II 118th CONGRESS 1st Session S. 2398 IN THE SENATE OF THE UNITED STATES July 19, 2023 Mr. Markey introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To require research into the health consequences of the environmental impacts of nuclear war, and for other purposes.

1. Short title This Act may be cited as the Health Impacts of Nuclear War Act of 2023 . 2. Findings Congress finds that— (1) nuclear weapons explosions would have devastating health impacts, including immediate radiation exposure, thermal burns, and blast injuries; (2) a large body of scientific literature suggests that the impacts of wide-spread nuclear weapons explosions are likely to extend well beyond the immediate effect of the explosions and may include long-lasting and catastrophic environmental effects, including— (A) the generation of vast quantities of soot as a result of firestorms generated by nuclear explosions; (B) the injection of such soot into the stratosphere; (C) a significant reduction in sunlight reaching the Earth’s surface as a result of such soot, causing a significant reduction in Earth’s surface temperatures, substantial changes to precipitation and ocean circulation patterns, and a dramatic decrease in crop and fisheries yields; and (D) damage to the ozone layer as a result of such soot, causing increased ultraviolet radiation at the Earth’s surface; (3) such an environmental catastrophe could impact the United States even if the nuclear weapons explosions were outside the United States; (4) the health consequences of such an environmental catastrophe would be severe and long-lasting and may include— (A) increased cancer rates as a result of higher ultra-violet radiation levels or radioactive fallout; (B) malnutrition as a result of decreases in agricultural and fisheries productivity after an abrupt reduction in sunlight; (C) infectious disease spread due to deteriorated public health concerns and compromised immunity; (D) hypothermia, frostbite, and other consequences of exposure to extreme cold; and (E) other, cascading effects, such as consequences of widespread damage to critical infrastructure; (5) such health consequences may be even more damaging and long-lasting than the initial impact of nuclear explosions, and the prospects for recovery from such consequences are currently unclear; (6) such health consequences should be considered when preparing all-hazards emergency plans as a component of chemical, biological, radiological, and nuclear threats; (7) the focus of existing Federal Government preparedness and planning for nuclear threats has primarily been on individual nuclear detonation incidents, and not on responding to the long-term environmental and health impacts; and (8) research into, and preparedness for, the health consequences of the environmental impacts of nuclear war is of critical importance to the national security of the United States. 3. Health consequences of the environmental impacts of nuclear war Subtitle C of title XXVIII of the Public Health Service Act ( 42 U.S.C. 300hh–31 et seq. ) is amended by adding at the end the following: 2827. Health consequences of the environmental impacts of nuclear war (a) Definitions In this section: (1) Environmental impacts of nuclear war The term environmental impacts of nuclear war means changes to the environment resulting, either directly or indirectly, from the explosion of nuclear weapons, including— (A) the generation of vast quantities of soot as a result of firestorms generated by nuclear explosions; (B) the injection of such soot into the stratosphere; (C) a significant reduction in sunlight reaching the Earth’s surface as a result of such soot, causing a significant reduction in Earth’s surface temperatures, substantial changes to precipitation and ocean circulation patterns, and a dramatic decrease in crop and fisheries yields; (D) damage to the ozone layer as a result of such soot, causing increased ultraviolet radiation at the Earth’s surface; and (E) other impacts, as determined by the Secretary. (2) Health consequences of the environmental impacts of nuclear war The term health consequences of the environmental impacts of nuclear war means adverse effects on the physical or mental well-being of individuals resulting, either directly or indirectly, from environmental impacts of nuclear war, including— (A) increased cancer rates as a result of higher ultra-violet radiation levels or radioactive fallout; (B) malnutrition as a result of decreases in agricultural and fisheries productivity after an abrupt reduction in sunlight; (C) infectious disease spread due to deteriorated public health conditions and compromised immunity, including due to malnutrition; (D) hypothermia, frostbite, and other consequences of exposure to extreme cold; and (E) other consequences, as determined by the Secretary. (3) Nuclear war The term nuclear war means military conflict involving the detonation of multiple nuclear weapons. (b) Research grants To study the health consequences of the environmental impacts of nuclear war (1) Research and preparedness program The Secretary, in collaboration with the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, and the Assistant Secretary for Preparedness and Response, shall develop and implement a 5-year research and preparedness program, which may include activities carried out by the Secretary, as well as grants, contracts, and cooperative agreements awarded to eligible entities, to address the health consequences of the environmental impacts of nuclear war. (2) Components of research and preparedness program The program may include— (A) scientific study of the potential health consequences of the environmental impacts of nuclear war, including the longevity of such effects and the prospects for recovery; (B) exercises and drills to understand possible health system response to the environmental impacts of nuclear war; (C) identifying and addressing capability and capacity gaps for health system response to the environmental impacts of nuclear war; and (D) developing countermeasures to combat the health effects of the environmental impacts of nuclear war. (3) Eligible entities To be eligible to receive a grant, contract, or cooperative agreement described in paragraph (1), an entity shall— (A) be— (i) a nonprofit entity; (ii) a nonprofit research institution; or (iii) an institution of higher education (as defined in section 102 of the Higher Education Act of 1965); and (B) submit an application to the Secretary, at such time, in such manner, and containing such information as the Secretary may require. (4) Authorization of appropriations To carry out this subsection, there are authorized to be appropriated $10,000,000 for each of fiscal years 2024 through 2028. (c) Assessment and recommendations by the Secretary (1) Assessment The Secretary shall conduct an assessment of the ability of the health systems of the United States to respond to the health consequences of the environmental impacts of nuclear war, including— (A) an assessment of the possible health consequences of the environmental impacts of nuclear war; (B) an assessment of existing State and Federal governmental preparedness and response authorities, capabilities, protocols, and plans to respond to the likely health consequences of the environmental impacts of nuclear war; (C) an assessment of current countermeasures to address the range of likely health impacts in the event of environmental impacts of nuclear war; (D) an assessment of the current scientific uncertainties relating to the environmental consequences of nuclear war, their health consequences, and their implications for preparedness; (E) recommendations for further scientific research to address any uncertainties identified under subparagraph (D); and (F) identification and prioritization of the most critical preparedness and response gaps of the United States to address the health consequences of the environmental impacts of nuclear war. (2) Assessment report Not later than 1 year after the date of enactment of the Health Impacts of Nuclear War Act of 2023 , the Secretary shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that contains the findings of the study conducted under paragraph (1). (3) Coordination In carrying out the assessment under paragraph (1), the Secretary shall coordinate with the following: (A) Each of the following heads of agencies or departments (or the designees of such heads): (i) The Director of the National Institutes of Health. (ii) The Assistant Secretary for Preparedness and Response. (iii) The Director of the Centers for Disease Control and Prevention. (iv) The Assistant to the President for National Security Affairs. (v) The Director of the Office of Science and Technology Policy. (vi) The Secretary of Energy. (vii) The Under Secretary of Energy for Nuclear Security. (viii) The Administrator of the National Nuclear Security Administration. (ix) The Director of the Office of Science of the Department of Energy. (x) The Secretary of Commerce. (xi) The Under Secretary of Commerce for Oceans and Atmosphere. (xii) The Director of the National Center for Atmospheric Research. (xiii) The Secretary of the Interior. (xiv) The Director of the United States Geological Survey. (xv) The Administrator of the Environmental Protection Agency. (xvi) The Director of the National Science Foundation. (xvii) The Secretary of Defense. (xviii) The Director of the Defense Threat Reduction Agency. (xix) The Chairman of the Joint Chiefs of Staff. (xx) The Secretary of State. (xxi) The Under Secretary of State for Arms Control and International Security. (xxii) The Administrator of the Federal Emergency Management Authority. (xxiii) The Secretary of Agriculture. (xxiv) The Secretary of Homeland Security. (B) Other stakeholders, as the Secretary determines appropriate. . 4. Scope of nuclear threats The Public Health Service Act is amended— (1) in section 319C–1 ( 42 U.S.C. 247d–3a )— (A) in subsection (b)(2)(A)(i), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after nuclear threats ; and (B) in subsection (g)(1)(A), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after nuclear threats ; (2) in section 319C–2(c) ( 42 U.S.C. 247d–3b ), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after nuclear threats ; (3) in section 319C–3(c)(1) (42 U.S.C. 247d–3c(c)(1)), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after infectious diseases ; (4) in section 319F(d)(3)(A) ( 42 U.S.C. 247d–6(d)(3)(A) ), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after infectious diseases ; (5) in section 319L(c)(4)(F)(i) (42 U.S.C. 247d–7e(c)(4)(F)(i)), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after infectious diseases ; (6) in section 2801(d)(3) ( 42 U.S.C. 300hh(d)(3) ), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 before the semicolon; (7) in section 2811 ( 42 U.S.C. 300hh–10 )— (A) in subsection (b)(4)(J)(i), in the matter preceding subclause (I), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after infectious diseases ; (B) in subsection (d)(1), by inserting , including the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after nuclear threats ; and (C) in subsection (d)(2)(A), by inserting , including with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827, after Nation ; and (8) in section 2811–1(c)(1)(A) (42 U.S.C. 300hh–10a(c)(1)(A)), by inserting and with respect to the health consequences of the environmental impacts of nuclear war, as defined in section 2827 after infectious diseases .