Mr. President, I rise to offer a Sense of the Senate resolution that the Senate supports improving American defenses against the spread of infectious diseases from abroad. The United States and other nations have a serious global problem in confronting the natural outbreak or deliberate spread of infectious diseases. The Central Intelligence Agency's January 2000 National Intelligence Estimate (NIE), The Global Infectious Disease Threat and Its Implications for the United States found that infectious diseases are a leading cause of death worldwide and that "New and reemerging infectious diseases will pose a rising global health threat and will complicate U.S. and global security over the next 20 years."
I have been concerned about the bioterrorist threat to this country for some time. In 2001, as chairman of the Senate Governmental Affairs Subcommittee on International Security, Proliferation, and Federal Services, I chaired hearings that addressed the nation's preparedness to respond to a bioterrorist attack. Sadly, the SARS outbreak demonstrated that naturally occurring diseases can be spread extraordinarily quickly through international air travel. This raises questions over our nation's ability to counter a bioterrorist attack and protect our public health in general. Preparations that organize our health care network against a naturally occurring disease outbreak can also help guard Americans against a bioterrorist attack. Our first line of defense must be pushed beyond the borders of the United States to countries overseas. We should help stop the spread of a disease at its source before tens or hundreds of air-travelers inadvertently spread it around the globe.
The World Health Organization (WHO) World Health Report 2002 estimates that infectious diseases accounted for more than 11 million deaths in 2001. Most of these infectious disease deaths occurred in the developing world, where they imposed a terrible burden on societies whose public health systems were already stretched beyond their limits. Infectious diseases, however, pose a threat to people in all parts of the world. Diseases easily spread beyond national borders.
The NIE noted that many infectious diseases come from outside U.S. borders and are introduced by international travelers, immigrants, returning U.S. military personnel, or imported animals or foodstuffs. The report states the increase in international air travel and trade will "dramatically increase the prospects," that infectious diseases will "spread quickly around the globe, often in less time than the incubation period of most diseases."
Diseases that originated overseas, such as HIV/AIDS, have had a serious impact on the health and welfare of U.S. population. For example, according to the Centers for Disease Control and Prevention (CDC), since the beginning of the HIV/AIDS epidemic, there have been almost 450,000 deaths. There are an estimated 800,000 to 900,000 people currently living with human immunodeficiency virus in the United States with approximately 40,000 new human immunodeficiency virus infections occurring in the U.S. every year. SARS and the West Nile virus have also had an impact in the United States.
The danger of an outbreak of a deadly disease overseas affecting the United States is increasing. The NIE found that war, natural disasters, economic collapse, and human complacency around the world are causing a breakdown in health care delivery and helping the emergence or reemergence of infectious diseases. To be forewarned is to be forearmed. The early warning of a disease outbreak is key to its identification; the quick application of countermeasures; and the development of cures. The General Accounting Office (GAO) noted in its August 2001 report, Global Health: Challenges in Improving Infectious Disease Surveillance Systems, that "disease surveillance provides national and international public health authorities with information they need to plan and manage to control these diseases."
The next disease to strike the United States, like SARS, may be an unrecognized pathogen. As of July 2003, the SARS virus has sickened more than 8,000 people, including over 35 in the United States. The disease has killed more than 800 since the outbreak began in southern China, and has had severe economic repercussions in the countries beset by the outbreak. Although the disease appears to be under control for the moment, many fear there will be resurgence of SARS in the fall when the general flu and cold season begins.
We have to do a better job next time, and by helping others we will help ourselves to do so. We need to strengthen our ability to detect foreign diseases before they cross our borders. The CDC has played a significant role in foreign disease surveillance for many years. Its Field Epidemiology Training Programs is an important program that strengthens global disease surveillance by training foreign specialists in modern epidemiology. FETPs have existed for almost 20 years and involve working with ministries of health around the world and the World Health Organization. Currently FETPs are in 30 countries throughout the world, supporting disease detection efforts and providing an essential link in global surveillance.
The work of the FETPs is critical to establishing a first line of defense overseas to protect the health of local populations and of American citizens from the spread of deadly infectious diseases. This work is more timely and necessary than ever. As Dr. James Hughes, Director of the National Center for Infectious Diseases at the CDC told the Governmental Affairs Committee's Permanent Subcommittee on Investigations on July 30th, the lessons learned from the SARS outbreak show, "The SARS experience reinforces the importance of global surveillance," as well as having prompt reporting and a strong laboratory capability.
We need to ensure that the CDC work in this area, which is at times heroic, is given the funding it requires. We also need to keep this question prominently on our national agenda. We need attention focused on infectious diseases on an annual basis. We need to understand better the political and economic implications of the spread of infectious diseases for foreign countries and the United States, and we need to know what are likely future trends depending on the level of intervention to address this problem. I suggest that a NIE on infectious diseases should be produced each year so that we have a comprehensive analysis of worldwide infectious disease and health developments.
The G-8 group of leading industrialized nations is playing a role on global health issues. At the 2003 Evian summit, the G-8 made a commitment to fight against the so-called big three diseases of AIDS, tuberculosis, and malaria. But the G-8 recognized the spread of SARS demonstrated "the importance of global collaboration, including global disease surveillance." These words need to be backed by vigorous, coordinated actions. I urge the President to work with the G-8 to create regional FETP programs so that every part of the world can be covered by a strong public health disease surveillance system.
Moreover, we should support the World Health Organization, whose work provides a critical underpinning to the efforts of the global public health community. The World Health Organization's regular budget has been more or less flat since the mid-1990s in nominal terms, around $420 million a year. In real terms, some estimate this means it has been reduced by 25 percent or more. WHO receives additional extra budgetary funding of several hundred million dollars a year. But most of this is project specific and does not directly support the basic public health activities of WHO and is not a substitute for funding core WHO activities. WHO global surveillance activities have been built with very modest extra budgetary contributions on top of a modest amount of core resources. But WHO's global disease surveillance work is underfunded and is being conducted in an overall context of declining real WHO core funding.
The rapid and easy transport of diseases to and throughout the United States underscores that Americans are now part of a global public health system. I have been impressed by the commendable effort that the Bill and Melinda Gates Foundation has made to improve health in the developing world. The foundation has spent over $3 billion for this goal. Such visionary leadership should not only exist in the world of philanthropy. This country should take a stronger lead in improving public health and disease surveillance systems overseas.
