S3678DEC8

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Week Ending December 8, 2006

S.3678 A bill to amend the Public Health Service Act with respect to public health security and all-hazards preparedness and response, and for other purposes.

Congress passed the Public Health Security and Bio-terrorism Preparedness and Response Act in 2002 but a 2005 study showed that local public health agencies are still unprepared to handle large infectious disease outbreaks. A GAO study uncovered that few states can evaluate, diagnose and treat 500 or more patients in a single incident.

Homeland Security reports that 68% of states do not feel fully confident with inadequate disaster plans ability to manage a catastrophic event. Further study showed that 48 percent of epidemiologists have no academic degree in epidemiology and 45 percent are slated to retire in the next few years.

Data on the risk level reveals that the potential number of victims who would need to be hospitalized is 5 to 10 million but the US on has 970,000 staffed hospital beds and 100,000 ventilators with three quarters in use on any given day.

Title I concerns itself with preparedness, planning and leadership is an emergency. The Secretary of Health and Human Services is required to lead all federal public health and medical response to public health emergencies. Those responsibilities would be delegated to an Assistant Secretary for Preparedness and response who would be the advisor to the Secretary and would oversee research, development, production and procurement of countermeasures and pandemic and epidemic products to maintain the Strategic National Stockpile. The Assistant would provide logistical support for federal preparedness and responses.

Payment to vendors providing medicine could be paid for the products after a sufficient amount-determined by the Secretary-is delivered unless partial payments are agreed to. No more than ten percent of the contract fee can be paid in advance of delivery and a provision must require return of that money if the product is not delivered. Five percent payment for achieving milestones is authorized up to 50 percent of the total contract and if the milestones are met then five percent of the advance payment is waived.

Whatever company contracts with the US for the medicines, etcetera can have an exclusive supplier status during the life of the contract providing the vendor is able to satisfy the needs of the Government. Vendors, during the period of exclusivity, can assign its rights to another entity but only with the Secretary’s approval.

Vendors must provide domestic manufacturing capacity to ensure that additional production is available. Such a contract would provide a fee to the vendor for establishing and maintaining that capacity in excess of the initial requirement of the product and the cost of maintaining the domestic manufacturing facility is allowed as a direct cost in the contract with the US government.

Title II opens the door for state subdivisions or a consortium of states to receive funding but benchmarks for preparedness and objective standards for assessing the preparedness must come first. States must accept a uniform response plan to pandemic influenza and failure to meet the benchmarks will result in funds being withhold.

Grants for preparedness could come with matching fund requirements.

An interoperable network of data sharing systems is ordered to enhance early detection, rapid response and management of potentially catastrophic infectious disease outbreaks and other health emergencies. Grants to States for such networks are available as well as for the purchase of diagnostic medical equipment to analyze real-time clinical specimens for pathogens of bio-terrorism significance.

Individuals in the public health community and schooling programs would possibly qualify for a loan repayment program if they agree to complete their service on a State, local or tribal health department in areas where such personnel and services are short.

The National Science Advisory Board for Bio-security would advise and provide a core curriculum and training requirements for workers in maximum containment biological laboratories and evaluate the systems and facilities.

Title III considers begins to assess the Nation’s ability to handle a medical surge. At-risk individuals would get a special assessment of their needs.

The Secretary must establish a Medical Reserve Corps to provide a supply of volunteers in emergencies and must create another interoperable system to quickly verify a volunteer’s and professional’s qualifications, credentials and background. States are urged to waive licensing requirements of health professionals in an emergency. The Secretary must also develop a core health and medical response curricula and training program, 20 new officer positions in Epidemic Intelligence Service Program and center for excellence at accredited schools of public health.

Programs are expanded to improve hospital preparedness for such emergencies along with grants to improve surge capacity. Veterans hospitals would be trained and equipped to assist.

Sponsor: Senator Richard Burr (R-NC)

Vote: Passed Senate by Unanimous Consent December 5, 2006. Passed House by voice vote December 7, 2006. Clearing the way for the President.

Cost to the taxpayers: Security Preparedness $824 million-2007, Coordinate with DHS $10 million 2007-CBO estimate $3.1 billion through 2011.// Information technology $102 million in 2007, $414 through 2011.// Public Health Workforce enhancement-Estimated to $72 million through 2011.// Distribution of flu vaccines-No budget impact.// Medical Surge Capacity-$141 million through 2011.// Medical Reserve Corps-$53 million through 2011.// Health Professional Volunteers-$31 million through 2011.// Education and Training-$187 million through 2011; State and Regional Hospital Preparedness-$1.8 billion through 2011.// VA Medical Centers- $178 million through 2011

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MORE INFORMATION

VII. SECTION BY SECTION ANALYSIS AND COMMITTEE VIEWS

Section 1. Short title

Pandemic and All-Hazards Preparedness Act.

Section 101. Public health and medical preparedness and response functions of the Secretary of Health and Human Services

This section amends the PHSA and authorizes the Secretary of Health and Human Services to lead all federal public health and medical responses to public health emergencies, and incidents covered by the National Response Plan developed pursuant to the Homeland Security Act of 2002.

The Secretary of HHS shall establish interagency agreements with the Secretaries of Veterans Affairs, Transportation, Defense, and Homeland Security in which the Secretary of HHS shall assume operational control of emergency public health and medical response assets, as necessary, in the event of an emergency. These agreements will outline the operational roles and relationships of such federal agencies and will pre-designate assets that can be mobilized in support of HHS in response to a catastrophic event. Such agreements may also address the coordination of public health preparedness and response activities abroad through inclusion of the Secretaries of State, Agriculture, and Defense.

The committee intends for these provisions to clarify the roles and responsibilities of Federal officials during preparations for and responses to emergencies, whether deliberate, accidental, or natural. The lack of a durable incident command system, providing clear roles and responsibilities, was identified by the White House as a problem during the response to Hurricanes Katrina and Rita that hit the Gulf Coast in 2005 (Federal Response to Hurricane Katrina: Lessons Learned). Lessons learned from the last three Top Officials (TOPOFF) exercises also highlighted deficiencies in the Federal response to catastrophic deliberate attacks. Of principle concern is the ambiguity concerning the Federal public health and medical leadership role under the National Response Plan. With continued potential threats from an influenza pandemic and possible terrorist attacks using chemical, biological, radiological or nuclear agents, clarifying leadership roles and ensuring unified command and control during a public health emergency is vital. The need to clarify such roles led the committee to identify the Secretary of HHS as the lead Federal official for public health and medical preparedness and response, consistent with the National Response Plan.

Section 102. Assistant Secretary for Preparedness and Response

This section re-names the Assistant Secretary for Public Health Emergency Preparedness as the Assistant Secretary for Preparedness and Response and codifies this position under the Secretary of HHS. The President, with the advice and consent of the Senate, shall appoint an individual to serve in this position.

Using the approach utilized in the Goldwater-Nicholas Department of Defense Reorganization Act of 1986 (P.L. 99-433) to restructure the Department of Defense, this section consolidates public health and medical authorities, responsibilities and resources under the Assistant Secretary for Preparedness and Response (ASPR). It is the committee's view that aligning these functions under a single individual achieves unity of command and control under a clearly identified authority. The practical consequence of this approach is to consolidate existing Federal preparedness and medical response capabilities within HHS under the ASPR, including the National Disaster Medical System (NDMS) and its Disaster Medical Assistance Teams (DMATs), which are transferred from the Department of Homeland Security, the Strategic National Stockpile, the Cities Readiness Initiative, and the hospital preparedness and public health preparedness cooperative agreement programs. The ASPR may also assume other duties and authorities as deemed appropriate by the Secretary.

The committee intends that the Secretary may determine how best to administer the hospital preparedness and public health preparedness cooperative agreement programs, including by maintaining day to day program management at the Centers for Disease Control and Prevention and the Health Resources and Services Administration, while ensuring that necessary oversight, coordination, policy setting, and responsibility is maintained by the ASPR. In making any necessary transfers of personnel or assets, the Secretary shall ensure an orderly transition that minimizes duplication of effort and confusion at the state and local levels.

The Medical Reserve Corps and the Emergency System for Advance Registration of Volunteer Health Professionals, which are maintained at the state and local levels, shall be coordinated by the ASPR and integrated with other Federal response capabilities. The ASPR should also promote the use of the State Emergency Management Assistance Compact for sharing public health and medical mutual aid between states.

One of the duties of the ASPR is to augment the emergency medical services system through medical direction and integration. Emergency Medical Services operates at the intersection of health care, public health, and public safety and is therefore an integral part of the medical and public health infrastructure.

One of the additional duties of the ASPR is to provide leadership in international programs, initiatives, and policies that deal with public health and medical emergency preparedness and response.

Section 103. National health security strategy

The Committee finds that public health preparedness is an integral part of national security. As such, it requires a national strategy, continuous assessments and periodic reviews to evaluate trends and identify gaps. Therefore, this section requires that every 4 years the Secretary of HHS submit to Congress a comprehensive national health security strategy. Similar to the Quadrennial Defense Review conducted by the Department of Defense, this section requires the Secretary of HHS to evaluate future challenges to national public health security and outline a strategy and plan for public health and medical preparedness and response. This strategy should reflect an all-hazards approach to public heath emergency preparedness. The plan should identify requirements for the capabilities necessary to meet the preparedness goals included in this section, benchmarks and standards, timelines for accomplishing preparedness goals and a process for ensuring continuous improvements in preparedness. The strategy should also include a plan to collaborate with appropriate foreign governments and international public health organizations to enhance public health disease situational awareness capabilities.

The committee recognizes that all catastrophic natural disasters and acts of terrorism inflict psychological as well as physical harm to its victims. Accordingly, in laying the foundation for advancing the goals of public health security and medical preparedness, the committee underscores that such preparedness must address all aspects of health, including mental health. Importantly, the mental health consequences of disasters and attacks may be reduced by comprehensive response planning that addresses both risk communication and public preparedness to mitigate the short and long-term mental health impacts from such events. The reported bill anticipates that, just as mental health is essential to overall health, mental health must be an element of the National Health Security Strategy and all aspects of public health and medical preparedness and response activities for public health emergencies, and must be addressed comprehensively and in a fully coordinated manner at the Federal, state and local levels.

As is reflected in the public health security goals, the committee recognizes the importance of decontamination of medical assets and facilities.

A critical component of the strategy required in this section is creating a robust, trained public health workforce. HHS is required to assess the status of and remedies to correct near and long-term shortages in the public health workforce. Reportedly, 45 percent of the State government public health workforce is expected to retire in the next few years. Workforce shortages figure prominently in the determination of surge capacity. Recent surveys suggest that as many as 46 percent of local public health workers are unlikely to show up for work during an influenza pandemic (BMC Public Health, April 18, 2006). Current estimates indicate the human case fatality rate from H5N1 avian influenza virus is 20 times that of the 1918 pandemic influenza virus (World Health Organization, June 2006).

The committee recognizes that the importance of protecting health care workers and health care first responders from workplace exposures during a public health emergency is inextricably linked to accomplishing the strategy established in this section. Health care workers and health care first responders are on the frontline in a public health emergency. If they are not protected from workplace exposures to hazards, they will be unable to care for the rest of the population and medical surge capacity will collapse. They are particularly at risk in the event of a public health emergency, such as a pandemic influenza outbreak. In the SARS outbreak of 2003 that occurred in China, other countries in East Asia, and Canada, when appropriate protections for workers were not adequate, the consequence was a high rate of infection and death among the nurses treating SARS patients and the further spread of a disease. The committee has identified the development of plans as appropriate pre-disaster planning and preparedness activities to reduce the risk of workplace exposure during a public health emergency and the negative consequences of the 2003 SARS outbreak.

The committee recognizes that disasters place children, pregnant women, senior citizens and other individuals at risk for increased morbidity and mortality. It is not possible to entirely specify what constitutes individuals at-risk as it depends on the nature of the disaster, the degradation of local medical services and infrastructure and other factors including language, mobility and other potential disabilities. Children represent a special subset of individuals at-risk, however, as they comprise several distinct sub-groups such as neonates and toddlers that have unique physiological and pharmacological considerations. The committee notes and encourages HHS to promote appropriate pre-disaster planning and preparedness activities at the State and local level to address the medical and public health needs of at-risk individuals in local communities during a public health emergency.

Section 201. Improving state and local health security

This section reauthorizes through 2011 HHS cooperative agreements for states, political subdivisions or consortium of such entities to enhance public health security preparedness. New requirements are included that the committee intends will ensure fiscal accountability, progress measured through evidence-based benchmarks and objective standards as determined by the Secretary, and regular exercises. HHS is authorized to provide technical assistance to entities to assist in achieving preparedness goals. This section also establishes a new state matching requirement, beginning in 2009, to ensure a shared financial responsibility between Federal and State investments in public health preparedness and to ensure maintenance of state efforts.

While allowing states to apply for funding as part of a consortium, the committee does not intend this section to change any funding formulas or amounts to individual states. The committee intends to encourage regionalized funding opportunities and inter-state collaboration. A consortium would be eligible to receive the same amount of funding as each entity would have been eligible to receive on its own, unless the Secretary determines that a funding incentive is necessary to encourage states to develop regional approaches to preparedness that cross state boundaries.

The funds authorized in this section are primarily intended to assist states and localities in developing and sustaining the minimum essential public health security capabilities identified in section 103. However, this list should be interpreted broadly as the committee recognizes that there are a broad range of activities that will assist entities in achieving these capabilities.

States and localities are required to participate in regular drills and exercises and report back to HHS on the strengths and weaknesses identified in such exercises, and corrective measures taken to address such material weaknesses. HHS should evaluate and disseminate best practices and lessons learned through such activities. These best practices and lessons learned should undergo peer review and be disseminated and shared widely. This best practice effort should be closely coordinated and jointly disseminated with the Department of Homeland Security's Lessons Learned Information System (LLIS).

Additionally, the committee supports the research performed by the Agency for Healthcare Research and Quality with regard to best practices and standards of care during disasters. The committee also recommends the Secretary to support public health systems research that contributes to the development of evidence-based benchmarks and objective standards to measure public health preparedness.

The committee recognizes that no state is prepared unless every community in the state is prepared. This section therefore requires the Secretary to evaluate the emergency preparedness plans and exercises and compliance with benchmarks and standards by States and political subdivisions. This evaluation should distinguish between preparedness activities that have statewide impact and those that necessarily take place at the local level and that are in direct coordination with local emergency management plans, local first responders, and local hospitals, health care providers, schools, businesses, and others.

The committee recognizes that local health departments and other emergency medical first responders (regardless of their form of governance) will be the first responders to any public health emergency that affects the communities they serve. The committee requires the Secretary to establish procedures for ensuring funding of local entities, to provide assistance in instances where local consensus, approval or concurrence with entities' spending plans has not been achieved, and to inform all parties in advance about such procedures and assistance. The

committee intends that nothing in this section be interpreted to weaken existing HHS/CDC requirements for local consensus, approval or concurrence.

Section 202. Using information technology to improve situational awareness in public health emergencies

This section requires the Secretary of HHS to build on existing State and local public health situational awareness capabilities to establish a near real-time nationwide public health situational awareness capability to enhance early detection of, rapid response to, and management of potentially catastrophic infectious disease outbreaks and public health emergencies.

It is the committee's view that HHS should establish explicit goals and a coherent strategy for achieving adequate `situational awareness' relevant to public health emergencies before making additional major investments in related information technology systems. The strategy should include clear timelines and goals for building these systems at local, State, regional and national levels.

This strategy should adopt a network of systems architecture that allows entities such as Federal, State, tribal and local agencies, organizations that monitor zoonotic diseases, public and private sector health care entities, pharmacies, Poison Control Centers, clinical laboratories and others to share data and information. Each system will transmit a minimal set of key data to a national expert system that will compile and analyze the data and disseminate information to member systems on a near real-time basis. Data and analyses should be available to all participating members, except when prohibited by law. This architecture is intended to provide flexibility to the member systems and foster greater communication between local and State partners and between State and Federal agencies. To the extent appropriate and feasible, the committee expects the Secretary to work with other Departments within the Administration and work with foreign governments, international organizations, and private sector entities to facilitate the exchange of public health data or summaries of such data with the public health reporting networks of such governments, organizations, and entities.

In addition, it is essential that the Nation make it a priority to ensure that there are robust and redundant communication connections between health care providers--especially hospitals--and public health departments. These connections are essential to situational awareness and informed decisionmaking during public health emergencies.

The nationwide public health situational awareness capacity implemented by the Secretary should take into account public health data collection and reporting systems maintained by foreign governments, international organizations, and the private sector, to enhance early detection of public health threats abroad. The committee encourages the Secretary to continue to work with the World Health Organizations and other stakeholders to improve situational awareness of potentially catastrophic infectious diseases. This strategy should include an emphasis on States bordering Canada and Mexico, and would encourage cooperative work that improves and strengthens situational awareness capabilities in those areas.

An eligible entity that receives a grant under this subsection (f)(4)(A) is strongly recommended to use the funds awarded to purchase and implement the use of the most innovative and advanced automated rapid detection diagnostic medical laboratory equipment available to analyze real-time clinical specimens for pathogens of public health or bioterrorism significance.

Amounts made available to carry out subsection (f)(4)(B) should be used to supplement and not supplant other Federal, State or local funds provided for such center or professional organization.

Section 203. Public health workforce enhancements

This section builds on an existing demonstration project and grants to States through the National Health Service Corps. It authorizes a new demonstration project for loan repayments to individuals who agree to complete their service obligation in a state or local health department that serves a health professional shortage area or area at high risk of a public health emergency. The Secretary must report to Congress within 3 years regarding the impact of such demonstration project and the feasibility of permanently allowing such placements in the National Health Service Corps Loan Repayment Program. The committee expects that this report will provide initial useful data to be supplemented by additional information on the impact of such project. The section also authorizes competitive grants to States to fund State loan repayment programs for individuals who serve in a State or local health department in a health professional shortage area or other area at risk of a public health emergency, as determined by the Secretary.

The demonstration project and any health professionals who are selected to participate in such project should be placed so as to enhance local public health capabilities but not disrupt or limit community access to basic medical care.

Section 204. Vaccine tracking and distribution

With the United States having experienced multiple shortages of seasonal flu vaccine since 2000, the committee notes the interest in developing a system to track the distribution of vaccine supplies, especially as we face the threat of pandemic influenza. It is the goal of this section to promote communication so as to help maximize the delivery and availability of vaccines to patients, with a particular focus on high priority populations.

This section requires the Secretary to promote communication between state and local public health officials and such manufacturers, wholesalers and distributors as agree to participate regarding the effective distribution of seasonal influenza vaccine. The committee intends for this communication to be voluntary for manufacturers, distributors and wholesalers, and the committee encourages all relevant entities to participate in the communication. The language does not provide the Secretary with the authority to apply or enforce any sanctions or reward for participation on such entities that choose not to participate in this communication. The committee does intend for this communication to include estimates of high priority populations, as determined by the Secretary, in state and local jurisdictions in order to inform Federal, state and local decision makers during vaccine shortages and supply disruptions. It is the sense of the committee that in developing such estimates, the Secretary should work in conjunction with

State and local health departments and incorporate existing information available through Federal, State and local databases, and surveys to better guide the distribution of influenza vaccine.

The committee recognizes CDC's efforts since 2004 to work with State and local public health officials, provider groups, manufacturers, distributors and other stakeholders to improve seasonal flu vaccine communication and distribution through the Flu Vaccine Finder. The committee appreciates these efforts, and encourages CDC to continue to work with such entities to grow and expand these efforts as necessary. The committee encourages State, local and tribal public health officials to work through the CDC to obtain information relevant to the effective distribution of seasonal flu vaccine.

While a tracking system is one component of helping to develop a stable vaccine market, the committee recognizes that another important component is raising awareness of the importance of flu vaccines. The committee would like to highlight the CDC's efforts in this area, and emphasize that it is important for them to carry out such efforts in conjunction with State and local health departments, provider groups, mass vaccination clinics, health care institutions, and groups representing high priority populations.

Section 205. National Science Advisory Board for Biosecurity

This section authorizes the National Science Advisory Board for Biosecurity, at the request of the Secretary, to provide advice, guidance or recommendations to relevant Federal departments concerning evaluations of biosafety level 4 laboratory capacity nationwide and a core curriculum for workers in such laboratories. The committee recognizes that the CDC has a role in training workers for and providing oversight of these laboratories and expects the NSABB to collaborate with CDC when appropriate.

Section 301. National Disaster Medical System

This section transfers the National Disaster Medical System (NDMS) from the Department of Homeland Security to the Department of Health and Human Services. The committee believes that the best way to ensure a coordinated public health and medical response to emergencies is to have clear lines of authority and unity of command. Based on the White House report following Hurricane Katrina in 2005, which recommended transferring NDMS back to HHS, the committee authorizes such transfer effective January 1, 2007.

The Secretary of HHS, in coordination with the Secretaries of Homeland Security, Defense, and Veterans Affairs, shall conduct a joint review of NDMS that includes an evaluation of the roles and mission of NDMS in the future; the roles and responsibilities of the Departments of Homeland Security, Defense, and Veterans Affairs in support of NDMS; the appropriate organizational structure, size and number of teams, and methods for deploying teams; a plan for providing initial and ongoing logistical support, including appropriate cache inventory and deployment, and communications capabilities; Federal capabilities, including Federal facilities and mobile medical assets that are capable of being used during a public health emergency and pre-designating such capabilities and facilities; methods to integrate other medical response assets, including assets supported jointly by public and private funding, with such System; methods to increase health care facility participation and the capacity of the facilities involved; requirements to strengthen necessary medical evacuation capabilities; and other matters determined appropriate by such Secretaries.

Based on the joint review, the Secretary shall modify the policies of the National Disaster Medical System as the Secretary deems necessary, including with respect to command and coordination of overall operations, team deployments, and participating hospitals; enrolling, licensing, and credentialing of system participants; training, exercising, and continuing education of system participants; methods for providing logistical support; medical evacuation; and participating hospital requirements, benefits, and methods to increase hospital participation.

As the United States continues to re-evaluate its disaster preparedness, the needs of children in both bioterrorism attacks and natural disasters need to be addressed at all levels. In the wake of Hurricane Katrina, where the Nation was faced not only with large numbers of displaced and dehydrated children but also with the large scale evacuation of children's hospitals, the creation of a more robust pediatric specialty team response should be examined. The teams stationed in Boston and Atlanta are examples of how high quality pediatric care can be taken into the disaster field using Pediatric Specialty Teams (PST's). One example of a new program in formation is PST-Ohio. This group combines the talents of Ohio's network of 7 children's hospitals and offers a potential model of PST's across the Nation by combining the resources of several children's hospitals to form a team so that not one hospital in particular has to shoulder the burden of staffing changes during deployment, drawing of talent across many specialties, and allowing rapid deployment of a regional asset.

As the National Disaster Medical System is transferred to HHS, the committee encourages the development of pediatric specialty teams to help augment the current Disaster Medical Assistance Team (DMAT) infrastructure.

Building on the authority given to the Secretary in the Project Bioshield Act of 2004, this section also authorizes the Secretary to extend the waiver of the Emergency Medical Treatment and Active Labor Act in the case of a pandemic infectious disease that is declared a public health emergency under section 319 of the PHSA, for 60 days or such less time upon the termination of the applicable public health emergency declaration. The committee strongly supports modifying such waiver requirements to permit hospital emergency rooms to follow State pandemic plans during an outbreak of pandemic influenza, which may include separate triage facilities or vaccination sites. This approach will ensure patients receive the care they need during a pandemic.

This section also reauthorizes and expands the scope of the National Advisory Committee on Children and Terrorism (NACCT) to include at-risk individuals, including pregnant women, senior citizens, and other individuals who have special public health and medical needs during a public health emergency, as determined by the Secretary. The Advisory Committee was disbanded in 2003, following the release of recommendations to the Secretary. The committee encourages the Secretary to review and take into account the findings of the NACCT.

The intent of this expansion is not to deemphasize the issues faced by pediatric populations, but to revitalize our efforts in developing an all-hazards response capacity in which the public health and medical needs of children are effectively addressed. The committee notes that some of this work will entail cooperation with other Federal agencies, including the Department of Education, and believes that such coordination should be a priority for the Assistant Secretary for Preparedness and Response.

Section 302. Enhancing medical surge capacity

This section requires the Secretary of HHS to evaluate strategies to improve medical surge capacity, such as considering the acquisition and operation of mobile medical assets and utilization of Federal facilities, including former health care facilities from Federal departments and agencies. The committee encourages the Secretary to consider establishing memorandum of understanding with other Federal departments and agencies to permit such facilities to be used to augment local surge capacity in the event of a disaster. This section requires the Secretary to consider joint public and private sector funding of mobile medical assets that can be utilized by the Secretary to respond to public health emergencies.

Section 303. Encouraging health professional volunteers

This section codifies the existing local volunteer Medical Reserve Corps (MRC) and establishes a national infrastructure to utilize the deployment of willing health professional volunteers during a national public health emergency. This section is not intended to federalize state or local MRC teams. The section provides the national infrastructure so that willing MRC volunteers can be utilized to augment Federal medical responses to catastrophic emergencies. When activating or deploying MRC volunteers who are managed locally, the committee encourages the Secretary and local officials to also notify relevant State officials. The committee recommends that the Secretary use discretion in deploying members of the MRC who are already serving in areas designated as health professional shortage areas so as not to exacerbate the health professional need in the MRC members' areas of origin.

The MRC should utilize the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) to verify the credentials of MRC volunteers. In addition, MRC volunteers should have completed core training, as determined by the Secretary.

MRC volunteers, if designated by the Secretary as intermittent Federal response personnel and deployed during a public health emergency, would receive liability and disability protections, consistent with the National Disaster Medical System. The liability protection for volunteers of the MRC is intended to cover actions performed within the scope of their employment and will not cover actions taken outside the scope of their employment.

This section also builds on the existing ESAR-VHP by requiring the Secretary to link existing state-based verification systems into a single interoperable network of systems. Such verification network shall be used to quickly identify and utilize pre-registered health professional volunteers in an emergency. In order to protect the confidentiality of such health professional volunteers, the Secretary shall establish and require the application of and compliance with measures to ensure the effective security of, integrity of, and access to the data included in the network.

Section 304. Core education and training

This section requires the Secretary to refocus and consolidate current health professions curricula development and training programs funded by the Health Resources and Services Administration to establish core public health and medical response curricula and training. Such curricula and training shall establish minimum levels of expertise appropriate to the type of trainee. These courses could be tiered to include basic, advanced, and specialized levels of training. The training would be designed for those included in ESAR-VHP, or participating in MRC and DMAT.

The Secretary of HHS, in collaboration with the Secretary of Defense could convene expert panels to develop these curricula that would be aimed at training health care providers treating patients, including at risk individuals, who were victims of natural disasters or deliberate attacks involving chemical, biological, radiological and nuclear and explosive agents. In partnership with the Secretary of Veterans Affairs and other public and private entities, the Secretary of HHS should provide for the dissemination and teaching of these materials for health professional volunteers including physicians, nurses, pharmacists, emergency medical technicians, mental health providers, and allied and support personnel, including public health, law enforcement and fire fighters, who may provide basic first aid or pre-hospital medical care. Such dissemination could be implemented through classroom, field, or on line instruction and could emphasize a train-the-trainer approach to effectively train large numbers of volunteers. The committee recommends that the materials developed under this section be comprehensive and implementable. The core content included in such materials can be expanded to address particular local or regional all-hazards emergency preparedness training needs. To maximize the effectiveness of such materials, the committee finds that the content should be disseminated through training modalities such as distance learning and train the trainer approaches.

The committee affirms the need to ensure that mental health preparedness is a component of such training. It is the sense of the committee that the training provided through this section should improve the care for mental health consequences in the event of a public health emergency and ensure that health and mental health professionals, and volunteers are able to respond effectively to the psychological needs of affected individuals, relief personnel and communities. Such response may include identifying symptoms of mental health distress and referring affected persons, as needed, for mental health care.

The committee also affirms the need to include a focus on protecting health care workers and health care first responders from workplace exposures during public health emergencies as a component of this training.

This section also expands the CDC's Epidemic Intelligence Service Program by 20 officer positions for individuals who agree to practice in underserved areas.

This section also authorizes the existing Centers for Public Health Preparedness program, administered by the CDC. To be eligible for funding through this program, accredited schools of public health must agree to develop core public health curricula and training for use by such schools. Eligible schools of public health must also collaborate with a state or local health department to ensure that any materials and trainings being developed by such school meet the needs of such department and are not duplicative of existing materials and trainings. The committee finds that the field of public health is extremely diverse and individuals graduating from schools of public health have varying skills and knowledge. The committee intends for the schools of public health that are Centers for Public Health Preparedness to develop core preparedness curricula and training that reflect the essential public health security capabilities identified in section 103.

This section also authorizes the Secretary of HHS to establish a research agenda for public health preparedness and response systems in order to document outcomes and establish evidence-based public health benchmarks and standards. The committee finds that public health systems research is a priority because there has been tremendous financial investment made to date for public health preparedness with no evidence-based measures for evaluating progress or preparedness. Over time, this research will contribute sufficiently to the knowledge base to further develop benchmarks and standards. The schools of public health that are Centers for Public Health Preparedness shall conduct public health systems research that is consistent with the agenda established by the Secretary.

In developing metrics and evaluating best practices under this section, the committee encourages CDC to take into account the continued work of the CDC Advanced Practice Centers. CDC has funded eight local Advanced Practice Centers at local health departments to develop, test and evaluate cutting-edge preparedness tools for local health departments. The committee encourages the development of best practices by local health departments to aid other local health departments in achieving critical benchmarks. The committee notes that CDC now requires all grantees to measure progress in pandemic influenza preparedness by using an innovative computer model for mass vaccination clinic operations developed by one such Advanced Practice Center. The committee does not intend anything in this Act to preclude continued funding of the Advanced Practice Centers and encourages their continued collaboration with Centers for Public Health Preparedness.

Section 305. Partnerships for state and regional hospital preparedness to improve surge capacity

This section reauthorizes through 2011 cooperative agreements to enhance the capacity of hospitals and other health care facilities for responding to emergencies. The Secretary shall continue to distribute funds to states and political subdivisions through the existing funding formula. In order to encourage regional health care partnerships, the Secretary may also distribute funds to partnerships of hospitals and other health care facilities that partner with a State or political subdivision and apply for funds directly from HHS. The Secretary may not award a cooperative agreement to a partnership unless the application is coordinated with an applicable state emergency preparedness plan.

The Secretary shall give preferences to partnerships that include a significant percentage of the hospitals and health care facilities within the geographic area served by such partnership. The Committee encourages the Secretary to take into account partnerships that incorporate emergency medical services as well as other health care facilities. Preferences shall also be awarded for partnerships that include at least one hospital that is a participant in the NDMS, partnerships that are located in a geographic area that faces a high degree of risk as determined in consultation with the Department of Homeland Security, and partnerships that have a significant need for funds to achieve the medical preparedness goals identified in section 103. In order to ensure a more robust NDMS, the committee encourages all hospitals to participate in NDMS. The committee believes that it is important to ensure an appropriate consideration of risk in making awards under this section. Risk is challenging to quantify, but the committee suggests that the Secretary of HHS, in consultation with the Secretary of the Department of Homeland Security, develops an objective formula for risk based on a quantitative assessment. This section should not be interpreted as precluding regional coordination across international borders with Canada or Mexico.

The funds authorized in this section are intended to achieve the medical preparedness goals identified in section 103. However, this list should be interpreted broadly as the committee recognizes that there are a broad range of activities that will assist entities in achieving these goals. The committee approves of the limitation for state administrative expenses included in the recent grant guidance from the Health Resources and Services Administration.

At the Secretary's discretion, the funds authorized in this section may be used to fund regional training medical centers and to support activities and programs that will provide for a coordinated medical response to emergencies. Such centers would support dynamic, flexible plans that would enable health care providers to respond effectively to the rapidly changing situations that occur during a disaster.

Section 306. Enhancing the role of the Department of Veterans Affairs

This section authorizes the Department of Veterans Affairs (VA) to organize, train and equip its personnel and medical treatment facilities to support responses to public health emergencies consistent with the National Response Plan. It also authorizes the VA to provide medical logistical support on a reimbursable basis for federal disaster responses to public health emergencies. The committee intends for HHS to utilize the VA's existing extensive medical procurement system to minimize duplication of effort and reduce costs by avoiding the creation of a new separate HHS logistics system.

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