S.Amdt. 4644

SA 4644. Mr. RISCH (for himself and Mr. Menendez) submitted an
amendment intended to be proposed to amendment SA 3867 submitted by Mr.
Reed and intended to be proposed to the bill H.R. 4350, to authorize
appropriations for fiscal year 2022 for military activities of the
Department of Defense, for military construction, and for defense
activities of the Department of Energy, to prescribe military personnel
strengths for such fiscal year, and for other purposes; which was
ordered to lie on the table; as follows:

At the end of title XII, add the following:

Subtitle H--International Pandemic Preparedness and COVID-19 Response

SEC. 1291. SHORT TITLE.

This subtitle may be cited as the ``International Pandemic
Preparedness and COVID-19 Response Act of 2021''.

SEC. 1292. DEFINITIONS.

In this subtitle:
(1) Appropriate congressional committees.--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) Global health security agenda; ghsa.--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 to elevate global health security as a national-level
priority, to share best practices, and to facilitate national
capacity to comply with and adhere to--
(A) the International Health Regulations (2005);
(B) the World Organisation for Animal Health international
standards and guidelines;
(C) United Nations Security Council Resolution 1540 (2004);
(D) 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'');
(E) the Global Health Security Agenda 2024 Framework; and
(F) other relevant frameworks that contribute to global
health security.
(3) Global health security index .--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) Global health security initiative.--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) Joint external evaluation.--The term ``Joint External
Evaluation'' means the World Health Organization-facilitated,
voluntary, collaborative, multi-sectoral process to assess
country capacity to prevent, detect, and rapidly respond to
public health risks occurring naturally or due to deliberate
or accidental events, assess progress in achieving the
targets under the International Health Regulations (2005),
and recommend priority actions.
(6) Key stakeholders.--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;

[[Page S8164]]

(B) other bilateral donors;
(C) international, regional, and local organizations,
including private, voluntary, nongovernmental, and civil
society 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.
(7) One health approach.--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.
(8) Relevant federal departments and agencies.--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.
(9) Resilience.--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 stresses and shocks in a manner
that reduces chronic vulnerability to pandemic threats and
facilitates inclusive growth.
(10) USAID.--The term ``USAID'' means the United States
Agency for International Development.

SEC. 1293. PURPOSE.

The purpose of this subtitle is to accelerate and enhance
the United States international response to pandemics,
including the COVID-19 pandemic, and to operationalize
lessons learned from current and prior emergency responses in
a manner that--
(1) advances the global health security and diplomacy
objectives of the United States;
(2) improves coordination among the relevant Federal
departments and agencies implementing United States foreign
assistance for global health security; and
(3) more effectively enables partner countries to
strengthen and sustain resilient health systems and supply
chains with the resources, capacity, and personnel required
to prevent, prepare for, detect, and respond to infectious
disease threats before they become pandemics.

SEC. 1294. ENHANCING THE UNITED STATES' INTERNATIONAL
RESPONSE TO COVID-19 AND FUTURE PANDEMICS.

(a) Statement of Policy Regarding International Cooperation
to End the COVID-19 Pandemic.--It shall be the policy of the
United States to lead and implement a comprehensive and
coordinated international response to end the COVID-19
pandemic in a manner that recognizes the critical role that
multilateral and regional organizations can and should play
in pandemic response, including by--
(1) seeking adoption of a United Nations Security Council
resolution that--
(A) declares pandemics, including the COVID-19 pandemic, to
be a threat to international peace and security; and
(B) urges member states to address this threat by aligning
their health preparedness plans with international best
practices, including those established by the Global Health
Security Agenda, to improve country capacity to prevent,
detect, and respond to infectious disease threats;
(2) advancing efforts to reform the World Health
Organization so that it serves as an effective, normative,
and coordinating body that is capable of aligning member
countries around a strategic operating plan to detect,
contain, treat, and deter the further spread of COVID-19;
(3) providing timely, appropriate levels of financial
support to United Nations agencies responding to the COVID-19
pandemic;
(4) prioritizing United States foreign assistance for the
COVID-19 response in the most vulnerable countries and
regions;
(5) encouraging other donor governments to similarly
increase contributions to the United Nations agencies
responding to the COVID-19 pandemic in the world's poorest
and most vulnerable countries;
(6) working with key stakeholders to accelerate progress
toward meeting and exceeding, as practicable, global COVID-19
vaccination goals, whereby--
(A) at least 40 percent of the population in all countries
is vaccinated by the end of 2021; and
(B) at least 70 percent of the population in all countries
is vaccinated by the opening date of the 77th regular session
of the United Nations General Assembly;
(7) engaging with key overseas stakeholders, including
through multilateral facilities such as the COVID-19 Vaccines
Global Access initiative (referred to in this section as
``COVAX'') and the Access to COVID-19 Tools (ACT) Accelerator
initiative, and expanding bilateral efforts, including
through the International Development Finance Corporation, to
accelerate the development, manufacturing, production, and
efficient and equitable distribution of--
(A) vaccines and related raw materials to meet or exceed
the vaccination goals under paragraph (6); and
(B) global health commodities, including supplies to combat
COVID-19 and to help immediately disrupt the transmission of
SARS-CoV-2;
(8) supporting global COVID-19 vaccine distribution
strategies that strengthen underlying health systems and
ensure that people living in vulnerable and marginalized
communities, including women, do not face undue barriers to
vaccination;
(9) working with key stakeholders, including through the
World Bank Group, the International Monetary Fund, the
International Finance Corporation, and other relevant
regional and bilateral financial institutions, to address the
economic and financial implications of the COVID-19 pandemic,
while taking into account the differentiated needs of
disproportionately affected, vulnerable, and marginalized
populations;
(10) entering into discussions with vaccine manufacturing
companies to support partnerships, with the goal of ensuring
adequate global supply of vaccines, which may include
necessary components and raw materials;
(11) establishing clear timelines, benchmarks, and goals
for COVID-19 response strategies and activities under this
section; and
(12) generating commitments of resources in support of the
goals referred to in paragraph (6).
(b) Oversight of United States Foreign Assistance to End
the COVID-19 Pandemic.--
(1) Reporting requirements.--Not later than 60 days after
the date of the enactment of this Act, the Secretary of State
and the USAID Administrator shall jointly submit to the
appropriate congressional committees--
(A) an unclassified report containing a description of
funds already obligated and expended under title X of the
American Rescue Plan Act of 2021 (Public Law 117-2); and
(B) a plan that describes the objectives and timeline for
the obligation and expenditure of all remaining funds
appropriated under title X of the American Rescue Plan Act of
2021, to include support for civil society for the protection
of human rights in the context of the COVID-19 pandemic,
which shall be submitted in an unclassified form, and should
include a description of steps taken pursuant to each
objective specified in the plan.
(2) Congressional consultation.--Not less frequently than
once every 60 days, until the completion or termination of
the implementation plan required under paragraph (1)(B), and
upon the request from one or more of the appropriate
congressional committees, the Secretary of State and the
USAID Administrator shall provide a briefing to the
appropriate congressional committees regarding the report
required under paragraph (1)(A) and the status of the
implementation of the plan required under paragraph (1)(B).
(3) Branding.--In providing assistance under this section,
the Secretary of State and the USAID Administrator, with due
consideration for the safety and security of implementing
partners and beneficiaries, shall prescribe the use of logos
or other insignia, which may include the flag of the United
States, to appropriately identify such assistance as being
from the people of the United States.
(c) United States Contributions to the Global Fund to Fight
AIDS, Tuberculosis, and Malaria COVID-19 Response
Mechanism.--United States contributions to the Global Fund to
Fight AIDS, Tuberculosis, and Malaria COVID-19 Response
Mechanism under section 10003(a)(2) of the American Rescue
Plan Act of 2021 (Public Law 107-2)--
(1) shall be meaningfully leveraged in a manner that
incentivizes other public and private donor contributions;
and
(2) shall be subject to the reporting and withholding
requirements under subsections (c), (d)(4)(A)(ii), (d)(4)(C),
(d)(5), (d)(6), (f), and (g) of section 202 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7622).
(d) Global COVID-19 Vaccine Distribution and Delivery.--
(1) Accelerating global vaccine distribution strategy.--The
President shall develop a strategy to expand access to, and
accelerate the global distribution of, COVID-19 vaccines to
other countries, which shall--
(A) identify the countries that have the highest infection
and death rates due to COVID-19, the lowest COVID-19
vaccination rates, and face the most difficult political,
logistical, and financial challenges to obtaining and
delivering COVID-19 vaccines, and describe the basis and
metrics used to make such determinations;
(B) identify which countries and regions will be
prioritized and targeted for COVID-19 vaccine delivery, and
the rationale for such prioritization;
(C) describe efforts that the United States is making to
increase COVID-19 vaccine manufacturing capacity, both
domestically and internationally, as appropriate, through

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support for the establishment or refurbishment of regional
manufacturing hubs in South America, South Africa, and South
Asia, including through the provision of international
development finance, and estimate when, how many, and which
types of vaccines will be provided by the United States
Government bilaterally and through COVAX;
(D) describe efforts to encourage international partners to
take actions similar to the efforts referred to in
subparagraph (C);
(E) describe how the United States Government will ensure
efficient delivery of COVID-19 vaccines to intended
recipients, including United States citizens residing
overseas, and identify complementary United States foreign
assistance that will facilitate vaccine readiness,
distribution, delivery, monitoring, and administration
activities;
(F) describe how the United States Government will ensure
the efficient delivery and administration of COVID-19
vaccines to United States citizens residing overseas,
including through the donation of vaccine doses to United
States embassies and consulates, as appropriate, giving
priority to--
(i) countries in which United States citizens are deemed
ineligible or low priority in the national vaccination
deployment plan; and
(ii) countries that are not presently distributing a COVID-
19 vaccine that--

(I) has been licensed or authorized for emergency use by
the Food and Drug Administration; or
(II) has met the necessary criteria for safety and efficacy
established by the World Health Organization;

(G) summarize the United States Government's efforts to
encourage and facilitate technology sharing and the licensing
of intellectual property, to the extent necessary, to support
the adequate and timely supply of vaccines and vaccine
components to meet the vaccination goals specified in
subsection (a)(6), giving due consideration to avoiding
undermining intellectual property innovation and intellectual
property rights or protections with respect to vaccine
development in performing the assessment required under this
subparagraph;
(H) describe the roles, responsibilities, tasks, and, as
appropriate, the authorities of the Secretary of State, the
USAID Administrator, the Secretary of Health and Human
Services, the Director of the Centers for Disease Control and
Prevention, the Chief Executive Officer of the United States
International Development Finance Corporation, and the heads
of other relevant Federal departments and agencies with
respect to the implementation of such strategy;
(I) describe how the Department of State and USAID will
coordinate with the Secretary of Health and Human Services
and the heads of other relevant Federal agencies to expedite
the export and distribution of excess federally purchased
vaccines to support countries in need and ensure such
vaccines will not be wasted;
(J) summarize the United States public diplomacy strategies
for branding and addressing vaccine misinformation and
hesitancy within partner countries; and
(K) describe efforts that the United States is making to
help countries disrupt the current transmission of COVID-19,
while simultaneously increasing vaccination rates, utilizing
medical products and medical supplies.
(2) Submission of strategy.--Not later than 90 days after
the date of the enactment of this Act, the President shall
submit the strategy described in paragraph (1) to--
(A) the appropriate congressional committees;
(B) the Committee on Health, Education, Labor, and Pensions
of the Senate; and
(C) the Committee on Energy and Commerce of the House of
Representatives.
(3) Limitation.--
(A) In general.--No Federal funds may be made available to
COVAX to procure vaccines produced by any companies owned or
controlled by the Government of the People's Republic of
China or by the Chinese Communist Party unless the Secretary
of State certifies that the People's Republic of China--
(i) is providing financial support to COVAX that is
commensurate with the United States' contribution to COVAX;
and
(ii) publically discloses transparent data on the quality,
safety, and efficacy of its COVID-19 vaccines.
(B) Safeguards.--The President shall ensure that
appropriate safeguards are put in place to ensure that the
condition described in subparagraph (A) is honored by Gavi,
the Vaccine Alliance.
(e) Leveraging United States Bilateral Global Health
Programs for the International COVID-19 Response.--
(1) Authorization for leveraging bilateral program
activities.--Amounts authorized to be appropriated or
otherwise made available to carry out section 104 of the
Foreign Assistance Act (22 U.S.C. 2151b) may be used in
countries receiving United States foreign assistance--
(A) to combat the COVID-19 pandemic, including through the
sharing of COVID-19 vaccines; and
(B) to support related activities, including--
(i) strengthening vaccine readiness;
(ii) reducing vaccine hesitancy and misinformation;
(iii) delivering and administering COVID-19 vaccines;
(iv) strengthening health systems and supply chains;
(v) supporting health care workforce planning, training,
and management;
(vi) enhancing transparency, quality, and reliability of
public health data;
(vii) increasing bidirectional testing, including screening
for symptomatic and asymptomatic cases; and
(viii) building laboratory capacity.
(2) Adjustment of targets and goals.--The Secretary of
State, in coordination with the heads of other relevant
Federal departments and agencies, shall submit an annual
report to the appropriate congressional committees that
identifies--
(A) any adjustments to original program targets and goals
that result from the use of funds for the purposes authorized
under paragraph (1); and
(B) the amounts needed in the following fiscal year to meet
the original program goals, as necessary and appropriate.
(f) Report on Humanitarian Response to the COVID-19
Pandemic.--
(1) In general.--Not later than 120 days after the date of
the enactment of this Act, the Secretary of State, in
consultation with the USAID Administrator and the Secretary
of Health and Human Services, shall submit a report to the
appropriate congressional committees that--
(A) assesses the global humanitarian response to COVID-19;
and
(B) outlines specific elements of the United States
Government's country-level humanitarian response to the
COVID-19 pandemic.
(2) Elements.--The report required under paragraph (1)
shall include--
(A) for countries receiving United States assistance, a
description of humanitarian and health-worker access to
crisis-affected areas, including--
(i) legal and bureaucratic restrictions on the entry of
humanitarian workers from abroad, to include visa
authorizations that do not allow adequate time for
humanitarian workers to quarantine upon arrival in-line with
host country regulations, conduct needs assessments, and
subsequently implement multilateral and United States-funded
programming in an efficient, effective, and unrestricted
manner;
(ii) restrictions on travel by humanitarian workers within
such country to reach the areas of operation where vulnerable
and marginalized populations reside;
(iii) access to medical evacuation in the event of a health
emergency;
(iv) access to personal protective equipment for United
States Government implementing partners; and
(v) efforts to support access to COVID-19 vaccines for
humanitarian and health-workers and crisis-affected
communities;
(B) an analysis and description of countries (regardless of
whether such countries have received direct United States
assistance) that have expressly prevented vulnerable
populations from accessing necessary assistance related to
COVID-19, including--
(i) the omission of vulnerable populations from national
response plans;
(ii) laws, policies, or practices that restrict or preclude
treatment of vulnerable populations at public hospitals and
health facilities; and
(iii) exclusion of, or discrimination against, vulnerable
populations in law, policy, or practice that prevents
equitable access to food, shelter, and other basic
assistance;
(C) a description of United States Government efforts to
facilitate greater humanitarian access, including--
(i) advocacy and diplomatic efforts with relevant foreign
governments and multilateral institutions to ensure that
vulnerable and marginalized populations are included in
national response plans and other relevant plans developed in
response to the COVID-19 pandemic; and
(ii) advocacy and diplomatic efforts with relevant foreign
governments to ensure that appropriate visas, work permits,
and domestic travel exemptions are issued for humanitarian
and health workers responding to the COVID-19 pandemic; and
(D) a description of United States Government plans and
efforts to address the second-order impacts of the COVID-19
pandemic and an assessment of the resources required to
implement such plans, including efforts to address--
(i) famine and acute food insecurity;
(ii) gender-based violence;
(iii) mental health and psychosocial support needs;
(iv) child protection needs;
(v) health, education, and livelihoods;
(vi) shelter; and
(vii) attempts to close civil society space, including
through bureaucratic, administrative, and health or security
related impediments.
(g) Safeguarding Democracy and Human Rights During the
COVID-19 Pandemic.--
(1) Sense of congress.--It is the sense of Congress that--
(A) governments may be required to take appropriate
extraordinary measures during public health emergencies to
halt the spread of disease, including closing businesses and
public events, limiting access to public spaces, and
restricting the movement of people;
(B) certain foreign governments have taken measures in
response to COVID-19 that violate the human rights of their
citizens without clear public health justification, oversight
measures, or sunset provisions;

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(C) governments using the COVID-19 pandemic as a pretext
for repression have undermined democratic institutions,
debilitated institutions for transparency and public
integrity, quashed legitimate dissent, and attacked
journalists, civil society organizations, activists,
independent voices, and vulnerable and marginalized
populations, including refugees and migrants, with far-
reaching consequences that will extend beyond the current
crisis;
(D) foreign governments should take immediate steps to
release from prison all arbitrarily detained United States
citizens and political prisoners who may be at increased risk
for contracting or suffering from complications from COVID-
19;
(E) COVID-19 threatens to roll back decades of progress for
women and girls, disproportionately affecting women
economically, educationally, and with respect to health,
while also leading to alarming rises in gender based
violence; and
(F) during and after the pandemic, the Department of State
and USAID should directly, and through nongovernmental
organizations or international organizations, provide
assistance and implement programs that support democratic
institutions, civil society, free media, and the advancement
of internationally recognized human rights.
(2) Funding for civil society and human rights defenders.--
(A) Program priorities.--Amounts made available for each of
the fiscal years 2022 through 2026 to carry out the purposes
of sections 101 and 102 of the Foreign Assistance Act of 1961
(22 U.S.C. 2151 and 2151-1), including programs to support
democratic institutions, human rights defenders, civil
society, and freedom of the press, should be targeted, to the
extent feasible, toward civil society organizations in
countries in which emergency government measures taken in
response to the COVID-19 pandemic have violated
internationally recognized human rights.
(B) Eligible organizations.--Civil society organizations
operating in countries in which emergency government measures
taken in response to the COVID-19 pandemic violated
internationally recognized human rights shall be eligible to
receive funds made available to carry out the purposes of
sections 101 and 102 of the Foreign Assistance Act of 1961
for each of the fiscal years 2022 through 2026, for--
(i) programs designed to strengthen and support civil
society, human rights defenders, freedom of association, and
the freedom of the press;
(ii) programs to restore democratic institutions; and
(iii) peacebuilding and conflict prevention to address the
impacts of COVID-19 on social cohesion, public trust, and
conflict dynamics by adapting existing programs or investing
in new ones.
(C) Final report.--Not later than 180 days after the date
of the enactment of this Act, the Secretary of State shall
submit a report to the appropriate congressional committees
that--
(i) lists the countries whose emergency measures limiting
internationally recognized human rights in a manner
inconsistent with the principles of limitation and derogation
remain in place;
(ii) describes such countries' emergency measures,
including--

(I) how such procedures violate internationally recognized
human rights; and
(II) an analysis of the impact of such measures on access
to health and efforts to control the COVID-19 pandemic within
the country;

(iii) describes--

(I) security and intelligence surveillance measures
implemented by countries during the COVID-19 pandemic;
(II) the extent to which such measures have been, or have
not been, rolled back; and
(III) whether and how such measures impact internationally
recognized human rights; and

(iv) includes a strategic plan by the Department of State
and USAID that addresses, through multilateral and bilateral
diplomacy and foreign assistance, the persistent issues
related to the restriction of internationally recognized
human rights in the COVID-19 response.
(h) Public Diplomacy and Combating Disinformation and
Misinformation About COVID-19.--
(1) United states agency for global media.--
(A) Finding.--Congress finds that the United States Agency
for Global Media (referred to in this subsection as
``USAGM'') broadcasting entities and grantees have proven
valuable in providing timely and accurate information,
particularly in countries in which the free press is under
threat.
(B) Sense of congress.--It is the sense of Congress that--
(i) accurate, investigative, and scientific journalism is
critical for societies to effectively combat global health
threats; and
(ii) Congress supports--

(I) accurate and objective investigative and scientific
reporting by USAGM networks and grantees regarding COVID-19;
and
(II) platforms that help dispel and combat misinformation
about the COVID-19 pandemic.

(C) Voice of america.--It is the sense of Congress that
amounts authorized to be appropriated or otherwise made
available to Voice of America should be used--
(i) to expand programs such as POLYGRAPH.info;
(ii) to provide critical tools for combating propaganda
associated with COVID-19; and
(iii) to assist journalists in providing accurate
information to local media outlets.
(D) Office of cuba broadcasting.--It is the sense of
Congress that Radio Television Marti and Digital Marti should
continue to broadcast programs that detect, highlight, and
dispel disinformation.
(E) Radio free europe/radio liberty.--
(i) Finding.--Congress finds that Radio Free Europe/Radio
Liberty (referred to in this section as ``RFE/RL'') operate
in media markets in which authoritarian state and nonstate
actors, including Russia, heavily invest in misinformation
and disinformation campaigns designed to promote confusion
and mistrust.
(ii) Sense of congress.--It is the sense of Congress that
RFE/RL should--

(I) increase investigative reporting regarding the impacts
of COVID-19, the political and social responses governments
are taking in response to COVID-19, and the lasting impacts
such actions will have on key political freedoms; and
(II) expand its ``digital first'' strategy.

(F) Radio free asia.--
(i) Finding.--Congress finds that Radio Free Asia (RFA)
operates in a media market dominated by powerful state-run
media that have invested heavily in media distortion and
disinformation, including about COVID-19.
(ii) Sense of congress.--It is the sense of Congress that
RFA should--

(I) commission technical experts to bolster efforts to
counter social media tools, including bots used by some
countries to promote misinformation;
(II) expand digital programming and local coverage to
expose China's media manipulation techniques; and
(III) increase English language content to help counter
China's propaganda directed toward English-speaking
audiences.

(G) Middle east broadcasting networks.--
(i) Finding.--Congress finds that the Middle East
Broadcasting Networks operate largely in closed media markets
in which malign state and nonstate actors remain active.
(ii) Sense of congress.--It is the sense of Congress that
the Middle East Broadcasting Networks should--

(I) continue plans to expand an investigative news unit;
and
(II) work to ensure that reporting continues amidst
operational challenges on the ground.

(H) Open technology fund.--
(i) Finding.--Congress finds that the Open Technology Fund
works to advance internet freedom in repressive environments
by supporting technologies that--

(I) provide secure and uncensored access to USAGM's content
and the broader internet; and
(II) counter attempts by authoritarian governments to
control the internet and restrict freedom online.

(ii) Sense of congress.--It is the sense of Congress that
the Open Technology Fund should--

(I) support a broad range of technologies to respond to
increasingly aggressive and sophisticated censorship and
surveillance threats and provide more comprehensive and
tailored support to USAGM's networks; and
(II) provide direct assistance to USAGM's networks to
improve the digital security of reporting operations and
journalists.

(2) Department of state public diplomacy programs.--
(A) Findings.--Congress finds the following:
(i) The Department of State's public diplomacy programs
build global networks that can address shared challenges,
such as the COVID-19 pandemic, including through exchanges of
researchers, public health experts, and scientists.
(ii) The programs referred to in clause (i) play a critical
role in creating open and resilient information environments
where democracies can thrive, as articulated in the 2020
Public Diplomacy Strategic Plan, including by--

(I) improving media quality with journalist training and
reporting tours;
(II) conducting media literacy programs; and
(III) supporting media access activities.

(iii) The International Visitor Leadership Program and
Digital Communications Network engaged journalists around the
world to combat COVID-19 disinformation, promote unbiased
reporting, and strengthen media literacy.
(iv) More than 12,000 physicians holding J-1 visas from 130
countries--

(I) are engaged in residency or fellowship training at
approximately 750 hospitals throughout the United States, the
majority of whom are serving in States that have been the
hardest hit by COVID-19; and
(II) throughout the pandemic, have served on the front
lines of the medical workforce and in United States
university laboratories researching ways to detect and treat
the virus.

(B) Visa processing briefing.--Not later than 30 days after
the date of the enactment of this Act, the Assistant
Secretary for Consular Affairs shall brief the appropriate
congressional committees by providing--
(i) a timeline for increasing visa processing capacities at
embassies around the world, notably where there are--

[[Page S8167]]

(I) many American citizens, including dual nationals; and
(II) many visa applicants for educational and cultural
exchange programs that promote United States foreign policy
objectives and economic stability to small businesses,
universities, and communities across the United States;

(ii) a detailed plan for using existing authorities to
waive or provide other alternatives to in-person appointments
and interviews;
(iii) an assessment of whether additional authorities and
resources are required for the use of videoconference
appointments and interviews as an alternative to in-person
appointments and interviews; and
(iv) a detailed plan for using existing authorities to
rapidly cross-train and surge temporary personnel to support
consular services at embassies and consulates of the United
States around the world, and an assessment of whether
additional authorities and resources are required.
(C) Global engagement center.--
(i) Finding.--Congress finds that since the beginning of
the COVID-19 pandemic, publications, websites, and platforms
associated with China, Russia, and Iran have sponsored
disinformation campaigns related to the COVID-19 pandemic,
including falsely blaming the United States for the disease.
(ii) Sense of congress.--It is the sense of Congress that
the Global Engagement Center should continue its efforts to
expose and counter state and non-state-sponsored
disinformation related to COVID-19, the origins of COVID-19,
and COVID-19 vaccinations.
(i) Findings and Sense of Congress Regarding the United
States International Development Finance Corporation.--
(1) Findings.--Congress finds the following:
(A) The COVID-19 pandemic is causing a global economic
recession, as evidenced by the global economic indicators
described in subparagraphs (B) through (D).
(B) The United Nations Conference on Trade and Development
determined that the COVID-19 pandemic pushed the global
economy into recession in 2020 on a scale that has not been
witnessed since the 1930s.
(C) Developed countries are expected to experience a
relatively more significant rebound in gross domestic product
growth during 2021 than is expected to be experienced in
developing countries, leading to concerns about a further
expansion in the gap between rich and poor countries,
particularly if this trend continues into 2022.
(D) Global markets have suffered losses ranging between 5
percent and over 10 percent since the beginning of the
pandemic. While markets are recovering in 2021, global job
losses and unemployment rates remain high, with--
(i) approximately 33,000,000 labor hours lost globally (13
per cent of the total hours lost) due to outright
unemployment; and
(ii) an estimated additional 81,000,000 labor hours lost
due to inactivity or underemployment.
(E) Given the prolonged nature of the COVID-19 pandemic,
African finance ministers have requested continued efforts to
provide--
(i) additional liquidity;
(ii) better market access;
(iii) more concessional resources; and
(iv) an extension in the Debt Service Suspension Initiative
established by the Group of 20.
(2) Sense of congress.--It is the sense of Congress that--
(A) even when markets begin to recover in the future, it is
likely that access to capital will be especially challenging
for developing countries, which still will be struggling with
the containment of, and recovery from, the COVID-19 pandemic;
(B) economic uncertainty and the inability of individuals
and households to generate income are major drivers of
political instability and social discord, which create
conditions for insecurity;
(C) it is in the security and economic interests of the
United States to assist in the economic recovery of
developing countries that are made more vulnerable and
unstable from the public health and economic impacts of the
COVID-19 pandemic;
(D) United States foreign assistance and development
finance institutions should seek to blunt the impacts of a
COVID-19 related economic recession by supporting investments
in sectors critical to maintaining economic stability and
resilience in low and middle income countries;
(E) the need for the United States International
Development Finance Corporation's support for advancing
development outcomes in less developed countries, as mandated
by the Better Utilization of Investments Leading to
Development Act of 2018 (22 U.S.C. 9601 et seq.), is critical
to ensuring lasting and resilient economic growth in light of
the COVID-19 pandemic's exacerbation of economic hardships
and challenges;
(F) The United States International Development Finance
Corporation should adjust its view of risk versus return by
taking smart risks that may produce a lower rate of financial
return, but produce significant development outcomes in
responding to the economic effects of COVID-19;
(G) to mitigate the economic impacts of the COVID-19
recession, the United States International Development
Finance Corporation should use its resources and authorities,
among other things--
(i) to ensure loan support for small- and medium-sized
enterprises;
(ii) to offer local currency loans to borrowers for working
capital needs;
(iii) to create dedicated financing opportunities for new
``customers'' that are experiencing financial hardship due to
the COVID-19 pandemic; and
(iv) to work with other development finance institutions to
create co-financing facilities to support customers
experiencing hardship due to the COVID-19 pandemic.
(j) Sense of Congress Regarding International Cooperation
to Prevent and Respond to Future Pandemics.--It is the sense
of Congress that--
(1) global pandemic preparedness and response requires
international and regional cooperation and action;
(2) the United States should lead efforts in multilateral
fora, such as the Group of 7, the Group of 20, and the United
Nations, by collaborating and cooperating with other
countries and international and regional organizations,
including the World Health Organization and other key
stakeholders, to implement international strategies, tools,
and agreements to better prevent, detect, and respond to
future infectious disease threats before they become
pandemics; and
(3) the United States should enhance and expand
coordination and collaboration among the relevant Federal
departments and agencies, the Food and Agriculture
Organization of the United Nations, the World Health
Organization, and the World Organization for Animal Health,
to advance a One Health approach toward preventing,
detecting, and responding to zoonotic threats in the human-
animal interface.
(k) Roles of the Department of State, the United States
Agency for International Development, and the Department of
Health and Human Services in International Pandemic
Response.--
(1) Designation of lead agencies for coordination of the
united states' international response to infectious disease
outbreaks with severe or pandemic potential.--The President
shall designate relevant Federal departments and agencies,
including the Department of State, USAID, and the Department
of Health and Human Services (including the Centers for
Disease Control and Prevention), to lead specific aspects of
the United States' international response to outbreaks of
emerging high-consequence infectious disease threats.
(2) Notification.--Not later than 120 days after the date
of the enactment of this Act, the President shall notify 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 of the designations made pursuant to
paragraph (1), including detailed descriptions of the roles
and responsibilities of each relevant department and agency.
(l) USAID Disaster Surge Capacity.--
(1) Surge capacity.--Amounts authorized to be appropriated
or otherwise made available to carry out part I and chapter 4
of part II of the Foreign Assistance Act of 1961 (22 U.S.C.
2151 et seq.), including funds made available for
``Assistance for Europe, Eurasia and Central Asia'', may be
used, in addition to amounts otherwise made available for
such purposes, for the cost (including support costs) of
individuals detailed to or employed by USAID whose primary
responsibility is to carry out programs in response to global
health emergencies and natural or man-made disasters.
(2) Notification.--Not later than 15 days before making
funds available to address man-made disasters pursuant to
paragraph (1), the Secretary of State or the USAID
Administrator shall notify the appropriate congressional
committees of such action.
(m) Statement of Policy on Humanitarian Assistance to
Countries Affected by Pandemics.--
(1) Statement of policy.--It shall be the policy of the
United States--
(A) to ensure that United States assistance to address
pandemics, including the provision of vaccines, reaches
vulnerable and marginalized populations, including racial and
religious minorities, refugees, internally displaced persons,
migrants, stateless persons, women, children, the elderly,
and persons with disabilities;
(B) to ensure that United States assistance, including
development finance, addresses the second order effects of a
pandemic, including acute food insecurity; and
(C) to protect and support humanitarian actors who are
essential workers in preventing, mitigating and responding to
the spread of a pandemic among vulnerable and marginalized
groups described in subparagraph (A), including ensuring that
such humanitarian actors--
(i) are exempted from unreasonable travel restrictions to
ensure that they can effectively provide life-saving
assistance; and
(ii) are prioritized as frontline workers in country
vaccine distribution plans.
(2) Facilitating effective and safe humanitarian
assistance.--The Secretary of State, in coordination with the
USAID Administrator, should carry out actions that accomplish
the policies set forth in paragraph (1), including by--
(A) taking steps to ensure that travel restrictions
implemented to help contain the spread of a pandemic are not
applied to individuals authorized by the United States
Government to travel to, or reside in, a designated country
to provide assistance related to, or otherwise impacted by,
an outbreak;

[[Page S8168]]

(B) approving the use of foreign assistance for the
procurement of personal protective equipment by United States
Government implementing partners from businesses within or
nearby the country receiving foreign assistance on an urgent
basis and in a manner consistent with efforts to respond to
the spread of a pandemic in the United States; and
(C) waiving certain travel restrictions implemented to help
contain the spread of a pandemic in order to facilitate the
medical evacuation of United States Government implementing
partners, regardless of nationality.

SEC. 1295. INTERNATIONAL PANDEMIC PREVENTION AND
PREPAREDNESS.

(a) Partner Country Defined.--In this section, the term
``partner country'' means a foreign country in which the
relevant Federal departments and agencies are implementing
United States assistance for global health security and
pandemic prevention and preparedness under this subtitle.
(b) United States Global Health Security and Diplomacy
Strategy and Report.--
(1) In general.--The President shall develop, update,
maintain, and advance a comprehensive strategy for improving
global health security and pandemic prevention, preparedness,
and response that--
(A) clearly articulates the policy goals related to
pandemic prevention, preparedness, and response, and actions
necessary to elevate and strengthen United States diplomatic
leadership in global health security and pandemic
preparedness, including by building the expertise of the
diplomatic corps;
(B) improves the effectiveness of United States foreign
assistance to prevent, detect, and respond to infectious
disease threats, including through the advancement of a One
Health approach, the Global Health Security Agenda, the
International Health Regulations (2005), and other relevant
frameworks and programs that contribute to global health
security and pandemic preparedness;
(C) establishes 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;
(D) establishes transparent means to improve coordination
and performance by the relevant Federal departments and
agencies and sets out clear roles and responsibilities that
reflect the unique capabilities and resources of each such
department and agency;
(E) establishes mechanisms to improve coordination and
avoid duplication of effort among the relevant Federal
departments and agencies, partner countries, donor countries,
the private sector, multilateral organizations, and other key
stakeholders, and ensures collaboration at the country level;
(F) supports, and is aligned with, partner country-led,
global health security policy and investment plans, developed
with input from key stakeholders, as appropriate;
(G) prioritizes 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, the Global Health Security Agenda, other
risk-based assessments, and other 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;
(H) reduces long-term reliance upon United States foreign
assistance for global health security by--
(i) helping build and enhance community resilience to
infectious disease emergencies and threats, such as COVID-19
and Ebola;
(ii) ensuring that United States global health assistance
is strategically planned and coordinated in a manner that
contributes to the strengthening of overall health systems
and builds the capacity of local organizations and
institutions;
(iii) promoting improved domestic resource mobilization,
co-financing, and appropriate national budget allocations for
strong public health systems, global health security, and
pandemic preparedness and response in partner countries; and
(iv) ensuring partner country ownership of global health
security strategies, data, programs, and outcomes;
(I) supports health budget and workforce planning in
partner countries, including training in public financial
management and budget data transparency;
(J) works to ensure that--
(i) partner countries have national action plans for health
security that are developed with input from key stakeholders,
including communities and the private sector;
(ii) United States foreign assistance for global health
security is aligned with such national action plans for
health security in partner countries, developed with input
from key stakeholders, including communities and the private
sector, to the greatest extent practicable and appropriate;
and
(iii) United States global health security efforts are
aligned with ongoing strategies and initiatives across
government agencies to help nations better identify and
prevent health impacts related to deforestation, climate-
related events, and increased unsafe interactions between
wildlife, livestock, and people, including the emergence,
reemergence, and spread of zoonoses;
(K) strengthens 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, Gavi,
the Vaccine Alliance, and regional health organizations, that
contribute to the development of more resilient health
systems and supply chains in partner countries with the
capacity, resources, and personnel required to prevent,
detect, and respond to infectious disease threats; and
(L) supports innovation and partnerships with the private
sector, health organizations, civil society, nongovernmental
organizations, and health research and academic institutions
to improve pandemic preparedness and response, including for
the prevention and detection of infectious disease, and the
development and deployment of effective and accessible
infectious disease tracking tools, diagnostics, therapeutics,
and vaccines.
(2) Submission of strategy.--Not later than 120 days after
the date of the enactment of this Act, the President shall
submit the strategy required under paragraph (1) 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.
(3) Annual report.--
(A) In general.--Not later than 1 year after the submission
of the strategy to the congressional committees referred to
in paragraph (2), and not later than October 1 of each year
thereafter for the following 4 fiscal years, the President
shall submit a report to such congressional committees that
describes--
(i) the status of the implementation of the strategy
required under paragraph (1);
(ii) any necessary updates to the strategy;
(iii) the progress made in implementing the strategy, with
specific information related to the progress toward improving
countries' ability to detect, respond and prevent the spread
of infectious disease threats, such as COVID-19 and Ebola;
and
(iv) details on the status of funds made available to carry
out the purposes of this section.
(B) Agency-specific plans.--The reports required under
subparagraph (A) shall include specific implementation plans
from each relevant Federal department and agency that
describe--
(i) how updates to the strategy may have impacted the
agency's plan during the preceding calendar year;
(ii) the progress made in meeting the goals, objectives,
and benchmarks under implementation plans during the
preceding year;
(iii) the anticipated staffing plans and contributions of
the department or agency, including technical, financial, and
in-kind contributions, to implement the strategy;
(iv) a transparent, open, and detailed accounting of
obligations by each of the relevant Federal departments and
agencies to implement the strategy, including--

(I) the statutory source of obligated funds;
(II) the amounts obligated;
(III) implementing partners;
(IV) targeted beneficiaries; and
(V) 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 returns, including through specific
activities to strengthen health systems, as appropriate; and
(vi) a plan for regularly reviewing and updating programs
and partnerships, and for sharing lessons learned with a wide
range of stakeholders in an open, transparent manner.
(C) Form.--The reports required under subparagraph (A)
shall be submitted in unclassified form, but may contain a
classified annex.
(c) Committee on Global Health Security and Pandemic and
Biological Threats.--
(1) Statement of policy.--It shall be the policy of the
United States--
(A) to promote global health security as a core national
security interest; and
(B) to ensure effective coordination and collaboration
between the relevant Federal departments and agencies engaged
in efforts to advance the global health security of the
United States.
(2) Coordination.--
(A) Establishment of committee.--There is authorized to be
established, within the National Security Council, the
Committee on Global Health Security and Pandemic and
Biological Threats (referred to in this subsection as the
``Committee''), whose day-to-day operations should be led by
the Special Advisor for Global Health Security.
(B) Special advisor for global health security.--The
Special Advisor for Global Health Security--
(i) should serve on the staff of the National Security
Council; and
(ii) may also be the Senior Director for the Global Health
Security and Biodefense Directorate within the Executive
Office of the President, who reports to the Assistant to the
President for National Security Affairs.
(C) Functions.--

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(i) In general.--The functions of the Committee should be--

(I) to provide strategic guidance for the development of a
policy framework for United States Government activities
relating to global health security, including pandemic
prevention, preparedness and response; and
(II) to ensure policy coordination between United States
Government agencies.

(ii) Activities.--In carrying out the functions described
in clause (i), the Committee should--

(I) conduct, in coordination with the heads of relevant
Federal departments and agencies, a review of existing United
States global health security policies and strategies;
(II) develop recommendations for how the Federal Government
may regularly update and harmonize the policies and
strategies referred to in subclause (I) to enable the United
States Government to respond to pandemic threats and to
monitor the implementation of such strategies;
(III) develop a plan for modernizing global early warning
and trigger systems for scaling action to prevent, detect,
respond to, and recover from emerging biological threats;
(IV) provide policy-level recommendations regarding the
Global Health Security Agenda goals, objectives, and
implementation, and other international efforts to strengthen
pandemic prevention, preparedness and response;
(V) review the progress toward, and working to resolve
challenges in, achieving United States commitments under the
Global Health Security Agenda;
(VI) develop protocols for coordinating and deploying a
global response to emerging high-consequence infectious
disease threats that outline the respective roles for
relevant Federal agencies in facilitating and supporting such
response operations that should facilitate the operational
work of Federal agencies and of the Special Advisor for
Global Health Security;
(VII) make recommendations regarding appropriate responses
to specific pandemic threats and ensure the coordination of
domestic and international agencies regarding the Federal
Government's efforts to prevent, detect, respond to, and
recover from biological events;
(VIII) take steps to strengthen the global pandemic supply
chain and address any barriers to the timely delivery of
supplies in response to a pandemic, including through
engagement with the private sector, as appropriate;
(IX) develop recommendations to ensure the effective
sharing of information from domestic and international
sources about pandemic threats among the relevant Federal
departments and agencies, State and local governments, and
international partners and organizations; and
(X) develop guidelines to enhance and improve the
operational coordination between State and local governments
and Federal agencies with respect to pandemic threats.

(D) Responsibilities of departments and agencies.--The
Committee and the Special Advisor for Global Health Security
shall not assume any responsibilities or authorities of the
head of any Federal department, agency, or office, including
the foreign affairs responsibilities and authorities of the
Secretary of State to oversee the implementation of programs
and policies that advance global health security within
foreign countries.
(E) Specific roles and responsibilities.--
(i) In general.--The heads of the relevant Federal
departments and agencies should--

(I) make global health security and pandemic threat
reduction a high priority within their respective departments
and agencies, and include global health security and pandemic
threat reduction-related activities within their respective
agencies' strategic planning and budget processes;
(II) designate a senior-level official to be responsible
for global health security and pandemic threat reduction at
each of their respective departments and agencies;
(III) designate an appropriate representative at the
Assistant Secretary level or higher to participate on the
Committee whenever the head of the department or agency
cannot participate;
(IV) keep the Committee apprised of Global Health Security
and pandemic threat reduction-related activities undertaken
within their respective departments and agencies;
(V) ensure interagency cooperation and collaboration and
maintain responsibility for agency-related programmatic
functions including, as applicable, in coordination with
partner governments, country teams, and global health
security in-country teams; and
(VI) keep the Committee apprised of GHSA-related activities
undertaken within their respective agencies.

(ii) Additional roles and responsibilities.--In addition to
the roles and responsibilities described in clause (i), the
heads of the relevant Federal departments and agencies should
carry out their respective roles and responsibilities
described in--

(I) Executive Order 13747 (81 Fed. Reg. 78701; relating to
Advancing the Global Health Security Agenda to Achieve a
World Safe and Secure from Infectious Disease Threats); and
(II) the National Security Memorandum-1 on United States
Global Leadership to Strengthen the International COVID-19
Response and to Advance Global Health Security and Biological
Preparedness, as in effect on the day before the date of the
enactment of this Act.

(d) United States Overseas Global Health Security and
Diplomacy Coordination.--
(1) Establishment.--There is established, within the
Department of State, a Special Representative for United
States International Activities to Advance Global Health
Security and Diplomacy Overseas (referred to in this
subsection as the ``Special Representative'').
(2) Appointment; qualifications.--The Special
Representative--
(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 fields of
development and public health, epidemiology, or medicine; and
(ii) relevant diplomatic, policy, and political expertise.
(3) Authorities.--The Special Representative is
authorized--
(A) to operate internationally to carry out the purposes of
this section;
(B) to lead in developing a global pandemic prevention,
preparedness and response framework to support global
pandemic prevention, preparedness, responses and recovery
efforts, including through--
(i) diplomatic engagement and related foreign policy
efforts, such as multilateral and bilateral arrangements,
enhanced coordination of engagement with multilateral
organizations and countries, and the mobilization of donor
contributions; and
(ii) support for United States citizens living abroad,
including consular support;
(C) to serve as the representative of the Department of
State on the Committee on Global Health Security and Pandemic
and Biological Threats authorized to be established under
subsection (b)(2)(B);
(D) to represent the United States in the multilateral,
catalytic financing mechanism described in section
1296(b)(1);
(E) to transfer and allocate United States foreign
assistance funding authorized to be appropriated pursuant to
paragraph (6) to the relevant Federal departments and
agencies implementing the strategy required under subsection
(b), in coordination with the Office of Management and Budget
and USAID;
(F) to utilize detailees, on a reimbursable or
nonreimbursable basis, from the relevant Federal departments
and agencies and hire personal service contractors, who may
operate domestically and internationally, to ensure that the
Office of the Special Representative has access to the
highest quality experts available to the United States
Government to carry out the functions under this subtitle;
and
(G) to perform such other functions as the Secretary of
State may assign.
(4) Duties.--The Special Representative shall coordinate,
manage, and oversee United States foreign policy, diplomatic
efforts, and foreign assistance funded with amounts
appropriated pursuant to paragraph (6) to advance the
relevant elements of the United States Global Health Security
and Diplomacy Strategy developed pursuant to subsection (b),
including by--
(A) developing and coordinating a global pandemic
prevention, preparedness and response framework consistent
with paragraph (3)(B);
(B) enhancing engagement with multilateral organizations
and partner countries, including through the mobilization of
donor support;
(C) enhancing coordination of consular services for United
States citizens abroad in the event of a global health
emergency;
(D) ensuring effective program coordination and
implementation of international activities, by the relevant
Federal departments and agencies by--
(i) formulating, issuing, and updating related policy
guidance;
(ii) establishing, in consultation with USAID and the
Department of Health and Human Services, unified auditing,
monitoring, and evaluation plans;
(iii) aligning, in coordination with United States chiefs
of mission and country teams in partner countries--

(I) the foreign assistance resources funded with amounts
appropriated pursuant to paragraph (6); and
(II) international activities described in the
implementation plans required under subsection (b)(3)(B) with
the relevant Federal departments and agencies in a manner
that--

(aa) is consistent with Executive Order 13747 (81 Fed. Reg.
78701; relating to Advancing the Global Health Security
Agenda to Achieve a World Safe and Secure from Infectious
Disease Threats);
(bb) is consistent with the National Security Memorandum on
United States Global Leadership to Strengthen the
International COVID-19 Response and to Advance Global Health
Security and Biological Preparedness, issued by President
Biden on January 21, 2021; and
(cc) reflects and leverages the unique capabilities of each
such department and agency;
(iv) convening, as appropriate, an interagency working
group on international pandemic prevention and preparedness,
headed by the Special Representative and including
representatives from the relevant Federal departments and
agencies, to facilitate coordination of activities relating
to pandemic

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prevention and preparedness in partner countries under this
subtitle;
(v) working with, and leveraging the expertise and
activities of, the Office of the United States Global AIDS
Coordinator, the Office of the United States Global Malaria
Coordinator, and similar or successor entities that are
implementing United States global health assistance overseas;
and
(vi) avoiding duplication of effort and working to resolve
policy, program, and funding disputes among the relevant
Federal departments and agencies;
(E) leading diplomatic efforts to identify and address
current and emerging threats to global health security;
(F) coordinating, in consultation with the Secretary of
Health and Human Services and the USAID Administrator,
effective representation of the United States in relevant
international forums, including at the World Health
Organization, the World Health Assembly, and meetings of the
Global Health Security Agenda and of the Global Health
Security Initiative;
(G) working to enhance coordination with, and transparency
among, the governments of partner countries and key
stakeholders, including the private sector;
(H) promoting greater donor and national investment in
partner countries to build more resilient health systems and
supply chains, including through representation and
participation in a multilateral, catalytic financing
mechanism for global health security and pandemic prevention
and preparedness, consistent with section 1296;
(I) securing bilateral and multilateral financing
commitments to advance the Global Health Security Agenda, in
coordination with the relevant Federal departments and
agencies, including through funding for the financing
mechanism described in section 1296; and
(J) 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 duties described in this subsection.
(5) Deputy representative.--The Special Representative
should be supported by a deputy, who--
(A) should be an employee of USAID serving in a career or
noncareer position in the Senior Executive Service or at the
level of a Deputy Assistant Administrator or higher;
(B) should have demonstrated knowledge and experience in
the fields of development and public health, epidemiology, or
medicine; and
(C) serves concurrently as the deputy and performs the
functions described in section 3(h) of Executive Order 13747
(81 Fed. Reg. 78701).
(6) Authorization of appropriations.--
(A) In general.--There is authorized to be appropriated
$5,000,000,000, for the 5-year period beginning on October 1,
2022, to carry out the purposes of this subsection and
section 1296, which, in consultation with the appropriate
congressional committees and subject to the requirements
under chapters 1 and 10 of part I and section 634A of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.), may
include support for--
(i) enhancing preparedness in partner countries through
implementation of the Global Health Security Strategy
developed pursuant to subsection (b);
(ii) replenishing the Emergency Reserve Fund at USAID,
established pursuant to section 7058(c)(1) of the Department
of State, Foreign Operations, and Related Programs
Appropriations Act, 2017 (division J of Public Law 115-31) to
address new or emerging infectious disease threats, as
necessary and appropriate;
(iii) United States contributions to the World Bank Health
Emergency Preparedness and Response Multi-Donor Fund; and
(iv) United States contributions to a multilateral,
catalytic financing mechanism for global health security and
pandemic prevention and preparedness described in section
1296(b).
(B) Exception.--Section 110 of the Trafficking Victims
Protection Act of 2000 (22 U.S.C. 7107) shall not apply to
assistance made available pursuant to this subsection.
(e) Resilience.--It shall be the policy of the United
States to support the growth of healthier, more stable
societies, while advancing the global health security
interests of the United States by working with key
stakeholders--
(1) in developing countries that are highly vulnerable to
the emergence, reemergence, and spread of infectious diseases
with pandemic potential, including disease outbreaks
resulting from natural and manmade disasters, human
displacement, loss of natural habitat, poor access to water,
sanitation, and hygiene, and other political, security,
economic, and climatic shocks and stresses;
(2) to develop effective tools to identify, analyze,
forecast, and mitigate the risks that make such countries
vulnerable;
(3) to better integrate short-, medium-, and long-term
recovery efforts into global health emergency response and
disaster relief; and
(4) to ensure that international assistance and financing
tools are effectively designed, objectively informed,
strategically targeted, carefully coordinated, reasonably
adapted, and rigorously monitored and evaluated in a manner
that advances the policy objectives under this subsection.
(f) Strengthening Health Systems.--
(1) Statement of policy.--It shall be the policy of the
United States to ensure that bilateral global health
assistance programs are effectively managed and coordinated
to contribute to the strengthening of health systems in each
country in which such programs are carried out, as necessary
and appropriate for the purposes of achieving improved health
outcomes.
(2) Coordination.--The Administrator of USAID shall work
with the Global Malaria Coordinator and the United States
Global AIDS Coordinator and Special Representative for Global
Health Diplomacy at the Department of State, and, as
appropriate, the Secretary of Health and Human Services, to
identify areas of collaboration and coordination in countries
with global health programs and activities undertaken by
USAID pursuant to the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law 108-
25) and other relevant statutes to ensure that such
activities contribute to health systems strengthening.
(3) Pilot program .--
(A) In general.--The Administrator of USAID should identify
not fewer than 5 countries in which the United States has
significant bilateral investments in global health to develop
an integrated approach toward health systems strengthening
that takes advantage of all sources of funding for global
health in such country, with the aim of establishing an
enduring model for coordinating health systems strengthening
activities, including improving pandemic preparedness in
additional countries in the future.
(B) Assessment.--In each of the countries selected under
subparagraph (A), USAID missions, in consultation with
USAID's Office of Health Systems, should conduct an
assessment that--
(i) takes a comprehensive view of the constraints in the
country's health system that prevent the achievement of
desired outcomes of United States Government-supported health
programs;
(ii) identifies the best opportunities for improving health
systems to achieve improved outcomes, including obstacles to
health service delivery;
(iii) maps the resources of the country and other donors in
the health sector with a focus on investment in health system
strengthening; and
(iv) develops, based on the results of the assessment
described in clause (i), and implements a new or revised 5-
year strategy for United States assistance to strengthen the
country's health system that--

(I) provides a framework for implementing such strategy;
(II) identifies key areas for investments to strengthen the
health system in alignment with other donors and achieve
health outcomes beyond a single sector;
(III) specifies the anticipated role of health programs
undertaken by each of the relevant Federal departments and
agencies operating in the country in implementing such
strategy;
(IV) includes clear goals, benchmarks, outputs, desired
outcomes, a means of measuring progress and a cost analysis;
and
(V) requires reporting by each Federal department and
agency regarding their participation and contribution,
including in the PEPFAR Annual Report to Congress.

(C) Strategies to strengthen health systems.--USAID
missions in countries identified pursuant subparagraph (A)
should develop a strategy to strengthen health systems based
on the assessment developed pursuant to subparagraph (B)
that--
(i) ensures complementarity with priorities identified
under any other action plan focused on strengthening a
country's health system, such as the World Health
Organization's Joint External Evaluation and National Action
Plans for Health Security;
(ii) identifies bureaucratic barriers and inefficiencies,
including poor linkages between government ministries and
between ministries and donor agencies and the extent of any
corruption, and identify actions to overcome such barriers;
(iii) identifies potential obstacles to the implementation
of the strategy, such as issues relating to lack of political
will, poor governance of an effective health system at all
levels of the country's public health systems, especially
with respect to governing bodies and councils at the
provincial, district, and community levels, and the exclusion
of women, minorities, other underserved groups, and frontline
health workers in decision making;
(iv) includes proposals for mobilizing sufficient and
durable financing for health systems;
(v) identifies barriers to building and retaining an
effective frontline health workforce with key global health
security capacities, informed by the International Health
Regulations (2005), including--

(I) strengthened data collection and analysis;
(II) data driven decision making capacity;
(III) recommendations for partner country actions to
achieve a workforce that conforms with the World Health
Organization's recommendation for at least 44.5 doctors,
nurses, and midwives and at least 15 paid, trained, equipped,
and professionally supervised community health workers for
every 10,000 people, while supporting proper distribution and
high-quality job performance; and
(IV) inclusion of the community health workforce in
planning for a resilient health

[[Page S8171]]

system to ensure essential service delivery and pandemic
response;

(vi) identifies deficiencies in information systems and
communication technologies that prevent linkages at all
levels of the health system delivery and medical supply
systems and promotes interoperability across data systems
with near real-time data, while protecting data security;
(vii) identifies weaknesses in supply chain and procurement
systems and practices, and recommends ways to improve the
efficiency, transparency, and effectiveness of such systems
and practices;
(viii) identifies obstacles to health service access and
quality and improved health outcomes for women and girls, and
for the poorest and most vulnerable, including a lack of
social support and other underlying causes, and
recommendations for how to overcome such obstacles;
(ix) includes plans for integrating innovations in health
technologies, services, and systems;
(x) identifies barriers to health literacy, community
engagement, and patient empowerment, and recommendations for
overcoming such barriers;
(xi) includes proposals for strengthening community health
systems and the community-based health workforce informed by
the World Health Organization guideline on health policy and
system support to optimize community health worker programmes
(2018), including the professionalization of community health
workers;
(xii) describes the role of the private sector and
nongovernmental health providers, including community groups
engaged in health promotion and mutual assistance and other
institutions engaged in health delivery, including the extent
to which the local population utilizes such health services;
(xiii) facilitates rapid response during health
emergencies, such as last mile delivery of vaccines to
respond to and prevent the spread of infectious diseases with
epidemic and pandemic potential; and
(xiv) ensures that relevant USAID missions and bureaus are
appropriately staffed and resourced to carry out such
activities efficiently, effectively, and in-line with best
practices.
(D) Consultation and reporting requirements.--
(i) Consultation.--In developing a strategy pursuant to
subparagraph (C), each USAID mission should consult with a
wide variety of stakeholders, including--

(I) relevant partner government institutions;
(II) professional associations;
(III) patient groups;
(IV) civil society organizations (including international
nongovernmental organizations with relevant expertise in
program implementation); and
(V) the private sector.

(ii) Reporting.--Not later than 180 days after the date of
the enactment of this Act, the Administrator of USAID and the
United States Global AIDS Coordinator shall submit a report
to the appropriate congressional committees detailing the
progress of the pilot program authorized under this
paragraph, including--

(I) progress made toward the integration and co-financing
of health systems strengthening activities by USAID and the
Office of the Global AIDS Coordinator; and
(II) the results of integrated efforts under this section,
including for cross-cutting efforts to strengthen local
health workforces.

(4) Technical capacity.--
(A) In general.--The Administrator of USAID shall ensure
that USAID is sufficiently resourced and staffed to ensure
performance, consistency, and adoption of best practices in
USAID's health systems programs, including the pilot program
authorized under paragraph (3).
(B) Resources.--The Administrator of USAID and the United
States Global AIDS Coordinator shall include detail in the
fiscal year 2023 Congressional Budget Justification regarding
health systems strengthening activities, including--
(i) the plans for, and the progress toward, reaching the
capacity described in subparagraph (A);
(ii) the requirements for sustaining such capacity,
including the resources needed by USAID; and
(iii) budget detail on the integration and joint funding of
health systems capacity building, as appropriate.
(5) International efforts.--The Secretary of State, in
coordination with the Administrator of USAID and, as
appropriate, the Secretary of Health and Human Services,
should work with the Global Fund to Fight AIDS, Tuberculosis,
and Malaria, Gavi, the Vaccine Alliance, bilateral donors,
and other relevant multilateral and international
organizations and stakeholders to develop--
(A) shared core indicators for strengthened health systems;
(B) agreements among donors that reporting requirements for
health systems come from country systems to reduce the burden
placed on partner countries;
(C) structures for joint assessments, plans, auditing, and
consultations; and
(D) a regularized approach to coordination on health
systems strengthening.
(6) Public private partnerships to improve health systems
strengthening.--The country strategies developed under
paragraph (3)(C) should include a section that--
(A) discusses the role of the private sector (including
corporate, local, and international organizations with
relevant expertise); and
(B) identifies relevant opportunities for the private
sector--
(i) to accelerate research and development of innovative
health and information technology, and to offer training
related to its use;
(ii) to contribute to improvements in health administration
and management processes;
(iii) to improve system efficiency;
(iv) to develop training related to clinical practice
guidelines; and
(v) to help countries develop systems for documenting
outcomes and achievements related to activities undertaken to
strengthen the health sector.
(7) Authorization for use of funds.--Amounts authorized to
be appropriated or otherwise made available to carry out
section 104 of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b) may be made available to carry out this subsection.
(g) Additional Authorities.--
(1) Foreign assistance act of 1961.--Chapter 1 of part I of
the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.)
is amended--
(A) in section 104(c)(1) (22 U.S.C. 2151b(c)(1)), by
inserting ``(emphasizing health systems strengthening, as
appropriate)'' after ``health services'';
(B) in section 104A (22 U.S.C. 2151b-2)--
(i) in subsection (b)(3)(D), by striking ``including health
care systems, under other international donor support'' and
inserting ``including through support for health systems
strengthening, under other donor support''; and
(ii) in subsection (f)(3)(Q), by inserting ``the Office of
the United States Global AIDS Coordinator, partner countries,
and the Global Fund to Fight AIDS, Tuberculosis, and Malaria
to ensure that their actions support the activities taken to
strengthen the overall health systems in recipient countries,
and efforts by'' after ``efforts by''; and
(C) in section 104B(g)(2) (22 U.S.C. 2151b-3(g)(2)), by
inserting ``strengthening the health system of the country
and'' after ``contribute to''.
(2) United states leadership against hiv/aids,
tuberculosis, and malaria act of 2003.--Section 204(a) of the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7623(a)) is amended--
(A) in paragraph (1)(A), by inserting ``in a manner that is
coordinated with, and contributes to, efforts through other
assistance activities being carried out to strengthen
national health systems and health policies'' after
``systems''; and
(B) in paragraph (2)--
(i) in subparagraph (C), by inserting ``as part of a
strategy to improve overall health'' before the semicolon at
the end;
(ii) in subparagraph (D), by striking ``and'' at the end;
(iii) in subparagraph (E), by striking the period at the
end and inserting ``; and''; and
(iv) by adding at the end the following:
``(F) to contribute to efforts that build health systems
capable of preventing, detecting and responding to HIV/AIDS,
tuberculosis, malaria and other infectious diseases with
pandemic potential.''.
(h) Authorization for United States Participation in the
Coalition for Epidemic Preparedness Innovations.--
(1) In general.--The United States is authorized to
participate in the Coalition for Epidemic Preparedness
Innovations (referred to in this subsection as ``CEPI'').
(2) Investors council and board of directors.--
(A) Initial designation.--The President shall designate an
employee of USAID to serve on the Investors Council and, if
nominated, on the Board of Directors of CEPI, as a
representative of the United States during the period
beginning on the date of such designation and ending on
September 30, 2022.
(B) Ongoing designations.--The President may designate an
employee of the relevant Federal department or agency with
fiduciary responsibility for United States contributions to
CEPI to serve on the Investors Council and, if nominated, on
the Board of Directors of CEPI, as a representative of the
United States.
(C) Qualifications.--Any employee designated pursuant to
subparagraph (A) or (B) shall have demonstrated knowledge and
experience in the fields of development and public health,
epidemiology, or medicine, from the Federal department or
agency with primary fiduciary responsibility for United
States contributions pursuant to paragraph (3).
(D) Coordination .--In carrying out the responsibilities
under this subsection, an employee designated by the
President to serve on the Investors Council or the Board of
Directors, as applicable, shall coordinate with the Secretary
of Health and Human Services to promote alignment, as
appropriate, between CEPI and the strategic objectives and
activities of the Secretary of Health and Human Services with
respect to the research, development, and procurement of
medical countermeasures, consistent with titles III and
XXVIII of the Public Health Service Act (42 U.S.C. 241 et
seq. and 300hh et seq.).
(3) Consultation.--Not later than 60 days after the date of
the enactment of this Act, the employee designated pursuant
to paragraph (2)(A) shall consult with the appropriate
congressional committees, the Committee on Health, Education,
Labor, and Pensions of the Senate, and the Committee

[[Page S8172]]

on Energy and Commerce of the House of Representatives
regarding--
(A) the manner and extent to which the United States plans
to participate in CEPI, including through the governance of
CEPI;
(B) any planned financial contributions from the United
States to CEPI; and
(C) how participation in CEPI is expected to support--
(i) the United States Global Health Security Strategy
required under this subtitle;
(ii) the applicable revision of the National Biodefense
Strategy required under section 1086 of the National Defense
Authorization Act for Fiscal Year 2017 (6 U.S.C. 104); and
(iii) any other relevant programs relating to global health
security and biodefense.
(4) United states contributions.--
(A) Sense of congress.--It is the sense of Congress that
the President, consistent with the provisions under section
10003(a)(1) of the American Rescue Plan Act of 2021, should
make an immediate contribution to CEPI in the amount of
$300,000,000, to expand research and development of vaccines
to combat the spread of COVID-19 variants.
(B) Notification.--Not later than 15 days before a
contribution is made available pursuant to subparagraph (A),
the President shall notify the appropriate congressional
committees of the details of the amount, purposes, and
national interests served by such contribution.
(i) Intelligence Assessments Regarding Novel Diseases and
Pandemic Threats.--
(1) Defined term.--In this subsection, the term
``appropriate committees of Congress'' means--
(A) the Committee on Foreign Relations of the Senate;
(B) the Select Committee on Intelligence of the Senate;
(C) the Committee on Health, Education, Labor, and Pensions
of the Senate;
(D) the Committee on Foreign Affairs of the House of
Representatives;
(E) the Permanent Select Committee on Intelligence of the
House of Representatives; and
(F) the Committee on Energy and Commerce of the House of
Representatives.
(2) Intelligence assessments.--
(A) In general.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter for the
following 4 years, the National Intelligence Council shall
submit to the appropriate committees of Congress an
intelligence assessment regarding the risks posed to the
national security interests of the United States by the
emergence, reemergence, and overseas transmission of
pathogens with pandemic potential.
(B) Elements.--The intelligence assessments submitted
pursuant to subparagraph (A) shall--
(i) identify the countries or regions most vulnerable to
the emergence or reemergence of a pathogen with pandemic
potential, including the most likely sources and pathways of
such emergence or reemergence, whether naturally occurring,
accidental, or deliberate;
(ii) assess the likelihood that a pathogen described in
clause (i) will spread to the United States, the United
States Armed Forces, diplomatic or development personnel of
the United States stationed abroad, or citizens of the United
States living abroad in a manner that could lead to an
epidemic in the United States or otherwise affect the
national security or economic prosperity of the United
States;
(iii) assess the preparedness of countries around the
world, particularly those identified pursuant to clause (i),
to prevent, detect, and respond to pandemic threats; and
(iv) identify any scientific, capacity, or governance gaps
in the preparedness of countries identified pursuant to
clause (i), including an analysis of the capacity and
performance of any country or entity described in clause
(iii) in complying with biosecurity standards, as applicable.
(3) Congressional briefings.--The National Intelligence
Council shall provide an annual briefing to the appropriate
committees of Congress regarding--
(A) the most recent intelligence assessments submitted
pursuant to paragraph (2)(A); and
(B) the emergence or reemergence of pathogens with pandemic
potential that could lead to an epidemic described in
paragraph (2)(A)(ii).
(4) Public availability.--The Director of National
Intelligence shall make publicly available an unclassified
version of each intelligence assessment submitted pursuant to
paragraph (2)(A).
(j) Pandemic Early Warning Network.--
(1) In general.--The Secretary of State and the Secretary
of Health and Human Services, in coordination with the USAID
Administrator, the Director of the Centers for Disease
Control and Prevention, and the heads of the other relevant
Federal departments and agencies, shall work with the World
Health Organization and other key stakeholders to establish
or strengthen effective early warning systems, at the partner
country, regional, and international levels, that utilize
innovative information and analytical tools and robust review
processes to track, document, analyze, and forecast
infectious disease threats with epidemic and pandemic
potential.
(2) Report.--Not later than 1 year after the date of the
enactment of this Act, and annually thereafter for the
following 4 years, the Secretary of State, in coordination
with the Secretary of Health and Human Services and the heads
of the other relevant Federal departments and agencies, shall
submit a report 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 that describes United States
Government efforts and opportunities to establish or
strengthen effective early warning systems to detect
infectious disease threats internationally.
(k) International Emergency Operations.--
(1) Sense of congress.--It is the sense of Congress that it
is essential to enhance the capacity of key stakeholders to
effectively operationalize early warning and execute multi-
sectoral emergency operations during an infectious disease
outbreak, particularly in countries and areas that
deliberately withhold critical global health data and delay
access during an infectious disease outbreak in advance of
the next infectious disease outbreak with pandemic potential.
(2) Public health emergencies of international concern.--
The Secretary of State, in coordination with the Secretary of
Health and Human Services, should work with the World Health
Organization and like-minded member states to adopt an
approach toward assessing infectious disease threats under
the International Health Regulations (2005) for the World
Health Organization to identify and transparently
communicate, on an ongoing basis, varying levels of risk
leading up to a declaration by the Director General of the
World Health Organization of a Public Health Emergency of
International Concern for the duration and in the aftermath
of such declaration.
(3) Emergency operations.--The Secretary of State and the
Secretary of Health and Human Services, in coordination with
the USAID Administrator, the Director of the Centers for
Disease Control and Prevention, and the heads of other
relevant Federal departments and agencies, and consistent
with the requirements under the International Health
Regulations (2005) and the objectives of the World Health
Organization's Health Emergencies Programme, the Global
Health Security Agenda, and national actions plans for health
security, shall work, in coordination with the World Health
Organization, with partner countries and other key
stakeholders to support the establishment, strengthening, and
rapid response capacity of global health emergency operations
centers, at the partner country and international levels,
including efforts--
(A) to collect and share 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. 1296. FINANCING MECHANISM FOR GLOBAL HEALTH SECURITY AND
PANDEMIC PREVENTION AND PREPAREDNESS.

(a) Eligible Partner Country Defined.--In this section, the
term ``eligible partner country'' means a country in which
the Fund for Global Health Security and Pandemic Prevention
and Preparedness to be established under subsection (b) may
finance global health security and pandemic prevention and
preparedness assistance programs under this subtitle based on
the country's demonstrated--
(1) need, as identified through the Joint External
Evaluation process, the Global Health Security Index
classification of health systems, national action plans for
health security, the World Organization for Animal Health's
Performance of Veterinary Services evaluation, and other
complementary or successor indicators of global health
security and pandemic prevention and preparedness; and
(2) commitment to transparency, including--
(A) budget and global health data transparency;
(B) complying with the International Health Regulations
(2005);
(C) investing in domestic health systems; and
(D) achieving measurable results.
(b) Establishment of Fund for Global Health Security and
Pandemic Prevention and Preparedness.--
(1) Negotiations for establishment of fund for global
health security and pandemic prevention and preparedness.--
The Secretary of State, in coordination with the USAID
Administrator, the Secretary of Health and Human Services,
and the heads of other relevant Federal departments and
agencies, as necessary and appropriate, should seek to enter
into negotiations with donors, relevant United Nations
agencies, including the World Health Organization, and other
key multilateral stakeholders, to establish--
(A) a multilateral, catalytic financing mechanism for
global health security and pandemic prevention and
preparedness, which may be known as the Fund for Global
Health Security and Pandemic Prevention and Preparedness
(referred to in this section as ``the Fund''), to address the
need for and secure durable financing in accordance with the
provisions of this subsection; and
(B) an Advisory Board to the Fund in accordance with
subsection (e).

[[Page S8173]]

(2) Purposes.--The purposes of the Fund should be--
(A) to close critical gaps in global health security and
pandemic prevention and preparedness; and
(B) to work with, and build the capacity of, eligible
partner countries in the areas of global health security,
infectious disease control, and pandemic prevention and
preparedness, in a manner that--
(i) prioritizes capacity building and financing
availability in eligible partner countries;
(ii) incentivizes countries to prioritize the use of
domestic resources for global health security and pandemic
prevention and preparedness;
(iii) leverages government, nongovernment, and private
sector investments;
(iv) regularly responds to and evaluates progress based on
clear metrics and benchmarks, such as the Joint External
Evaluation and the Global Health Security Index;
(v) aligns with and complements 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) helps countries accelerate and achieve compliance with
the International Health Regulations (2005) and the
fulfillment of the Global Health Security Agenda 2024
Framework not later than 5 years after the date on which the
Fund is established, in coordination with the ongoing Joint
External Evaluation national action planning process.
(3) Executive board.--
(A) In general.--The Fund should be governed by a
transparent and accountable body (referred to in this section
as the ``Executive Board''), which should--
(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 20 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) Duties.--The Executive Board should--
(i) be charged with approving strategies, operations, and
grant making authorities in order to conduct effective
fiduciary, monitoring, and evaluation efforts, and other
oversight functions;
(ii) determine operational procedures such that the Fund is
able to effectively fulfill its mission;
(iii) provide oversight and accountability for the Fund in
collaboration with the Inspector General to be established
pursuant to subsection (d)(5)(A)(i);
(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 United
States and other nations leading outbreak prevention,
preparedness, and response activities in partner countries,
as appropriate.
(C) Composition.--The Executive Board should include--
(i) representatives of the governments of founding member
countries who, in addition to the requirements under
subparagraph (A), qualify based upon meeting an established
initial contribution threshold, which should be not less than
10 percent of total initial contributions, and a demonstrated
commitment to supporting the International Health Regulations
(2005);
(ii) a geographically diverse group of members who--

(I) come from donor countries, eligible partner countries,
academic institutions, independent civil society, including
indigenous organizations, and the private sector; and
(II) are selected on the basis of their experience and
commitment to innovation, best practices, and the advancement
of global health security objectives;

(iii) representatives of the World Health Organization; and
(iv) the chair of the Global Health Security Steering
Group.
(D) Contributions.--Each government or private sector
entity represented on the Executive Board should agree to
make annual contributions to the Fund in an amount not less
than the minimum determined by the Executive Board.
(E) Qualifications.--Individuals appointed to the Executive
Board should have demonstrated knowledge and experience
across a variety of sectors, including human and animal
health, agriculture, development, defense, finance, research,
and academia.
(F) Conflicts of interest.--
(i) Technical experts.--The Executive Board may include
independent technical experts who are not affiliated with, or
employed by, a recipient country or organization.
(ii) Multilateral bodies and institutions.--Executive Board
members appointed pursuant to subparagraph (C)(iii) should be
required to recuse themselves from matters presenting
conflicts of interest, including financing decisions relating
to such bodies and institutions.
(G) United states representation.--
(i) Founding member.--The Secretary of State should seek--

(I) to establish the United States as a founding member of
the Fund; and
(II) to ensure that the United States is represented on the
Executive Board by an officer or employee of the United
States, who shall be appointed by the President.

(ii) Effective and termination dates.--

(I) Effective date.--This subparagraph shall take effect
upon the date on which the Secretary of State certifies and
submits to Congress an agreement establishing the Fund.
(II) Termination date.--The membership established pursuant
to clause (i) shall terminate upon the date of termination of
the Fund.

(H) Removal procedures.--The Fund should establish
procedures for the removal of members of the Executive Board
who--
(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.
(c) Authorities.--
(1) Program objectives.--
(A) In general.--In carrying out the purpose set forth in
subsection (b), the Fund, acting through the Executive Board,
should--
(i) develop grant making requirements to be administered by
an independent technical review panel comprised of entities
barred from applying for funding or support;
(ii) provide grants, including challenge grants, technical
assistance, concessional lending, catalytic investment funds,
and other innovative funding mechanisms, in coordination with
ongoing bilateral and multilateral efforts, as appropriate--

(I) to help eligible partner countries close critical gaps
in health security, as identified through the Joint External
Evaluation process, the Global Health Security Index
classification of health systems, and national action plans
for health security and other complementary or successor
indicators of global health security and pandemic prevention
and preparedness; and
(II) to support measures that enable such countries, at the
national and subnational levels, and in partnership with
civil society and the private sector, to strengthen and
sustain resilient health systems and supply chains with the
resources, capacity, and personnel required to prevent,
detect, mitigate, and respond to infectious disease threats,
including the emergence or reemergence of pathogens, before
they become pandemics;

(iii) leverage the expertise, capabilities, and resources
of proven, existing agencies and organizations to effectively
target and manage resources for impact, including through
alignment with, and co-financing of, complementary programs,
as appropriate and consistent with subparagraph (C); and
(iv) develop recommendations for a mechanism for assisting
countries that are at high risk for the emergence or
reemergence of pathogens with pandemic potential to
participate in the Global Health Security Agenda and the
Joint External Evaluations.
(B) Activities supported.--The activities to be supported
by the Fund should include efforts--
(i) to enable eligible partner countries to formulate and
implement national health security and pandemic prevention
and preparedness action plans, advance action packages under
the Global Health Security Agenda, and adopt and uphold
commitments under the International Health Regulations (2005)
and other related international health agreements and
arrangements, as appropriate;
(ii) to support health security budget planning in eligible
partner countries, including training in public financial
management, budget and health data transparency, human
resource information systems, and integrated and transparent
budget and health data;
(iii) to strengthen the health workforce, including hiring,
training, and deploying experts and other essential staff,
including community health workers, to improve frontline
prevention of, and monitoring and preparedness for, unknown,
new, emerging, or reemerging pathogens, epidemics, and
pandemic threats, including capacity to surge and manage
additional staff during emergencies;
(iv) to improve the quality of community health worker
programs as the foundation of pandemic preparedness and
response through application of appropriate assessment tools;
(v) to improve infection prevention and control, the
protection of healthcare workers, including community health
workers, and access to water and sanitation within healthcare
settings;
(vi) to combat the threat of antimicrobial resistance;
(vii) to strengthen laboratory capacity and promote
biosafety and biosecurity through the provision of material
and technical assistance;
(viii) to reduce the risk of bioterrorism, the emergence,
reemergence, or spread of zoonotic disease (whether through
loss of natural habitat, the commercial trade in wildlife for
human consumption, or other means), and accidental biological
release;
(ix) to build technical capacity to manage, as appropriate,
supply chains for applicable global health commodities
through effective

[[Page S8174]]

forecasting, procurement, warehousing, and delivery from
central warehouses to points of service in both the public
and private sectors;
(x) to enable bilateral, regional, and international
partnerships and cooperation, including through pandemic
early warning systems and emergency operations centers, to
identify and address transnational infectious disease threats
exacerbated by natural and man-made disasters, human
displacement, and zoonotic infection;
(xi) to establish partnerships for the sharing of best
practices and enabling eligible countries to meet targets and
indicators under the Joint External Evaluation process, the
Global Health Security Index classification of health
systems, and national action plans for health security
relating to the prevention, detection, and treatment of
neglected tropical diseases;
(xii) to build the capacity of eligible partner countries
to prepare for and respond to second order development
impacts of infectious disease outbreaks and maintain
essential health services, while accounting for the
differentiated needs and vulnerabilities of marginalized
populations, including women and girls;
(xiii) to develop and utilize metrics to monitor and
evaluate programmatic performance and identify best
practices, including in accordance with Joint External
Evaluation benchmarks, Global Health Security Agenda targets,
and Global Health Security Index indicators;
(xiv) to develop and deploy mechanisms to enhance and
independently monitor the transparency and accountability of
global health security and pandemic prevention and
preparedness programs and data, in compliance with the
International Health Regulations (2005), including through
the sharing of trends, risks, and lessons learned;
(xv) to promote broad participation in health emergency
planning and advisory bodies, including by women and
frontline health workers;
(xvi) to develop and implement simulation exercises,
produce and release after action reports, and address related
gaps;
(xvii) to support countries in conducting Joint External
Evaluations;
(xviii) to improve disease surveillance capacity in partner
counties, including at the community level, such that those
countries are better able to detect and respond to known and
unknown pathogens and zoonotic infectious diseases; and
(xix) to support governments through coordinated and
prioritized assistance efforts to prevent the emergence,
reemergence, or spread of zoonotic diseases caused by
deforestation, commercial trade in wildlife for human
consumption, climate-related events, and unsafe interactions
between wildlife, livestock, and people.
(C) Implementation of program objectives.--In carrying out
the objectives under subparagraph (A), the Fund should work
to eliminate duplication and waste by upholding strict
transparency and accountability standards and coordinating
its programs and activities with key partners working to
advance global health security and pandemic prevention and
preparedness, including--
(i) governments, independent civil society, nongovernmental
organizations, research and academic institutions, and
private sector entities in eligible partner countries;
(ii) the pandemic early warning systems and international
emergency operations centers to be established under
subsections (j) and (k) of section 1295;
(iii) the World Health Organization;
(iv) the Global Health Security Agenda;
(v) the Global Health Security Initiative;
(vi) the Global Fund to Fight AIDS, Tuberculosis, and
Malaria;
(vii) the United Nations Office for the Coordination of
Humanitarian Affairs, UNICEF, and other relevant funds,
programs, and specialized agencies of the United Nations;
(viii) Gavi, the Vaccine Alliance;
(ix) the Coalition for Epidemic Preparedness Innovations
(CEPI);
(x) The World Organisation for Animal Health;
(xi) The United Nations Environment Programme;
(xii) Food and Agriculture Organization; and
(xiii) the Global Polio Eradication Initiative.
(2) Priority.--In providing assistance under this section,
the Fund should give priority to low-and lower middle income
countries with--
(A) low scores on the Global Health Security Index
classification of health systems;
(B) measurable gaps in global health security and pandemic
prevention and preparedness identified under Joint External
Evaluations and national action plans for health security;
(C) demonstrated political and financial commitment to
pandemic prevention and preparedness; and
(D) demonstrated commitment to upholding global health
budget and data transparency and accountability standards,
complying with the International Health Regulations (2005),
investing in domestic health systems, and achieving
measurable results.
(3) Eligible grant recipients.--Governments and
nongovernmental organizations should be eligible to receive
grants as described in this section.
(d) Administration.--
(1) Appointments.--The Executive Board should appoint--
(A) an Administrator, who should be responsible for
managing the day-to-day operations of the Fund; and
(B) an independent Inspector General, who should be
responsible for monitoring grants implementation and
proactively safeguarding against conflicts of interests.
(2) Authority to accept and solicit contributions.--The
Fund should be authorized to solicit and accept contributions
from governments, the private sector, foundations,
individuals, and nongovernmental entities.
(3) Accountability; conflicts of interest; criteria for
programs.--As part of the negotiations described in
subsection (b)(1), the Secretary of the State, consistent
with paragraph (4), should--
(A) take such actions as are 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;
(B) 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
potential divestments of interests, prohibition from engaging
in certain activities, recusal from certain decision-making
and administrative processes, and representation by an
alternate board member; and
(C) seek agreement on the criteria that should be used to
determine the programs and activities that should be assisted
by the Fund.
(4) Selection of partner countries, projects, and
recipients.--The Executive Board should establish--
(A) eligible partner country selection criteria, to include
transparent metrics to measure and assess global health
security and pandemic prevention and preparedness strengths
and vulnerabilities in countries seeking assistance;
(B) minimum standards for ensuring eligible partner country
ownership and commitment to long-term results, including
requirements for domestic budgeting, resource mobilization,
and co-investment;
(C) criteria for the selection of projects to receive
support from the Fund;
(D) standards and criteria regarding qualifications of
recipients of such support;
(E) such rules and procedures as may be necessary for cost-
effective management of the Fund; and
(F) such rules and procedures as may be necessary to ensure
transparency and accountability in the grant-making process.
(5) Additional transparency and accountability
requirements.--
(A) Inspector general.--
(i) In general.--The Secretary of State shall seek to
ensure that the Inspector General appointed pursuant to
paragraph (1)--

(I) is fully enabled to operate independently and
transparently;
(II) 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; and
(III) establishes an investigative unit that--

(aa) develops an oversight mechanism to ensure that grant
funds are not diverted to illicit or corrupt purposes or
activities; and
(bb) submits an annual report to the Executive Board
describing its activities, investigations, and results.
(ii) Sense of congress on corruption.--It is the sense of
Congress that--

(I) corruption within global health programs contribute
directly to the loss of human life and cannot be tolerated;
and
(II) in making financial recoveries relating to a corrupt
act or criminal conduct under a grant, as determined by the
Inspector General, the responsible grant recipient should be
assessed at a recovery rate of up to 150 percent of such
loss.

(B) Administrative expenses.--The Secretary of State shall
seek to ensure the Fund establishes, maintains, and makes
publicly available a system to track the administrative and
management costs of the Fund on a quarterly basis.
(C) Financial tracking systems.--The Secretary of State
shall ensure that the Fund establishes, maintains, and makes
publicly available a system to track the amount of funds
disbursed to each grant recipient and sub-recipient during a
grant's fiscal cycle.
(D) Exemption from duties and taxes.--The Secretary should
ensure that the Fund adopts rules that condition grants upon
agreement by the relevant national authorities in an eligible
partner country to exempt from duties and taxes all products
financed by such grants, including procurements by any
principal or sub-recipient for the purpose of carrying out
such grants.
(e) Advisory Board.--
(1) In general.--There should be an Advisory Board to the
Fund.
(2) Appointments.--The members of the Advisory Board should
be composed of--
(A) a geographically diverse group of individuals that
includes representation from low- and middle-income
countries;
(B) individuals with experience and leadership in the
fields of development, global health, epidemiology, medicine,
biomedical research, and social sciences; and

[[Page S8175]]

(C) representatives of relevant United Nations agencies,
including the World Health Organization, and nongovernmental
organizations with on-the ground experience in implementing
global health programs in low and lower-middle income
countries.
(3) Responsibilities.--The Advisory Board should provide
advice and guidance to the Executive Board of the Fund on the
development and implementation of programs and projects to be
assisted by the Fund and on leveraging donations to the Fund.
(4) Prohibition on payment of compensation.--
(A) In general.--Except for travel expenses (including per
diem in lieu of subsistence), no member of the Advisory Board
should receive compensation for services performed as a
member of the Board.
(B) United states representative.--Notwithstanding any
other provision of law (including an international
agreement), a representative of the United States on the
Advisory Board may not accept compensation for services
performed as a member of the Board, except that such
representative may accept travel expenses, including per diem
in lieu of subsistence, while away from the representative's
home or regular place of business in the performance of
services for the Board.
(5) Conflicts of interest.--Members of the Advisory Board
should be required to disclose any potential conflicts of
interest prior to serving on the Advisory Board and, in the
event of any conflicts of interest, recuse themselves from
such matters during their service on the Advisory Board.
(f) Reports to Congress.--
(1) Status report.--Not later than 180 days after the date
of the enactment of this Act, the Secretary of State, in
coordination with the USAID Administrator, and the heads of
other relevant Federal departments and agencies, shall submit
a report to the appropriate congressional committees that
describes the progress of international negotiations to
establish the Fund.
(2) Annual report.--
(A) In general.--Not later than 1 year after the date of
the establishment of the Fund, and annually thereafter for
the duration of the Fund, the Secretary of State, shall
submit a report to the appropriate congressional committees
regarding the administration of the Fund.
(B) Report elements.--The report required under
subparagraph (A) shall describe--
(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.
(3) GAO report on effectiveness.--Not later than 2 years
after the date on which the Fund is established, the
Comptroller General of the United States shall submit a
report to the appropriate congressional committees that
evaluates the effectiveness of the Fund, including the
effectiveness of the programs, projects, and activities
supported by the Fund, as described in subsection (c)(1).
(g) United States Contributions.--
(1) In general.--Subject to submission of the certification
under this subsection, the President is authorized to make
available for United States contributions to the Fund such
funds as may be appropriated or otherwise made available for
such purpose.
(2) Notification.--The Secretary of State shall notify the
appropriate congressional committees not later than 15 days
in advance of making a contribution to the Fund, including--
(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) Limitation.--During the 5-year period beginning on the
date of the enactment of this Act, a United States
contribution to the Fund may not cause the cumulative total
of United States contributions to the Fund to exceed 33
percent of the total contributions to the Fund from all
sources.
(4) Withholdings.--
(A) Support for acts of international terrorism.--If the
Secretary of State determines that the Fund has provided
assistance to a country, the government of which the
Secretary of State has determined, for purposes of section
620A of the Foreign Assistance Act of 1961 (22 U.S.C. 2371)
has repeatedly provided support for acts of international
terrorism, the United States shall withhold from its
contribution to the Fund for the next fiscal year an amount
equal to the amount expended by the Fund to the government of
such country.
(B) Excessive salaries.--During the 5-year period beginning
on the date of the enactment of this Act, if the Secretary of
State determines that the salary of any individual employed
by the Fund exceeds the salary of the Vice President of the
United States for such fiscal year, the United States should
withhold from its contribution for the next fiscal year an
amount equal to the aggregate amount by which the salary of
each such individual exceeds the salary of the Vice President
of the United States.
(C) Accountability certification requirement.--The
Secretary of State may withhold not more than 20 percent of
planned United States contributions to the Fund until the
Secretary certifies to the appropriate congressional
committees that the Fund has established procedures to
provide access by the Office of Inspector General of the
Department of State, as cognizant Inspector General, the
Inspector General of the Department of Health and Human
Services, the Inspector General of USAID, and the Comptroller
General of the United States to the Fund's financial data and
other information relevant to United States contributions to
the Fund (as determined by the Inspector General of the
Department of State, in consultation with the Secretary of
State).
(h) Compliance With the Foreign Aid Transparency and
Accountability Act of 2016.--Section 2(3) of the Foreign Aid
Transparency and Accountability Act of 2016 (Public Law 114-
191; 22 U.S.C. 2394c note) is amended--
(1) in subparagraph (D), by striking ``and'' at the end;
(2) in subparagraph (E), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(F) the International Pandemic Preparedness and COVID-19
Response Act of 2021.''.
(i) Prohibition Against United States Foreign Assistance
for the Government of the People's Republic of China.--None
of the assistance authorized to be appropriated under this
subtitle may be made available to the Government of the
People's Republic of China or to any entity owned or
controlled by the Government of the People's Republic of
China.
______