[Presidential Decision Directives - PDD]

Background

The National Science and Technology Council (NSTC) has determined that the national and International system of infectious disease surveillance, prevention, and response is inadequate to protect the health of U.S. citizens. The NSTC reports, "Infectious Disease -- A Global Health Threat" (September 1995), "Meeting the Challenge -- A Research Agenda for Health, Safety, and Food" (February 1996), and "Proceedings of the Conference on Human Health and Global Climate Change" (May 1996), make a number of recommendations to improve our surveillance, prevention, and response capabilities which are reflected in this policy.

Policy Goals

1. Strengthen the domestic infectious disease surveillance and response system, both at the Federal, State, and local levels and at ports of entry into the United States, in cooperation with the private sector and with public health and medical communities.

2. Establish a global infectious disease surveillance and response system, based on regional hubs and linked by modern communications.

3. Strengthen research activities to improve diagnostics, treatment, and prevention, and to improve the understanding of the biology of infectious disease agents.

4. Ensure the availability of the drugs, vaccines, and diagnostic tests needed to combat infectious diseases and infectious disease emergencies through public and private sector cooperation.

5. Expand missions and establish the authority of relevant United States Government agencies to contribute to a worldwide infectious disease surveillance, prevention, and response network.

6. Promote public awareness of emerging infectious diseases through cooperation with nongovernmental organizations and the private sector.

U.S. Government Roles and Responsibilities

1. Enhance the surveillance and response components of our domestic and international public health infrastructure.
   • Strengthen Federal and State laboratory and epidemiological response capabilities. The Centers for Disease Control and Prevention (CDC) will coordinate Federal government efforts to strengthen Federal, State and local health departments surveillance and response capabilities.

   • Strengthen research, training, and technology development for establishing new and more effective interventions to combat emerging infectious diseases.

   • The Federal government, in cooperation with State and local governments, international organizations, the private sector, and public health, medical and veterinary communities, will establish a national and international electronic network for surveillance and response regarding emerging infectious diseases.

2. Enhance biomedical and behavioral research efforts on emerging infectious diseases.
   • The National Institutes of Health (NIH) will lead Federal government efforts to strengthen research on the development of new tools to detect and control emerging infectious diseases and on the biology and pathology of infectious agents, with particular emphasis on antimicrobial drug resistance. Research will include the development of new mechanisms for the control and prevention of zoonotic infectious agents, which are derived from domesticated and wild animals, and the health effects of climate change.

   • Federal agencies will coordinate with the private sector, as appropriate, including representatives of the pharmaceutical industry and the academic, medical, and public health communities.

3. Expand formal training for health care providers.
   • Senior United States Government officials will work with health care provider, health research organizations, and professional organizations to urge that emerging infectious diseases be given greater emphasis in fellowship programs and on certifying and re-certifying examinations.

   • NIH will work with appropriate medical college and public health school associations, urging them to advise their member institutions to expand training in emerging infectious diseases and antimicrobial drug resistance in student curricula.

4. Review and update regulations, procedures, and resources for screening and quarantine at ports of entry into the United States.
   • CDC will lead an interagency group to review and update current screening and quarantine regulations, procedures, and resources aimed at minimizing the threats disease outbreaks can pose to national health and security. Issues considered should include early warning systems abroad, stricter controls at ports of entry, and improved surveillance after persons, animals, or material have entered the United States.

   • The National Security Council (NSC) will ensure that any recommendations support counterterrorism measures.

5. Make information about ill international travelers with communicable diseases more accessible to domestic Health authorities.
   • CDC will be the lead agency in the development of cooperative arrangements with the transportation industry to provide needed information when follow-up of passengers with communicable diseases arriving at United States ports of entry is required.

6. Encourage other nations and international organizations to assign higher priority to emerging infectious diseases.
   • The Department of State and Office of Science and Technology Policy (OSTP), in consultation with other agencies, will develop and coordinate a sustained effort to enlist support from other nations and international bodies. State will raise the issue of emerging infectious diseases in bilateral, regional, and multilateral discussions and will negotiate cooperative agreements with other nations to promote the establishment of a global surveillance and response network.

7. Support the World Health Organization (WHO) and other bodies in playing a stronger role in the surveillance, prevention, and response to emerging infectious diseases.
   • The United States will participate in the WHO-proposed revision of the International Health Regulations to ensure improved screening and quarantine capabilities.

   • The United States will urge the WHO to develop regional inventories of resources for combating emerging infectious diseases and will explore joint steps to strengthen surveillance and response capabilities of WHO and other international organizations, as appropriate.

8. Expand United States agency missions and mandates in order to ensure that responsible agencies are provided with the authority, emergency procurement powers, and resources to respond to worldwide disease outbreaks that have the potential to adversely affect the United States.
   • CDC's mandate to protect the Health of United States citizens will be more clearly stated to allow conduct of surveillance and response activities, including outbreak investigations and selected responses to epidemics overseas. In disaster relief operations involving infectious diseases, CDC will operate as part of the United States effort, as appropriate.

   • The U.S. Agency for International Development (USAID) will continue to address the root causes of emerging diseases through its ongoing portfolio of assistance to developing countries.

   • The mission of the Department of Defense (DoD) will be expanded to include support of global surveillance, training, research, and response to emerging infectious disease threats. DoD will strengthen its global disease reduction efforts through: centralized coordination; improved preventive health programs and epidemiological capabilities; and enhanced involvement with military treatment facilities and United States and overseas laboratories.

     DoD will ensure the availability of diagnostic capabilities at its three domestic and six overseas laboratories. DoD will make available its overseas laboratory facilities, as appropriate, to serve as focal points for the training of foreign technicians and epidemiologists.

Coordination by a Standing Task Force

The Task Force will be co-chaired by the Centers for Disease Control and Prevention and the White House Office of Science and Technology Policy. The Task Force will seek the views of the private sector and health service providers in implementing this initiative.

Reporting Requirements

WASHINGTON -- Calling emerging infectious diseases a growing global health threat, Vice President Gore today (6/12) announced President Clinton's new policy to establish a worldwide infectious disease surveillance and response system, and expand certain federal agency mandates to better protect American citizens.

"Emerging infectious diseases present one of the most significant health and security challenges facing the global community," Vice President Gore said during remarks to the annual meeting of the National Council for International Health in Crystal City, Virginia. "Through President Clinton's leadership, we now have the first national policy to deal with this serious international problem.

"We are committed to ensuring that American citizens have the best protection possible from emerging infectious diseases, and that means a coordinated, comprehensive approach at both the national and international levels," Vice President Gore said.

In the United States, the death rate from infectious diseases, excluding HIV/AIDS, rose by 22 percent between 1980 and 1992. Contributing factors include climate change, increased movements of people and goods, and the deterioration of public health infrastructures. Since most cities in the United States are within a 36-hour commercial flight of any area of the world -- less time than the incubation period of many infectious diseases -- addressing the problem of emerging infectious diseases requires a global strategy.

Specifically, the presidential policy announced by Vice President Gore today (6/12) calls for improved domestic and international surveillance, prevention and response measures to emerging infectious diseases.

For example, the policy directs the United States government to work with other nations and international organizations to establish a global infectious disease surveillance and response system, based on regional hubs and linked by modern communications technologies. It also expands designated federal agency missions and it mandates in order to ensure that they have tile authority, emergency procurement powers and resources to respond to worldwide disease outbreaks that have the potential to impact the United States.

In addition, the policy calls for strengthening research activities to improve diagnosis, treatment and prevention of emerging infectious diseases; ensuring the availability of the drugs, vaccines, and diagnostic tests needed to combat emerging infectious diseases; and promoting public awareness of emerging infectious diseases through cooperation with nongovernment organizations and the private sector. The policy establishes a standing Task Force of the National Science and Technology Council (NSTC) to provide strategic planning and further coordination on issues of emerging infectious diseases.

"The Clinton Administration has made the war against emerging infectious diseases a priority," said Health and Human Services Secretary Donna E. Shalala who joined the Vice President at today's announcement.- "These diseases know no boundaries, and our international pursuit of them must know no end."

Dr. John H. Gibbons, President Clinton's Science and Technology Advisor, said, "This is yet another instance where we must pull together our full range of capabilities -- research, the global information infrastructure, international engagement -- to meet the challenge to the security and health of our society."