. 
(15) The National Institutes of Health. 
(16) The National Institute of Allergy and In-
fectious Diseases. 
(17) Such other agencies as the Council deter-
mines to be appropriate. 
(e) SPECIFIC ROLES AND RESPONSIBILITIES.— 
(1) IN GENERAL.—The heads of agencies de-
scribed in subsection (d) shall— 
(A) make the GHSA and its implementa-
tion and global pandemic preparedness a high 
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priority within their respective agencies, and in-
clude GHSA- and global pandemic prepared-
ness-related activities within their respective 
agencies’ strategic planning and budget proc-
esses; 
(B) designate a senior-level official to be 
responsible for the implementation of this Act; 
(C) designate, in accordance with sub-
section (d), 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 
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(G) coordinate across national health secu-
rity action plans and with GHSA and other 
partners, as appropriate, to which the United 
States is providing assistance. 
(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 (d) 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. UNITED STATES COORDINATOR FOR GLOBAL 
HEALTH SECURITY. 
(a) IN GENERAL.—The President shall appoint an in-
dividual to the position of United States Coordinator for 
Global Health Security, who shall be responsible for the 
coordination of the interagency process for responding to 
global health security emergencies. As appropriate, the 
designee shall coordinate with the President’s Special Co-
ordinator for International Disaster Assistance. 
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(b) CONGRESSIONAL BRIEFING.—Not less frequently 
than twice each year, the employee designated under this 
section shall provide to the appropriate congressional com-
mittees a briefing on the responsibilities and activities of 
the individual under this section. 
SEC. 6. SENSE OF CONGRESS. 
It is the sense of the Congress that, given the complex 
and multisectoral nature of global health threats to the 
United States, the President— 
(1) should consider appointing an individual 
with significant background and expertise in public 
health or emergency response management to the 
position of United States Coordinator for Global 
Health Security, as required by section 5(a), who is 
an employee of the National Security Council at the 
level of Deputy Assistant to the President or higher; 
and 
(2) in providing assistance to implement the 
strategy required under section 7(a), should— 
(A) coordinate, through a whole-of-govern-
ment approach, the efforts of relevant Federal 
departments and agencies to implement the 
strategy; 
(B) seek to fully utilize the unique capa-
bilities of each relevant Federal department and 
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agency while collaborating with and leveraging 
the contributions of other key stakeholders; and 
(C) utilize open and streamlined solicita-
tions to allow for the participation of a wide 
range of implementing partners through the 
most appropriate procurement mechanisms, 
which may include grants, contracts, coopera-
tive agreements, and other instruments as nec-
essary and appropriate. 
SEC. 7. STRATEGY AND REPORTS. 
(a) STRATEGY.—The President shall coordinate the 
development and implementation of a strategy to imple-
ment the policy aims described in section 3, which shall— 
(1) seek to strengthen United States diplomatic 
leadership and improve the effectiveness of United 
States foreign assistance for global health security to 
prevent, detect, and respond to infectious disease 
threats, including through advancement of the Glob-
al Health Security Agenda (GHSA), the Inter-
national Health Regulations (2005), and other rel-
evant frameworks that contribute to global health 
security and pandemic preparedness; 
(2) establish specific and measurable goals, 
benchmarks, timetables, performance metrics, and 
monitoring and evaluation plans for United States 
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foreign assistance for global health security that pro-
mote learning and reflect international best practices 
relating to global health security, transparency, and 
accountability; 
(3) establish mechanisms to improve coordina-
tion and avoid duplication of effort between the 
United States Government and partner countries, 
donor countries, the private sector, multilateral orga-
nizations, and other key stakeholders; 
(4) prioritize working with partner countries 
with demonstrated— 
(A) need, as identified through the Joint 
External Evaluation process, the Global Health 
Security Index classification of health systems, 
national action plans for health security, GHSA 
Action Packages, and other complementary or 
successor indicators of global health security 
and pandemic preparedness; and 
(B) commitment to transparency, including 
budget and global health data transparency, 
complying with the International Health Regu-
lations (2005), investing in domestic health sys-
tems, and achieving measurable results; 
(5) reduce long-term reliance upon United 
States foreign assistance for global health security 
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by promoting partner country ownership, improved 
domestic resource mobilization, co-financing, and ap-
propriate national budget allocations for global 
health security and pandemic preparedness and re-
sponse; 
(6) assist partner countries in building the tech-
nical capacity of relevant ministries, systems, and 
networks to prepare, execute, monitor, and evaluate 
effective national action plans for health security, in-
cluding mechanisms to enhance budget and global 
health data transparency, as necessary and appro-
priate; 
(7) support and be aligned with country-owned 
global health security policy and investment plans 
developed with input from key stakeholders, as ap-
propriate; 
(8) facilitate communication and collaboration, 
as appropriate, among local stakeholders in support 
of a multi-sectoral approach to global health secu-
rity; 
(9) support the long-term success of programs 
by building the capacity of local organizations and 
institutions in target countries and communities; 
(10) develop community resilience to infectious 
disease threats and emergencies; 
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(11) support global health budget and work-
force planning in partner countries, including train-
ing in financial management and budget and global 
health data transparency; 
(12) align United States foreign assistance for 
global health security with national action plans for 
health security in partner countries, developed with 
input from key stakeholders, including the private 
sector, to the greatest extent practicable and appro-
priate; 
(13) strengthen linkages between complemen-
tary bilateral and multilateral foreign assistance pro-
grams, including efforts of the World Bank, the 
World Health Organization, the Global Fund to 
Fight AIDS, Tuberculosis, and Malaria, and Gavi, 
the Vaccine Alliance, that contribute to the develop-
ment of more resilient health systems and supply 
chains in partner countries with the capacity, re-
sources, and personnel required to prevent, detect, 
and respond to infectious disease threats; 
(14) support innovation and public-private part-
nerships to improve pandemic preparedness and re-
sponse, including for the development and deploy-
ment of effective, accessible, and affordable infec-
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tious disease tracking tools, diagnostics, thera-
peutics, and vaccines; 
(15) support collaboration with and among rel-
evant public and private research entities engaged in 
global health security; and 
(16) support collaboration between United 
States universities and public and private institu-
tions in partner countries that promote global health 
security and innovation. 
(b) 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 
a detailed description of how the United States in-
tends to advance the policy set forth in section 3 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 describe— 
(A) the anticipated contributions of the de-
partment or agency, including technical, finan-
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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. 
(c) 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 (b), and not 
later than October 1 of each year thereafter, the 
President shall submit to the appropriate congres-
sional committees a report that describes the status 
of the implementation of the strategy. 
(2) CONTENTS.—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 
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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, to the extent prac-
ticable, for each Federal department and agen-
cy, the statutory source of expenditures, 
amounts expended, partners, targeted popu-
lations, and types of activities supported; 
(E) describe how the strategy leverages 
other United States global health and develop-
ment assistance programs and bilateral and 
multilateral institutions; 
(F) assess efforts to coordinate United 
States global health security programs, activi-
ties, and initiatives with key stakeholders; 
(G) incorporate a plan for regularly review-
ing and updating strategies, partnerships, and 
programs and sharing lessons learned with a 
wide range of stakeholders, including key stake-
holders, in an open, transparent manner; and 
(H) describe the progress achieved and 
challenges concerning the United States Gov-
ernment’s ability to advance GHSA and pan-
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demic 
preparedness, 
including 
data 
disaggregated by priority country using indica-
tors that are consistent on a year-to-year basis 
and recommendations to resolve, mitigate, or 
otherwise address the challenges identified 
therein. 
(d) FORM.—The strategy required under subsection 
(a) and the report required under subsection (c) shall be 
submitted in unclassified form but may contain a classi-
fied annex. 
SEC. 8. ESTABLISHMENT OF FUND FOR GLOBAL HEALTH 
SECURITY AND PANDEMIC PREPAREDNESS. 
(a) NEGOTIATIONS FOR ESTABLISHMENT OF A FUND 
FOR GLOBAL HEALTH SECURITY AND PANDEMIC PRE-
PAREDNESS.—The Secretary of State, in coordination 
with the Secretary of the Treasury, the Administrator of 
the United States Agency for International Development, 
the Secretary of Health and Human Services, and the 
heads of other relevant Federal departments and agencies 
as necessary and appropriate, should seek to enter into 
negotiations with donors, relevant United Nations agen-
cies, including the World Health Organization, and other 
key multilateral stakeholders, for the establishment of— 
(1) a multilateral, catalytic financing mecha-
nism for global health security and pandemic pre-
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