I
106TH CONGRESS
2D SESSION
H. R. 4964
To amend title III of the Public Health Service Act to enhance the Nation’s
capacity to address public health threats and emergencies.
IN THE HOUSE OF REPRESENTATIVES
JULY 26, 2000
Mr. BURR of North Carolina (for himself and Mr. STUPAK) introduced the
following bill; which was referred to the Committee on Commerce
A BILL
To amend title III of the Public Health Service Act to
enhance the Nation’s capacity to address public health
threats and emergencies.
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 ‘‘Public Health Threats
and Emergencies Act’’.
SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT.
Part B of title III of the Public Health Service Act
(42 U.S.C. 243 et seq.) is amended by striking section
319 and inserting the following:
‘‘SEC. 319. PUBLIC HEALTH EMERGENCIES.
‘‘(a) EMERGENCIES.—If the Secretary determines,
after consultation with the Director of the Centers for Dis-
ease Control and Prevention and other public health offi-
cials as may be necessary, that—
‘‘(1) a disease or disorder presents a public
health emergency; or
‘‘(2) a public health emergency, including sig-
nificant outbreaks of infectious diseases or bioter-
rorist attacks, otherwise exists,
the Secretary may take such action as may be appropriate
to respond to the public health emergency, including mak-
ing grants and entering into contracts and conducting and
supporting investigations into the cause, treatment, or
prevention of a disease or disorder as described in para-
graphs (1) and (2).
‘‘(b) PUBLIC HEALTH EMERGENCY FUND.—
‘‘(1) IN GENERAL.—There is established in the
Treasury a fund to be designated as the ‘Public
Health Emergency Fund’ to be made available to
the Secretary without fiscal year limitation to carry
out subsection (a) only if a public health emergency
has been declared by the Secretary under such sub-
section. There is authorized to be appropriated to
the Fund such sums as may be necessary.
with State and local health officials, shall establish
reasonable capacities that are appropriate for na-
tional, State, and local public health systems and the
personnel or work forces of such systems. Such ca-
pacities shall be revised every 10 years, or more fre-
quently as the Secretary determines to be necessary.
‘‘(2) BASIS.—The capacities established under
paragraph (1) shall improve, enhance or expand the
capacity of national, state and local public health
agencies to detect and respond effectively to signifi-
cant public health threats, including major out-
breaks of infectious disease, pathogens resistant to
antimicrobial agents and acts of bioterrorism. Such
capacities may include the capacity to—
‘‘(A) recognize the clinical signs and epide-
miological characteristic of significant outbreaks
of infectious disease;
‘‘(B) identify disease-causing pathogens
rapidly and accurately;
‘‘(C) develop and implement plans to pro-
vide medical care for persons infected with dis-
ease-causing agents and to provide preventive
care as needed for individuals likely to be ex-
posed to disease-causing agents;
‘‘(D) communicate information relevant to
significant public health threats rapidly to local,
State and national health agencies; or
‘‘(E) develop or implement policies to pre-
vent the spread of infectious disease or anti-
microbial resistance.
‘‘(b) REPORT.—Not later than 1 year after the date
of enactment of this section, and every 10 years thereafter,
the Secretary shall prepare and submit to the Committee
on Health, Education, Labor, and Pensions of the Senate
and the Committee on Commerce of the House of Rep-
resentatives a report describing the capacities established
pursuant to subsection (a).
‘‘(c) SUPPLEMENT NOT SUPPLANT.—Funds appro-
priated under this section shall be used to supplement and
not supplant other Federal, State, and local public funds
provided for activities under this section.
‘‘(d) TECHNICAL ASSISTANCE.—The Secretary shall
provide technical assistance to the States to assist such
States in fulfilling the requirements of this section.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section
such sums as may be necessary for each of the fiscal years
2001 through 2006.
‘‘SEC. 319B. ASSESSMENT OF PUBLIC HEALTH NEEDS.
‘‘(a) PROGRAM AUTHORIZED.—Not later than 1 year
after the date of enactment of this section and every 10
years thereafter, the Secretary shall award grants to
States to perform, in collaboration with local public health
agencies, an evaluation to determine the extent to which
States or local public health agencies can achieve the ca-
pacities applicable to State and local public health agen-
cies described in subsection (a) of section 319A. The Sec-
retary shall provide technical assistance to States in addi-
tion to awarding such grants.
‘‘(b) PROCEDURE.—
‘‘(1) IN GENERAL.—A State may contract with
an outside entity to perform the evaluation described
in subsection (a).
‘‘(2) METHODS.—To the extent practicable, the
evaluation described in subsection (a) shall be com-
pleted by using commonly accepted methods.
‘‘(c) REPORT BY STATE.—Not later than 1 year after
the date on which a State receives a grant under this sub-
section, such State shall prepare and submit to the Sec-
retary a report describing the results of the evaluation de-
scribed in subsection (a) with respect to such State.
‘‘(d) SUPPLEMENT NOT SUPPLANT.—Funds appro-
priated under this section shall be used to supplement and
not supplant other Federal, State, and local public funds
provided for activities under this section.
‘‘(E) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section
such sums as may be necessary for each of the fiscal years
2002 and 2003.
‘‘SEC. 319C. GRANTS TO IMPROVE STATE AND LOCAL PUB-
LIC HEALTH AGENCIES.
‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall
award competitive grants to eligible entities to address
core public health capacity needs using the capacities de-
veloped under section 319A, with a particular focus on
building capacity to identify, detect, monitor, and respond
to threats to the public health.
‘‘(b) ELIGIBLE ENTITIES.—A State or political sub-
division of a State, or a consortium of 2 or more States
or political subdivisions of States, that has completed an
evaluation under section 319B(a), or an evaluation that
is substantially equivalent as determined by the Secretary
under section 319B(a), shall be eligible for grants under
subsection (b).
‘‘(c) USE OF FUNDS.—An eligible entity that receives
a grant under subsection (b), may use funds received
under such grant to—
‘‘(1) train public health personnel;
‘‘(2) develop, enhance, coordinate, or improve
participation in an electronic network by which dis-
ease detection and public health related information
can be rapidly shared among national, regional,
State, and local public health agencies and health
care providers;
‘‘(3) develop a plan for responding to public
health emergencies, including significant outbreaks
of infectious diseases or bioterrorism attacks, which
is coordinated with the capacities of applicable na-
tional, State, and local national health agencies; and
‘‘(4) enhance laboratory capacity and facilities.
‘‘(d) REPORT.—Not later than 1 year after the date
of enactment of this section and annually thereafter, the
Secretary shall prepare and submit to the Committee on
Health, Education, Labor, and Pensions of the Senate and
the Committee on Commerce of the House of Representa-
tives a report that describes the activities carried out
under this section.
‘‘(e) SUPPLEMENT NOT SUPPLANT.—Funds appro-
priated under this section shall be used to supplement and
not supplant other Federal, State, and local public funds
provided for activities under this section.
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section
such sums as may be necessary for each of the fiscal years
2001 through 2006.
‘‘SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE
CONTROL AND PREVENTION.
‘‘(a) FINDINGS.—Congress finds that the Centers for
Disease Control and Prevention have an essential role in
defending against and combatting public health threats of
the twenty-first century and requires secure and modern
facilities that are sufficient to enable such Centers to con-
duct this important mission.
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—For the
purposes of achieving the mission of the Centers for Dis-
ease Control and Prevention described in subsection (a),
for constructing new facilities and renovating existing fa-
cilities of such Centers, including laboratories, laboratory
support buildings, health communication facilities, office
buildings and other facilities and infrastructure, for better
conducting the capacities described in section 319A, and
for supporting related public health activities, there are
authorized to be appropriated such sums as may be nec-
essary for each of fiscal years 2001 through 2010.
‘‘SEC. 319E. COMBATING ANTIMICROBIAL RESISTANCE.
‘‘(a) TASK FORCE.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an Antimicrobial Resistance Task Force to co-
ordinate Federal programs relating to antimicrobial
resistance. The Secretary may appoint or select a
committee, or other organization in existence as of
the date of enactment of this section, to serve as
such a task force, if such committee, or other orga-
nization meets the requirements of this section.
‘‘(2) MEMBERS
OF
TASK
FORCE.—The task
force described in paragraph (1) shall be composed
of representatives from such Federal agencies, public
health constituencies, manufacturers, medical profes-
sional societies and others as determined to be nec-
essary by the Secretary, to develop and implement a
comprehensive strategic plan to address the public
health threat of antimicrobial resistance.
‘‘(3) AGENDA.—
‘‘(A) IN
GENERAL.—The task force de-
scribed in paragraph (1) shall consider factors
the 
Secretary 
considers 
appropriate,
including—
‘‘(i) public health factors contributing
to increasing antimicrobial resistance;
‘‘(ii) public health needs to detect and
monitor antimicrobial resistance;
‘‘(iii) detection, prevention, and con-
trol strategies for resistant pathogens;
‘‘(iv) the need for improved informa-
tion and data collection;
‘‘(v) the assessment of the risk im-
posed by pathogens presenting a threat to
the public health; and
‘‘(vi) any other issues which the Sec-
retary determines are relevant to anti-
microbial resistance.
‘‘(B) DETECTION
AND
CONTROL.—The
Secretary, in consultation with the task force
described in paragraph (1) and State and local
public health officials, shall—
‘‘(i) develop, improve, coordinate or
enhance participation in a surveillance plan
to detect and monitor emerging anti-
microbial resistance; and
‘‘(ii) develop, improve, coordinate or
enhance participation in an integrated in-
formation system to assimilate, analyze,
and exchange antimicrobial resistance data
between public health departments.
‘‘(4) MEETINGS.—The task force described
under paragraph (1) shall convene not less than
twice a year, or more frequently as the Secretary de-
termines to be appropriate.
‘‘(b) RESEARCH AND DEVELOPMENT OF NEW ANTI-
MICROBIAL DRUGS AND DIAGNOSTICS.—The Director of
National Institute of Health and the Director of the Cen-
ter for Disease Control and Prevention, in collaboration
with members of the task force established under sub-
section (a), shall conduct and support research, investiga-
tions, experiments, demonstrations, and studies in the
health sciences that are related to—
‘‘(1) the development of new therapeutics, in-
cluding vaccines and antimicrobials, against resist-
ant pathogens;
‘‘(2) the development or testing of medical
diagnostics 
to 
detect 
pathogens 
resistant 
to
antimicrobials;
‘‘(3) the epidemiology, mechanisms, and patho-
genesis of antimicrobial resistance;
‘‘(4) the sequencing of the genomes of priority
pathogens as determined by the Director of the Na-
tional Institutes of Health in consultation with the
task force established under subsection (a); and
‘‘(5) other relevant research areas.
‘‘(c) EDUCATION OF MEDICAL AND PUBLIC HEALTH
PERSONNEL.—The Secretary, after consultation with the
Surgeon General, the Director of the Centers for Disease
Control and Prevention, the Director of Health Resources
and Services Administration, the Director of the Agency
for Healthcare Research and Quality, members of the task
force described in subsection (a), and professional organi-
zations and societies, shall—
‘‘(1) develop and implement educational pro-
grams to increase the awareness of the general pub-
lic with respect to the public health threat of anti-
microbial resistance and the appropriate use of anti-
biotics;
‘‘(2) develop and implement educational pro-
grams to instruct health care professionals in the
prudent use of antibiotics; and
‘‘(3) develop and implement programs to train
laboratory personnel in the recognition or identifica-
tion of resistance in pathogens.
‘‘(d) GRANTS.—
‘‘(1) IN GENERAL.—The Secretary shall award
competitive grants to eligible entities to enable such
entities to increase the capacity to detect, monitor,
and combat antimicrobial resistance.
‘‘(2) ELIGIBLE ENTITIES.—Eligible entities for
grants under paragraph (1) shall be State or local
public health agencies.
‘‘(3) USE OF FUNDS.—An eligible entity receiv-
ing a grant under paragraph (1) shall use funds
from such grant for activities that are consistent
with the factors identified by the task force under
subsection (a)(3), which may include activities
that—
‘‘(A) provide training to enable such entity
to identify patterns of resistance rapidly and
accurately;
‘‘(B) develop, improve, coordinate or en-
hance participation in information systems by
which data on resistant infections can be shared
rapidly among relevant national, State, and
local health agencies and health care providers;
and
‘‘(C) develop and implement policies to
control the spread of antimicrobial resistance.
‘‘(e) GRANTS FOR DEMONSTRATION PROGRAMS.—
‘‘(1) IN GENERAL.—The Secretary shall award
competitive grants to eligible entities to establish
demonstration programs to promote judicious use of
antimicrobial drugs or control the spread of anti-
microbial-resistant pathogens.
‘‘(2) ELIGIBLE ENTITIES.—Eligible entities for
grants under paragraph (1) may include hospitals,
clinics, institutions of long-term care, or professional
medical societies.
‘‘(3) TECHNICAL ASSISTANCE.—The Secretary
shall provide appropriate technical assistance to eli-
gible entities that receive grants under paragraph
(1).
‘‘(f) SUPPLEMENT NOT SUPPLANT.—Funds appro-
priated under this section shall be used to supplement and
not supplant other Federal, State, and local public funds
provided for activities under this section.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section,
such sums as may be necessary for each of the fiscal years
2001 through 2006.
‘‘SEC. 319F. PUBLIC HEALTH COUNTERMEASURES TO A BIO-
TERRORIST ATTACK.
‘‘(a) WORKING GROUP ON PREPAREDNESS FOR ACTS
OF BIOTERRORISM.—The Secretary, in coordination with
the Secretary of Defense, shall establish a joint inter-
departmental working group on preparedness and readi-
ness for the medical and public health effects of a bioter-
rorist attack on the civilian population. Such joint working
group shall—
‘‘(1) coordinate research on pathogens likely to
be used in a bioterrorist attack on the civilian popu-
lation as well as therapies to treat such pathogens;
‘‘(2) coordinate research and development into
equipment to detect pathogens likely to be used in
a bioterrorist attack on the civilian population and
protect against infection from such pathogens;
‘‘(3) develop shared standards for equipment to
detect and to protect against infection from patho-
gens likely to be used in a bioterrorist attack on the
civilian population; and
‘‘(4) coordinate the development, maintenance,
and procedures for the release of, strategic reserves
of vaccines, drugs, and medical supplies which may
be needed rapidly after a bioterrorist attack upon
the civilian population.
‘‘(b) WORKING GROUP ON THE PUBLIC HEALTH AND
MEDICAL CONSEQUENCES OF BIOTERRORISM.—
‘‘(1) IN GENERAL.—The Secretary, in collabo-
ration with the Director of the Federal Emergency
Management Agency and the Attorney General, shall
establish a joint interdepartmental working group to
address the public health and medical consequences
of a bioterrorist attack on the civilian population.
‘‘(2) FUNCTIONS.—Such working group shall—
‘‘(A) assess the priorities for and enhance
the preparedness of public health institutions,
providers of medical care, and other emergency
service personnel to detect, diagnose, and re-
spond to a bioterrorist attack; and
‘‘(B) in the recognition that medical and
public health professionals are likely to provide
much of the first response to such an attack,
develop, coordinate, enhance, and assure the
quality of joint planning and training programs
that address the public health and medical con-
sequences of a bioterrorist attack on the civilian
population between—
‘‘(i) local firefighters, ambulance per-
sonnel, police and public security officers,
or other emergency response personnel;
and
‘‘(ii) hospitals, primary care facilities,
or public health agencies.
‘‘(3) WORKING GROUP MEMBERSHIP.—In estab-
lishing such working group, the Secretary shall act
through the Director of the Office of Emergency
Preparedness and the Director of the Centers for
Disease Control and Prevention.
‘‘(4) COORDINATION.—The Secretary shall en-
sure coordination and communication between the
working groups established in this subsection and
subsection (a).
‘‘(c) GRANTS.—
‘‘(1) IN GENERAL.—The Secretary, in coordina-
tion with the working group established under sub-
section (b), shall award grants on a competitive
basis to eligible entities to enable such entities to in-
crease their capacity to detect, diagnose, and re-
spond to acts of bioterrorism upon the civilian popu-
lation.
‘‘(2) ELIGIBILITY.—To be an eligible entity
under this subsection, such entity must be a State,
political subdivision of a State, consortium of 2 or
more States or political subdivisions of States, or a
hospital, clinic, or primary care facility.
‘‘(3) USE OF FUNDS.—An entity that receives
a grant under this subsection shall use such funds
for activities that are consistent with the priorities
identified by the working group under subsection
(b), including—
‘‘(A) training health care professionals and
public health personnel to enhance the ability of
such personnel to recognize the symptoms and
epidemiological characteristics of exposure to a
potential bioweapon;
‘‘(B) addressing rapid and accurate identi-
fication of potential bioweapons;
‘‘(C) coordinating medical care for individ-
uals exposed to bioweapons; and
‘‘(D) facilitating and coordinating rapid
communication of data generated from a bioter-
rorist attack between national, State, and local
health agencies.
‘‘(4) COORDINATION.—The Secretary, in award-
ing grants under this subsection, shall—
‘‘(A) notify the Director of the Office of
Justice Programs, and the Director of the Na-
tional Domestic Preparedness Office annually
as to the amount and status of grants awarded
under this subsection; and
‘‘(B) coordinate grants awarded under this
subsection with grants awarded by the Office of
Emergency Preparedness and the Centers for
Disease Control and Prevention for the purpose
of improving the capacity of health care pro-
viders and public health agencies to respond to
bioterrorist attacks on the civilian population.
‘‘(5) ACTIVITIES.—An entity that receives a
grant under this subsection shall, to the greatest ex-
tent practicable, coordinate activities carried out
with such funds with the activities of a local Metro-
politan Medical Response System.
‘‘(d) FEDERAL ASSISTANCE.—The Secretary shall
ensure that the Department of Health and Human Serv-
ices is able to provide such assistance as may be needed
to State and local health agencies to enable such agencies
to respond effectively to bioterrorist attacks.
‘‘(e) EDUCATION.—The Secretary, in collaboration
with members of the working group described in sub-
section (b), and professional organizations and societies,
shall—
‘‘(1) develop and implement educational pro-
grams to instruct public health officials, medical
professionals, and other personnel working in health
care facilities in the recognition and care of victims
of a bioterrorist attack; and
‘‘(2) develop and implement programs to train
laboratory personnel in the recognition and identi-
fication of a potential bioweapon.
‘‘(f) FUTURE RESOURCE DEVELOPMENT.—The Di-
rector of National Institutes of Health and the Director
of the Centers for Disease Control and Prevention shall
consult with the working group described in subsection
(a), to develop priorities for and conduct research, inves-
tigations, experiments, demonstrations, and studies in the
health sciences related to—
‘‘(1) the epidemiology and pathogenesis of po-
tential bioweapons;
‘‘(2) the development of new vaccines or other
therapeutics against pathogens likely to be used in
a bioterrorist attack;
‘‘(3) the development of medical diagnostics to
detect potential bioweapons; and
‘‘(4) other relevant research areas.
‘‘(g) REPORT.—Not later than 180 days after the
date of enactment of this section, and annually, on June
30 of each year thereafter, the Secretary shall prepare and
submit to the Committee on Health, Education, Labor,
and Pensions of the Senate, the Committee on Commerce
of the House of Representatives, the Committee on Armed
Services of the Senate, the Committee on Armed Services
of the House of Representatives, and other congressional
committees as may be appropriate, a report that—
‘‘(1) details the activities carried out by the
working groups under subsections (a) and (b) during
the fiscal year preceding the date on which the re-
port is submitted and describing such activities to be
undertaken by Federal agencies to combat bioter-
rorism in the subsequent year;
‘‘(2) describes the programs carried out under
subsection (c); and
‘‘(3) describes activities carried out by the Sec-
retary under subsections (d) and (e).
‘‘(h) GENERAL ACCOUNTING OFFICE REPORT.—Not
later than 180 days after the date of enactment of this
section, the Comptroller General shall submit to the Com-
mittee on Health, Education, Labor, and Pensions of the
Senate and the Committee on Commerce of the House of
Representatives a report that describes—
‘‘(1) Federal activities primarily related to re-
search on, preparedness for, and the management of
the public health and medical consequences of a bio-
terrorist attack against the civilian population;
‘‘(2) the coordination of the activities described
in paragraph (1);
‘‘(3) the amount of Federal funds authorized or
appropriated for the activities described in para-
graph (1); and
‘‘(4) the effectiveness of such efforts in pre-
paring national, State, and local authorities to ad-
dress the public health and medical consequences of
a potential bioterrorist attack against the civilian
population.
‘‘(i) SUPPLEMENT NOT SUPPLANT.—Funds appro-
priated under this section shall be used to supplement and
not supplant other Federal, State, and local public funds
provided for activities under this section.
‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section
such sums as may be necessary for each of the fiscal years
2001 through 2006.’’.
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