STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - June 25, 2007)
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By Mr. BIDEN (for himself, Mr. HAGEL, Mr. KENNEDY, and Mr. CASEY):
S. 1687. A bill to provide for global pathogen surveillance and response; to the Committee on Foreign Relations.
Mr. BIDEN. Mr. President, many have called the 20th Century ``the American century.'' The 21st Century will be one, too, provided that we understand and act on a new reality: that global interactions make each country, even the U.S., more dependent upon others. Nowhere is this more striking than in our battle against emerging infectious diseases and bioterrorism. Whether we like it or not, the very security of our Nation depends upon the capability of nations in remote regions to contain epidemics before they spread.
Today, I am introducing the Global Pathogen Surveillance Act of 2007. I am very pleased to have as original cosponsors Senator Hagel, who is an esteemed colleague on the Foreign Relations Committee, and Senator Kennedy, who chairs the HELP Committee. Each of these gentlemen also cosponsored earlier versions of this bill. Also cosponsoring this bill is one of my fine new colleagues on the Foreign Relations Committee, Senator Casey.
Our action today is timely, as there is still time to prevent bioterrorist attacks on the U.S. It is urgent, because the disease surveillance capabilities in foreign countries that this act will promote are vitally needed to protect our country against not only bioterrorism, but also natural diseases such as avian influenza, which threatens to become the greatest pandemic since at least 1918. And it is long overdue, as this bill was first passed by the Senate in 2001 and was again passed in 2005. All of us hope that the third time will be the charm.
The purpose of this bill is to bolster the ability of developing countries to detect, identify and report disease outbreaks, with particular attention to outbreaks that could be the result of terrorist activity. My concern, as Chairman of the Senate Foreign Relations Committee, is that today, the many deficiencies in the capability of developing nations to track and contain disease epidemics are the equivalent of cracks in a levee. Right now, when the epidemiological ``big one'' hits, whether it is a natural outbreak or a terrorist attack, the world simply won't be able to respond in time.
The odds of a major bioterrorism event are very low, but they are hardly zero. In 2001, the American news media, the U.S. Postal Service and this United States Senate learned first-hand what it is like to receive deadly pathogens in the mail. To this day, we do not know whether the murderous anthrax letters were just a criminal act or actually a bioterrorist attack. But we surely know that neither our military power nor our economic wealth or geographical distance affords us immunity from the risk that a deranged person or group will visit biological destruction upon us.
The odds of a major outbreak of a new, but natural, disease are much higher, and the possible consequences, while variable, are truly frightening. At the high end, an avian flu pandemic similar to the Spanish flu of 1918 could kill many millions of people and threaten social cohesion everywhere, including in the U.S. Viruses and other pathogens respect no borders. Increased contact between humans and animals, coupled with vastly increased travel of goods and people, has made it possible for a new and distant outbreak to become a sudden threat to every continent.
The SARS epidemic was a good example of this. Now the world watches nervously as avian flu spreads westward from Asia, occasionally striking poultry flocks in Europe and Africa. We wonder when it will reach the Western Hemisphere and whether, or when, it will mutate into a disease that is readily transmitted between humans, who lack any immunity to it.
Last month, a man with extensively drug-resistant tuberculosis, or XDRTB, flew across one ocean, twice, and drove across several national borders, reminding us how readily a disease can be spread in the modern world. We dodged a bullet this time; XDRTB is especially difficult to treat, but does not spread as readily as influenza or some other diseases. Authorities knew who the disease vector was, moreover, and they knew what he had. The risk with avian flu or a bioterrorism attack is heightened by the likelihood that the disease will spread before anybody even knows it's here.
As if that were not enough, recent advances in biotechnology that open the door to new cures for diseases could also lead to the development of new diseases, or new strains of old ones, with much greater virulence than in the past or with the ability to resist our current vaccines or medicines. Such man-made diseases have already been developed by accident, and there is a clear risk of their being developed on purpose.
The U.S., and this Senate, have acted to address the twin threats of bioterrorism and new pathogens. We enacted the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, introduced by Senators Frist and KENNEDY, to buttress the ability of U.S. public health institutions to deal with a bioterrorism emergency. In 2004 we enacted the Project BioShield Act to spur the development of new vaccines and medicines.
The Centers for Disease Control has a program to put electronic surveillance systems in 8 American cities as the cornerstone of an eventual national network. Delaware is developing the first State-wide, electronic reporting system for infectious diseases, which will serve as a prototype for other States. And the Department of Health and Human Services funded a 3-year, $5.4 million program, early warning infectious disease surveillance, to assist the Government of Mexico to improve its disease surveillance capabilities near the U.S. border. Other funds were provided to U.S. States on the Mexican border.
But these efforts, as vital as they are, address the threats of disease and bioterrorism only when they are inside our house or on our doorstep. We must lift our eyes and look farther, to the places around the world where diseases and terrorism so often breed. We must battle bioterrorism not just at home, but also in those countries where lax governance and the lack of public health resources could permit both strange groups and stranger diseases to get a foothold and to get out of hand. We must not treat the threat of a massive biological pandemic the way we treated the threat of a category 5 hurricane striking New Orleans. If we do not prepare to combat realistic, once-in-a-century threats, then we will be left again to pick up the pieces after enduring massive physical and social harm.
There are precedents in current programs, moreover, for promoting disease surveillance as a means to lessen the risk of bioterrorism. For example, our programs to find useful careers for former Soviet biological weapons scientists, under the leadership of the State Department's Office of Cooperative Threat Reduction, currently fund the disease surveillance activities of anti-plague institutes in six states of the former Soviet Union, which had a major pathogen surveillance program ever since tsarist days. The Department of Defense also has programs with former Soviet scientists, as well as overseas laboratories that work with doctors in developing countries.
We need to build on those programs. We must create a world-wide disease surveillance capability that matches that of the old anti-plague institutes. We must help the rest of the world gain the capability to detect, contain, and report on disease outbreaks in a timely manner, and especially to spot outbreaks that may be the result of biological terrorism.
Part of the answer to the threat of new natural diseases is to stockpile vaccines and medicines, and the means to deliver them quickly. But rapid detection and identification of an outbreak is equally necessary, wherever it occurs. Only disease surveillance can give us the lead time to manufacture vaccines and enable the world community to help control a disease outbreak where it initially occurs.
In 2005, two sets of researchers reported in the journals Nature and Science that, based on computer simulations, if an outbreak of human-to-human-transmitted avian flu occurred in a rural part of Southeast Asia, it might be possible to stem that dangerous epidemic by using anti-viral drugs to treat the tens of thousands of people who might have been exposed in the initial outbreak. One key requirement, however, was that the outbreak would have to be discovered, identified and reported very quickly; in one study, the assumption was that countermeasures were instituted when only 30 people had observable symptoms. That is a tall order for any country's disease surveillance system, let alone a poorly equipped one.
The National Intelligence Council, NIC, reported in January 2000 that developing nations in Africa and Asia have only rudimentary systems, at best, for disease surveillance. They lack sufficient trained personnel and laboratory equipment, and especially the modern communications equipment that is needed for speedy analysis and reporting of disease outbreaks. The NIC estimated that it would take at least a decade to create an effective world-wide disease surveillance system.
According to an August 2001 report by the General Accounting Office, World Health Organization officials said that more than 60 percent of laboratory equipment in developing countries was either outdated or nonfunctioning, and that the vast majority of national personnel were not familiar with quality assurance principles for handling and analyzing biological samples. Deficiencies in training and equipment meant that many public health units in Africa and Asia were simply unable to perform accurate and timely disease surveillance.
The poor sanitary conditions, poverty, close contact between people and animals, and weak medical infrastructure make developing countries ideal breeding grounds for epidemics.
So it is vital to give these countries the capability to track epidemics and to feed that information into international surveillance networks. Disease surveillance is a systematic approach that requires trained public health personnel, proper diagnostic equipment to identify viruses and pathogens, and prompt transmission of data from the doctor or clinic level all the way to national governments and the World Health Organization, Who.
The Global Pathogen Surveillance Act will offer such help to those countries that agree to give the United States or the World Health Organization prompt access to disease outbreaks, so that we can help determine their origin. Recipients of this training will also be able to learn to spot diseases that might be used in a bioterrorist attack.
In drafting this bill, we worked closely with the Department of Defense and others, which have all supported the underlying goals of the bill. We also accepted several suggestions for improving the bill from the State Department and, in 2005, from the HELP Committee, all of which contributed to making this a better bill.
This bill targets U.S. assistance to developing nations in the following areas: Training of public health personnel in epidemiology; aquisition of laboratory and diagnostic equipment; Acquisition of communications technology to quickly transmit data on disease patterns and pathogen diagnoses to national public health authorities and to international institutions like the WHO; expansion of overseas CDC and Department of Defense laboratories engaged in infectious disease research and disease surveillance, which expansion could take the form of additional laboratories, enlargement of existing facilities, increases in the number of personnel, and/or expanding the scope of their activities; and expanded assistance to WHO and regional disease surveillance efforts, including expansion of U.S.-administered foreign epidemiology training programs.
Two years ago the Secretary of State, Dr. Condoleezza Rice, expressed her strong backing for this legislation:
We believe that the Global Pathogen Surveillance Act will indeed help strengthen developing countries' abilities to identify and track pathogens that could be indicators of dangerous disease outbreaks--either naturally-occurring or deliberately-released. Improved disease surveillance and communication among nations are critical defenses against both bioterrorism and natural outbreaks. We look forward to working with you in support of the Global Pathogen Surveillance Act.
Secretary Rice went on to make clear that she shares the sense of urgency that Senators HAGEL, KENNEDY, CASEY and I feel on this subject:
One of the true ``nightmare'' scenarios--of a bioterrorist attack or a naturally-occurring disease--involves a contagious biological agent moving swiftly through a crowded urban area of a densely populated developing nation. Thus, we believe that it is critical to increase efforts to strengthen the public health and scientific infrastructure necessary to identify and quickly respond to infectious disease outbreaks--and that the Global Pathogen Surveillance Act will provide valuable support in these efforts.
The WHO also shares our concern. During the SARS epidemic, Dr. Michael Heymann, who was the highest-ranking American in the WHO, stated: ``it is clear that the best defense against the spread of emerging infections such as SARS is strong national public health, national disease detection and response capacities that can identify new diseases and contain them before they spread internationally.'' He went on to highlight the important role that disease surveillance plays in combating both natural and terrorist outbreaks:
Global partnerships to combat global microbial threats make good sense as a defense strategy that brings immediate benefits in terms of strengthened pubic health and surveillance systems. The resulting infectious disease intelligence brings dual benefits in terms of protecting populations against both naturally occurring and potentially deliberately caused outbreaks. As SARS has so vividly demonstrated, the need is urgent and of critical importance to the health of economies as well as populations.
Support to developing countries such as proposed in the Global Pathogen Surveillance Act ..... will help strengthen capacity of public health professionals and epidemiologists, laboratory and other disease detection systems, and outbreak response mechanisms for naturally occurring infectious diseases such as SARS. This in turn will strengthen WHO and the world's safety net for outbreak detection and response, of which the United States is a major partner. And finally, strengthening this global safety net to detect and contain naturally occurring infectious diseases will strengthen the world's capacity to detect and respond to infectious diseases that may be deliberately caused.
The purpose of the Global Pathogen Surveillance Act is precisely to build these partnerships. And today, with the global war on terrorism an ever-present concern and with the threat of avian flu on the horizon, we have no time to waste. I urge my Senate colleagues to once again pass this bill and, with new leadership in the other body and with the support of Secretary Rice, I look forward to its speedy enactment.