§2151b. Population planning and health programs
(a) Congressional declaration of policy
The Congress recognizes that poor health conditions and uncontrolled population growth can vitiate otherwise successful development efforts.
Large families in developing countries are the result of complex social and economic factors which change relatively slowly among the poor majority least affected by economic progress, as well as the result of a lack of effective birth control. Therefore, effective family planning depends upon economic and social change as well as the delivery of services and is often a matter of political and religious sensitivity. While every country has the right to determine its own policies with respect to population growth, voluntary population planning programs can make a substantial contribution to economic development, higher living standards, and improved health and nutrition.
Good health conditions are a principal element in improved quality of life and contribute to the individual's capacity to participate in the development process, while poor health and debilitating disease can limit productivity.
(b) Assistance for voluntary population planning
In order to increase the opportunities and motivation for family planning and to reduce the rate of population growth, the President is authorized to furnish assistance, on such terms and conditions as he may determine, for voluntary population planning. In addition to the provision of family planning information and services, including also information and services which relate to and support natural family planning methods, and the conduct of directly relevant demographic research, population planning programs shall emphasize motivation for small families.
(c) Assistance for health programs; special health needs of children and mothers; Child Survival Fund; promotion of immunization and oral rehydration; control of AIDS and tuberculosis
(1) In order to contribute to improvements in the health of the greatest number of poor people in developing countries, the President is authorized to furnish assistance, on such terms and conditions as he may determine, for health programs. Assistance under this subsection shall be used primarily for basic integrated health services, safe water and sanitation, disease prevention and control, and related health planning and research. This assistance shall emphasize self-sustaining community-based health programs by means such as training of health auxiliary and other appropriate personnel, support for the establishment and evaluation of projects that can be replicated on a broader scale, measures to improve management of health programs, and other services and supplies to support health and disease prevention programs.
(2)(A) In carrying out the purposes of this subsection, the President shall promote, encourage, and undertake activities designed to deal directly with the special health needs of children and mothers. Such activities should utilize simple, available technologies which can significantly reduce childhood mortality, such as improved and expanded immunization programs, oral rehydration to combat diarrhoeal diseases, and education programs aimed at improving nutrition and sanitation and at promoting child spacing. In carrying out this paragraph, guidance shall be sought from knowledgeable health professionals from outside the agency primarily responsible for administering subchapter I of this chapter. In addition to government-to-government programs, activities pursuant to this paragraph should include support for appropriate activities of the types described in this paragraph which are carried out by international organizations (which may include international organizations receiving funds under part III of this subchapter) and by private and voluntary organizations, and should include encouragement to other donors to support such types of activities.
(B) In addition to amounts otherwise available for such purpose, there are authorized to be appropriated to the President $25,000,000 for fiscal year 1986 and $75,000,000 for fiscal year 1987 for use in carrying out this paragraph. Amounts appropriated under this subparagraph are authorized to remain available until expended.
(C) Appropriations pursuant to subparagraph (B) may be referred to as the "Child Survival Fund".
(3) The Congress recognizes that the promotion of primary health care is a major objective of the foreign assistance program. The Congress further recognizes that simple, relatively low cost means already exist to reduce incidence of communicable diseases among children, mothers, and infants. The promotion of vaccines for immunization, and salts for oral rehydration, therefore, is an essential feature of the health assistance program. To this end, the Congress expects the agency primarily responsible for administering subchapter I of this chapter to set as a goal the protection of not less than 80 percent of all children, in those countries in which such agency has established development programs, from immunizable diseases by January 1, 1991. Of the aggregate amounts made available for fiscal year 1987 to carry out paragraph (2) of this subsection (relating to the Child Survival Fund) and to carry out subsection (c) (relating to development assistance for health), $50,000,000 shall be used to carry out this paragraph.
(4)
(d) Administration of assistance
(1) Assistance under this part shall be administered so as to give particular attention to the interrelationship between (A) population growth, and (B) development and overall improvement in living standards in developing countries, and to the impact of all programs, projects, and activities on population growth. All appropriate activities proposed for financing under this part shall be designed to build motivation for smaller families through modification of economic and social conditions supportive of the desire for large families, in programs such as education in and out of school, nutrition, disease control, maternal and child health services, improvements in the status and employment of women, agricultural production, rural development, and assistance to the urban poor, and through community-based development programs which give recognition to people motivated to limit the size of their families. Population planning programs shall be coordinated with other programs aimed at reducing the infant mortality rate, providing better nutrition for pregnant women and infants, and raising the standard of living of the poor.
(2) Since the problems of malnutrition, disease, and rapid population growth are closely related, planning for assistance to be provided under subsections (b) and (c) of this section and under section 2151a of this title shall be coordinated to the maximum extent practicable.
(3) Assistance provided under this section shall emphasize low-cost integrated delivery systems for health, nutrition, and family planning for the poorest people, with particular attention to the needs of mothers and young children, using paramedical and auxiliary medical personnel, clinics and health posts, commercial distribution systems, and other modes of community outreach.
(e) Research and analysis
(1) Health and population research and analysis carried out under this chapter shall-
(A) be undertaken to the maximum extent practicable in developing countries by developing country personnel, linked as appropriate with private and governmental biomedical research facilities within the United States;
(B) take account of the special needs of the poor people of developing countries in the determination of research priorities; and
(C) make extensive use of field testing to adapt basic research to local conditions.
(2) The President is authorized to study the complex factors affecting population growth in developing countries and to identify factors which might motivate people to plan family size or to space their children.
(f) Prohibition on use of funds for performance or research respecting abortions or involuntary sterilization
(1) None of the funds made available to carry out subchapter I of this chapter may be used to pay for the performance of abortions as a method of family planning or to motivate or coerce any person to practice abortions.
(2) None of the funds made available to carry out subchapter I of this chapter may be used to pay for the performance of involuntary sterilizations as a method of family planning or to coerce or provide any financial incentive to any person to undergo sterilizations.
(3) None of the funds made available to carry out subchapter I of this chapter may be used to pay for any biomedical research which relates, in whole or in part, to methods of, or the performance of, abortions or involuntary sterilization as a means of family planning.
(g) Authorization of appropriations
(1) There are authorized to be appropriated to the President, in addition to funds otherwise available for such purposes-
(A) $290,000,000 for fiscal year 1986 and $290,000,000 for fiscal year 1987 to carry out subsection (b) of this section; and
(B) $205,000,000 for fiscal year 1986 and $180,000,000 for fiscal year 1987 to carry out subsection (c) of this section.
(2) Funds appropriated under this subsection are authorized to remain available until expended.
(
Editorial Notes
References in Text
The Consolidated Appropriations Resolution, 2003, referred to in subsec. (c)(4), is
This chapter, referred to in subsec. (e)(1), was in the original "this Act", meaning
Codification
Amendment by
Amendments
2003-Subsec. (c)(4) to (7).
2000-Subsec. (c)(4) to (7).
1986-Subsec. (c)(2)(B).
Subsec. (c)(3).
Subsec. (g)(1)(B).
1985-Subsec. (c)(2)(B).
Subsec. (c)(3).
Subsec. (g).
1984-Subsec. (c).
1981-Subsec. (f)(3).
Subsec. (g).
1980-Subsec. (b).
Subsec. (g).
1979-Subsec. (d)(1).
Subsec. (g)(1).
Subsec. (g)(2).
1978-
1977-Subsec. (a).
Subsec. (b).
Subsec. (c).
Subsec. (d).
1975-Subsec. (a).
Subsec. (b).
1974-
Statutory Notes and Related Subsidiaries
References to Subchapter I Deemed To Include Certain Parts of Subchapter II
References to subchapter I of this chapter are deemed to include parts IV (§2346 et seq.), VI (§2348 et seq.), and VIII (§2349aa et seq.) of subchapter II of this chapter, and references to subchapter II are deemed to exclude such parts. See section 202(b) of
Effective Date of 1985 Amendment
Amendment by
Effective Date of 1979 Amendment
Amendment by
Effective Date of 1978 Amendment
Amendment by
Effective Date of 1977 Amendment
International Pandemic Preparedness
"SEC. 5559. SHORT TITLE.
"This subtitle may be cited as the 'Global Health Security and International Pandemic Prevention, Preparedness and Response Act of 2022'.
"SEC. 5560. DEFINITIONS.
"In this subtitle:
"(1) The term 'appropriate congressional committees' means-
"(A) the Committee on Foreign Relations of the Senate;
"(B) the Committee on Appropriations of the Senate;
"(C) the Committee on Foreign Affairs of the House of Representatives; and
"(D) the Committee on Appropriations of the House of Representatives.
"(2) The terms 'Global Health Security Agenda' and 'GHSA' mean the multi-sectoral initiative launched in 2014, and renewed in 2018, that brings together countries, regions, international organizations, nongovernmental organizations, and the private sector-
"(A) to elevate global health security as a national-level priority;
"(B) to share best practices; and
"(C) to facilitate national capacity to comply with and adhere to-
"(i) the International Health Regulations (2005);
"(ii) the international standards and guidelines established by the World Organisation for Animal Health;
"(iii) United Nations Security Council Resolution 1540 (2004);
"(iv) the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological and Toxin Weapons and on their Destruction, done at Washington, London, and Moscow, April 10, 1972 (commonly referred to as the 'Biological Weapons Convention');
"(v) the Global Health Security Agenda 2024 Framework; and
"(vi) other relevant frameworks that contribute to global health security.
"(3) The term 'Global Health Security Index' means the comprehensive assessment and benchmarking of health security and related capabilities across the countries that make up the States Parties to the International Health Regulations (2005).
"(4) The term 'Global Health Security Initiative' means the informal network of countries and organizations that came together in 2001, to undertake concerted global action to strengthen public health preparedness and response to chemical, biological, radiological, and nuclear threats, including pandemic influenza.
"(5) The term 'IHR (2005) Monitoring and Evaluation Framework' means the framework through which the World Health Organization and the State Parties to the International Health Regulations, as amended in 2005, review, measure, and assess core country public health capacities and ensure mutual accountability for global health security under the International Health Regulations (2005), including through the Joint External Evaluations, simulation exercises, and after-action reviews.
"(6) The term 'Joint External Evaluation' means the voluntary, collaborative, multi-sectoral process facilitated by the World Health Organization-
"(A) to assess country capacity to prevent, detect, and rapidly respond to public health risks occurring naturally or due to deliberate or accidental events;
"(B) to assess progress in achieving the targets under the International Health Regulations (2005); and
"(C) to recommend priority actions.
"(7) The term 'key stakeholders' means actors engaged in efforts to advance global health security programs and objectives, including-
"(A) national and local governments in partner countries;
"(B) other bilateral donors;
"(C) international, regional, and local organizations, including private, voluntary, nongovernmental, and civil society organizations, including faith-based and indigenous organizations;
"(D) international, regional, and local financial institutions;
"(E) representatives of historically marginalized groups, including women, youth, and indigenous peoples;
"(F) the private sector, including medical device, technology, pharmaceutical, manufacturing, logistics, and other relevant companies; and
"(G) public and private research and academic institutions.
"(8) The term 'One Health approach' means the collaborative, multi-sectoral, and transdisciplinary approach toward achieving optimal health outcomes in a manner that recognizes the interconnection between people, animals, plants, and their shared environment.
"(9) The term 'pandemic preparedness' refers to the actions taken to establish and sustain the capacity and capabilities necessary to rapidly identify, prevent, protect against, and respond to the emergence, reemergence, and spread of pathogens of pandemic potential.
"(10) The term 'partner country' means a foreign country in which the relevant Federal departments and agencies are implementing United States foreign assistance for global health security and pandemic prevention, preparedness, and response under this subtitle.
"(11) The term 'relevant Federal departments and agencies' means any Federal department or agency implementing United States policies and programs relevant to the advancement of United States global health security and diplomacy overseas, which may include-
"(A) the Department of State;
"(B) the United States Agency for International Development;
"(C) the Department of Health and Human Services;
"(D) the Department of Defense;
"(E) the Defense Threat Reduction Agency;
"(F) the Millennium Challenge Corporation;
"(G) the Development Finance Corporation;
"(H) the Peace Corps; and
"(I) any other department or agency that the President determines to be relevant for these purposes.
"(12) The term 'resilience' means the ability of people, households, communities, systems, institutions, countries, and regions to reduce, mitigate, withstand, adapt to, and quickly recover from shocks and stresses in a manner that reduces chronic vulnerability to the emergence, reemergence, and spread of pathogens of pandemic potential and facilitates inclusive growth.
"(13) The terms 'respond' and 'response' mean the actions taken to counter an infectious disease.
"(14) The term 'USAID' means the United States Agency for International Development.
"SEC. 5561. ENHANCING THE UNITED STATES' INTERNATIONAL RESPONSE TO PANDEMICS.
"(a)
"(1) strengthening vaccine readiness;
"(2) reducing vaccine hesitancy;
"(3) delivering and administering vaccines;
"(4) strengthening health systems and global supply chains as necessary for global health security and pandemic preparedness, prevention, and response;
"(5) supporting global health workforce planning, training, and management for pandemic preparedness, prevention, and response;
"(6) enhancing transparency, quality, and reliability of public health data;
"(7) increasing bidirectional testing, including screening for symptomatic and asymptomatic cases; and
"(8) building laboratory capacity.
"(b)
"(1)
"(2)
"(3)
"(c)
"(1)
"(2)
"SEC. 5562. INTERNATIONAL PANDEMIC PREVENTION AND PREPAREDNESS.
"(a)
"(1)
"(A) clearly articulate United States policy goals related to pandemic prevention, preparedness, and response, including through actions to strengthen diplomatic leadership and the effectiveness of United States foreign policy and international preparedness assistance for global health security through advancement of a One Health approach, the Global Health Security Agenda, the International Health Regulations (2005), and other relevant frameworks that contribute to pandemic prevention and preparedness;
"(B) establish specific and measurable goals, benchmarks, timetables, performance metrics, and monitoring and evaluation plans for United States foreign policy and assistance for global health security that promote learning and adaptation and reflect international best practices relating to global health security, transparency, and accountability;
"(C) establish transparent mechanisms to improve coordination and avoid duplication of effort between and among the relevant Federal departments and agencies, partner countries, donor countries, the private sector, multilateral organizations, and other key stakeholders;
"(D) prioritize working with partner countries with-
"(i) demonstrated need, as identified through the Joint External Evaluation process, the Global Health Security Index classification of health systems, national action plans for health security, Global Health Security Agenda, other risk-based assessments, and complementary or successor indicators of global health security and pandemic preparedness; and
"(ii) demonstrated commitment to transparency, including budget and global health data transparency, complying with the International Health Regulations (2005), investing in domestic health systems, and achieving measurable results;
"(E) reduce long-term reliance upon United States foreign assistance for global health security by-
"(i) ensuring that United States global health assistance authorized under this subtitle is strategically planned and coordinated in a manner that delivers immediate impact and contributes to enduring results, including through efforts to enhance community capacity and resilience to infectious disease threats and emergencies; and
"(ii) ensuring partner country ownership of global health security strategies, data, programs, and outcomes and improved domestic resource mobilization, co-financing, and appropriate national budget allocations for global health security and pandemic prevention, preparedness, and response;
"(F) assist partner countries in building the technical capacity of relevant ministries, systems, and networks to prepare, execute, monitor, and evaluate national action plans for global health security and pandemic prevention, preparedness, and response that are developed with input from key stakeholders, including mechanism to enhance budget and global health data transparency, as necessary and appropriate;
"(G) support and align United States foreign assistance authorized under this subtitle with such national action plans for health security and pandemic prevention, preparedness, and response, as appropriate;
"(H) facilitate communication and collaboration, as appropriate, among local stakeholders in support of country-led strategies and initiatives to better identify and prevent health impacts related to the emergence, reemergence, and spread of zoonoses;
"(I) support the long-term success of programs by building the pandemic preparedness capacity of local organizations and institutions in target countries and communities;
"(J) develop community resilience to infectious disease threats and emergencies;
"(K) support global health budget and workforce planning in partner countries, consistent with the purposes of this subtitle, including training in financial management and budget and global health data transparency;
"(L) strengthen linkages between complementary bilateral and multilateral foreign assistance programs, 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 development of more resilient health systems and global supply chains for global health security and pandemic prevention, preparedness, and response in partner countries with the capacity, resources, and personnel required to prevent, detect, and respond to infectious disease threats; and
"(M) support innovation and partnerships with the private sector, health organizations, civil society, nongovernmental, faith-based and indigenous organizations, and health research and academic institutions to improve pandemic prevention, preparedness, and response, including for the development and deployment of effective and accessible infectious disease tracking tools, diagnostics, therapeutics, and vaccines.
"(2)
"(A)
"(i) the appropriate congressional committees;
"(ii) the Committee on Health, Education, Labor, and Pensions of the Senate; and
"(iii) the Committee on Energy and Commerce of the House of Representatives.
"(B)
"(i) the anticipated contributions of the Federal department or agency, including technical, financial, and in-kind contributions, to implement the strategy; and
"(ii) the efforts of the Federal department or agency to ensure that the activities and programs carried out pursuant to the strategy are designed to achieve maximum impact and long-term sustainability.
"(3)
"(A)
"(B)
"(i) identify any substantial changes made to the strategy during the preceding calendar year;
"(ii) describe the progress made in implementing the strategy, including specific information related to the progress toward improving countries' ability to detect, prevent, and respond to infectious disease threats;
"(iii) identify-
"(I) the indicators used to establish benchmarks and measure results over time; and
"(II) the mechanisms for reporting such results in an open and transparent manner;
"(iv) contain a transparent, open, and detailed accounting of obligations by relevant Federal departments and agencies to implement the strategy, including, to the extent practicable, for each such Federal department and agency, the statutory source of obligated funds, the amounts obligated, implementing partners and sub-partners, targeted beneficiaries, and activities supported;
"(v) the efforts of the relevant Federal department or agency to ensure that the activities and programs carried out pursuant to the strategy are designed to achieve maximum impact and enduring results, including through specific activities to strengthen health systems for global health security and pandemic prevention, preparedness, and response, as appropriate;
"(vi) assess efforts to coordinate United States global health security programs, activities, and initiatives with key stakeholders;
"(vii) incorporate a plan for regularly reviewing and updating strategies, partnerships, and programs and sharing lessons learned with a wide range of stakeholders in an open, transparent manner; and
"(viii) describe the progress achieved and challenges concerning the United States Government's ability to advance the Global Health Security Agenda and pandemic preparedness, including data disaggregated by priority country using indicators that are consistent on a year-to-year basis and recommendations to resolve, mitigate, or otherwise address the challenges identified through such indicators.
"(C)
"(b)
"(1) have significant background and expertise in public health, health security, and emergency response management;
"(2) coordinate, through a whole-of-government approach, the efforts of relevant Federal departments and agencies to implement the strategy under subsection (a); and
"(3) seek to fully use the unique capabilities of each relevant Federal department and agency and ensure effective and appropriate United States representation at relevant international forums, while collaborating with and leveraging the contributions of other key stakeholders.
"(c)
"(1)
"(2)
"(A) shall be appointed by the President, by and with the advice and consent of the Senate;
"(B) shall report to the Secretary of State; and
"(C) shall have-
"(i) demonstrated knowledge and experience in the field of health security, development, public health, epidemiology, or medicine; and
"(ii) relevant diplomatic, policy, and political expertise.
"(3)
"(A) operate internationally to carry out the purposes of this section;
"(B) ensure effective coordination, management, and oversight of United States foreign policy, diplomatic efforts, and foreign assistance funded with amounts authorized to be appropriated pursuant to section 5564(a) that are used by the Department of State to advance the relevant elements of the United States global health security and diplomacy strategy developed pursuant to subsection (a) by-
"(i) developing and updating, as appropriate, in collaboration with the Administrator of the USAID and the Secretary of Health and Human Services, related policy guidance and unified auditing, monitoring, and evaluation plans;
"(ii) avoiding duplication of effort and collaborating with other relevant Federal departments and agencies;
"(iii) leading, in collaboration with the Secretary of Health and Human Services, the Administrator of the USAID, and other relevant Federal departments and agencies, diplomatic efforts to identify and address current and emerging threats to global health security;
"(iv) working to enhance coordination with, and transparency among, the governments of partner countries and key stakeholders, including the private sector;
"(v) promoting greater donor and national investment in partner countries to build health systems and supply chains for global health security and pandemic prevention and preparedness;
"(vi) securing bilateral and multilateral financing commitments to advance the Global Health Security Agenda, in coordination with relevant Federal departments and agencies, including through funding for the Financial Intermediary Fund for Pandemic Prevention, Preparedness, and Response; and
"(vii) providing regular updates to the appropriate congressional committees, the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives regarding the fulfillment of the activities described in this paragraph;
"(C) ensure, in collaboration with the Secretary of the Treasury, the Secretary of Health and Human Services, and the Administrator of the USAID, effective representation of the United States in the Financial Intermediary Fund for Pandemic Prevention, Preparedness, and Response;
"(D) use detailees, on a reimbursable or nonreimbursable basis, from relevant Federal departments and agencies and hire personal service contractors, who may operate domestically and internationally, to ensure that the Ambassador-At-Large has access to the highest quality experts available to the United States Government to carry out the functions under this subtitle; and
"(E) perform such other functions as the Secretary of State may assign.
"(d)
"(1)
"(2)
"(e)
"(1)
"(2)
"(f)
"(1)
"(2)
"(3)
"(A) to collect and share de-identified public health data, assess risk, and operationalize early warning;
"(B) to secure, including through utilization of stand-by arrangements and emergency funding mechanisms, the staff, systems, and resources necessary to execute cross-sectoral emergency operations during the 48-hour period immediately following an infectious disease outbreak with pandemic potential; and
"(C) to organize and conduct emergency simulations.
"SEC. 5563. FINANCIAL INTERMEDIARY FUND FOR PANDEMIC PREVENTION, PREPAREDNESS, AND RESPONSE.
"(a)
"(1)
"(2)
"(A) closing critical gaps in pandemic prevention and preparedness; and
"(B) working with, and building the capacity of, eligible partner countries in the areas of global health security, infectious disease control, and pandemic prevention and preparedness in order to-
"(i) prioritize capacity building and financing availability in eligible partner countries;
"(ii) incentivize countries to prioritize the use of domestic resources for global health security and pandemic prevention and preparedness;
"(iii) leverage governmental, nongovernmental, and private sector investments;
"(iv) regularly respond to and evaluate progress based on clear metrics and benchmarks, such as those developed through the IHR (2005) Monitoring and Evaluation Framework and the Global Health Security Index;
"(v) align with and complement ongoing bilateral and multilateral efforts and financing, including through the World Bank, the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the Coalition for Epidemic Preparedness and Innovation, and Gavi, the Vaccine Alliance; and
"(vi) help countries accelerate and achieve compliance with the International Health Regulations (2005) and fulfill the Global Health Security Agenda 2024 Framework not later than 8 years after the date on which the Fund is established, in coordination with the ongoing Joint External Evaluation national action planning process.
"(3)
"(A)
"(i) function as a partnership with, and through full engagement by, donor governments, eligible partner countries, and independent civil society; and
"(ii) be composed of not more than 25 representatives of governments, foundations, academic institutions, independent civil society, indigenous people, vulnerable communities, frontline health workers, and the private sector with demonstrated commitment to carrying out the purposes of the Fund and upholding transparency and accountability requirements.
"(B)
"(i) be charged with approving strategies, operations, and grant making authorities such that it is able to conduct effective fiduciary, monitoring, and evaluation efforts, and other oversight functions;
"(ii) determine operational procedures to enable the Fund to effectively fulfill its mission;
"(iii) provide oversight and accountability for the Fund in collaboration with a qualified and independent Inspector General;
"(iv) develop and utilize a mechanism to obtain formal input from eligible partner countries, independent civil society, and implementing entities relative to program design, review, and implementation and associated lessons learned; and
"(v) coordinate and align with other multilateral financing and technical assistance activities, and with the activities of the United States and other nations leading pandemic prevention, preparedness, and response activities in partner countries, as appropriate.
"(C)
"(i) representatives of the governments of founding member countries who, in addition to meeting the requirements under subparagraph (A), qualify based upon-
"(I) meeting an established initial contribution threshold, which should be not less than 10 percent of the country's total initial contributions; and
"(II) demonstrating a commitment to supporting the International Health Regulations (2005);
"(ii) a geographically diverse group of members from donor countries, academic institutions, independent civil society, including faith-based and indigenous organizations, and the private sector who are selected on the basis of their experience and commitment to innovation, best practices, and the advancement of global health security objectives; and
"(iii) representatives of the World Health Organization, to serve in an observer status.
"(D)
"(E)
"(F)
"(G)
"(i) engage in a consistent pattern of human rights abuses;
"(ii) fail to uphold global health data transparency requirements; or
"(iii) otherwise violate the established standards of the Fund, including in relation to corruption.
"(b)
"(1)
"(2)
"(A)
"(B)
"(3)
"(A) upon the enactment of appropriate implementing legislation that provides for the approval of the specific agreement or agreements, including attachments, annexes, and supporting documentation, as appropriate; or
"(B) if concluded and submitted as a treaty, upon the approval by the Senate of the resolution of ratification of such treaty.
"(c)
"(d)
"(1) low scores on the Global Health Security Index classification of health systems;
"(2) measurable gaps in global health security and pandemic prevention and preparedness identified under the IHR (2005) Monitoring and Evaluation Framework and national action plans for health security;
"(3) demonstrated political and financial commitment to pandemic prevention and preparedness; and
"(4) demonstrated commitment to-
"(A) upholding global health budget and data transparency and accountability standards;
"(B) complying with the International Health Regulations (2005);
"(C) investing in domestic health systems; and
"(D) achieving measurable results.
"(e)
"(1) take such actions as may be necessary to ensure that the Fund will have in effect adequate procedures and standards to account for and monitor the use of funds contributed to the Fund, including the cost of administering the Fund, by-
"(A) engaging Fund stakeholders; and
"(B) actively promoting transparency and accountability of Fund governance and operations;
"(2) seek to ensure there is agreement to put in place a conflict of interest policy to ensure fairness and a high standard of ethical conduct in the Fund's decision-making processes, including proactive procedures to screen staff for conflicts of interest and measures to address any conflicts, such as-
"(A) potential divestments of interests;
"(B) prohibition from engaging in certain activities;
"(C) recusal from certain decision-making and administrative processes; and
"(D) representation by an alternate board member; and
"(3) seek agreement on the criteria that should be used to determine the programs and activities that should be assisted by the Fund.
"(f)
"(1) eligible partner country selection criteria, including transparent metrics to measure and assess global health security and pandemic prevention and preparedness strengths and vulnerabilities in countries seeking assistance;
"(2) minimum standards for ensuring eligible partner country ownership and commitment to long-term results, including requirements for domestic budgeting, resource mobilization, and co-investment;
"(3) criteria for the selection of projects to receive support from the Fund;
"(4) standards and criteria regarding qualifications of recipients of such support; and
"(5) such rules and procedures as may be necessary-
"(A) for cost-effective management of the Fund; and
"(B) to ensure transparency and accountability in the grant-making process.
"(g)
"(1)
"(A) is fully enabled to operate independently and transparently;
"(B) is supported by and with the requisite resources and capacity to regularly conduct and publish, on a publicly accessible website, rigorous financial, programmatic, and reporting audits and investigations of the Fund and its grantees, including subgrantees; and
"(C) establishes an investigative unit that-
"(i) develops an oversight mechanism to ensure that grant funds are not diverted to illicit or corrupt purposes or activities; and
"(ii) submits an annual report to the Governing Board describing its activities, investigations, and results.
"(2)
"(A) corruption within global health programs contribute directly to the loss of human life and cannot be tolerated; and
"(B) in making financial recoveries relating to a corrupt act or criminal conduct committed by a grant recipient, as determined by the Inspector General described in paragraph (1), the responsible grant recipient should be assessed at a recovery rate of up to 150 percent of such loss.
"(3)
"(A) the administrative and management costs of the Fund on a quarterly basis; and
"(B) the amount of funds disbursed to each grant recipient and subrecipient during each grant's fiscal cycle.
"(4)
"(h)
"(1)
"(A)
"(B)
"(i) the goals of the Fund;
"(ii) the programs, projects, and activities supported by the Fund;
"(iii) private and governmental contributions to the Fund; and
"(iv) the criteria utilized to determine the programs and activities that should be assisted by the Fund, including baselines, targets, desired outcomes, measurable goals, and extent to which those goals are being achieved.
"(2)
"(A) the effectiveness of the programs, projects, and activities supported by the Fund; and
"(B) an assessment of the merits of continued United States participation in the Fund.
"(i)
"(1)
"(2)
"(A) the amount of the proposed contribution;
"(B) the total of funds contributed by other donors; and
"(C) the national interests served by United States participation in the Fund.
"(3)
"(4)
"(A)
"(B)
"(C)
"SEC. 5564. GENERAL PROVISIONS.
"(a)
"(1)
"(2)
"(b)
"SEC. 5565. SUNSET.
"This subtitle shall cease to be effective on September 30, 2027.
"SEC. 5566. RULE OF CONSTRUCTION.
"Nothing in this subtitle may be construed to impair or otherwise affect the authorities granted to the Administrator of the USAID, the Secretary of Health and Human Services, or the head of any other Federal department or agency under any applicable law."
Findings
"(1) Since the development of antibiotics in the 1950s, tuberculosis has been largely controlled in the United States and the Western World.
"(2) Due to societal factors, including growing urban decay, inadequate health care systems, persistent poverty, overcrowding, and malnutrition, as well as medical factors, including the HIV/AIDS epidemic and the emergence of multi-drug resistant strains of tuberculosis, tuberculosis has again become a leading and growing cause of adult deaths in the developing world.
"(3) According to the World Health Organization-
"(A) in 1998, about 1,860,000 people worldwide died of tuberculosis-related illnesses;
"(B) one-third of the world's total population is infected with tuberculosis; and
"(C) tuberculosis is the world's leading killer of women between 15 and 44 years old and is a leading cause of children becoming orphans.
"(4) Because of the ease of transmission of tuberculosis, its international persistence and growth pose a direct public health threat to those nations that had previously largely controlled the disease. This is complicated in the United States by the growth of the homeless population, the rate of incarceration, international travel, immigration, and HIV/AIDS.
"(5) With nearly 40 percent of the tuberculosis cases in the United States attributable to foreign-born persons, tuberculosis will never be controlled in the United States until it is controlled abroad.
"(6) The means exist to control tuberculosis through screening, diagnosis, treatment, patient compliance, monitoring, and ongoing review of outcomes.
"(7) Efforts to control tuberculosis are complicated by several barriers, including-
"(A) the labor intensive and lengthy process involved in screening, detecting, and treating the disease;
"(B) a lack of funding, trained personnel, and medicine in virtually every nation with a high rate of the disease;
"(C) the unique circumstances in each country, which requires the development and implementation of country-specific programs; and
"(D) the risk of having a bad tuberculosis program, which is worse than having no tuberculosis program because it would significantly increase the risk of the development of more widespread drug-resistant strains of the disease.
"(8) Eliminating the barriers to the international control of tuberculosis through a well-structured, comprehensive, and coordinated worldwide effort would be a significant step in dealing with the increasing public health problem posed by the disease."
Progress Report on Implementation of Immunization and Oral Rehydration Promotion Programs
Executive Documents
Delegation of Functions
For delegation of functions of President under this section, see Ex. Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a note under section 2381 of this title.