[Presidential Decision Directives - PDD]
THE WHITE HOUSE
Office of Science and Technology Policy
FOR IMMEDIATE RELEASE
June 12, 1996
The President today established a national policy to address the threat
of emerging infectious diseases through improved domestic and
international surveillance, prevention, and response measures.
ADDRESSING THE THREAT OF EMERGING INFECTIOUS DISEASES
Emerging infectious diseases such as Ebola, drug-resistant
tuberculosis, and HIV/AIDS present one of the most significant health
and security challenges facing the global community. Deaths from
infectious disease have risen sharply over the past decade in the
United States and globally. In the United States alone, the death rate
from infectious diseases, excluding HIV/AIDS, rose by 22 percent between
1980 and 1992. Contributing factors, such as climate change, ecosystem
disturbance, increased movement of people and goods, and the
deterioration of public health infrastructures, show no
sign of abatement. Addressing this challenge requires a global strategy
as most cities in the United States are within a 36 hour commercial
flight of any area of the world -- less time than the incubation
period of many infectious diseases. Furthermore, the United States is
vulnerable to a release of biological agents by rogue nations or
terrorists, which could result in the spread of infectious diseases.
The National Science and Technology Council (NSTC) has determined that
the national and International system of infectious disease
surveillance, prevention, and response is inadequate to protect the
health of U.S. citizens. The NSTC reports, "Infectious Disease -- A Global
Health Threat" (September 1995), "Meeting the Challenge -- A Research
Agenda for Health, Safety, and Food" (February 1996), and "Proceedings of
the Conference on Human Health and Global Climate Change" (May 1996),
make a number of recommendations to improve
our surveillance, prevention, and response capabilities which are
reflected in this policy.
- Strengthen the domestic infectious disease surveillance and
response system, both at
the Federal, State, and local levels and at ports of entry into
the United States, in
cooperation with the private sector and with public health and
- Establish a global infectious disease surveillance and response
system, based on regional hubs and linked by modern communications.
- Strengthen research activities to improve diagnostics, treatment,
and prevention, and to improve the understanding of the biology of
infectious disease agents.
- Ensure the availability of the drugs, vaccines, and diagnostic tests
needed to combat infectious diseases and infectious disease emergencies
through public and private sector cooperation.
- Expand missions and establish the authority of relevant United
States Government agencies to contribute to a worldwide infectious
disease surveillance, prevention, and response network.
- Promote public awareness of emerging infectious diseases through
cooperation with nongovernmental organizations and the private sector.
U.S. Government Roles and Responsibilities
- Enhance the surveillance and response components of our domestic
and international public health infrastructure.
- Strengthen Federal and State laboratory and epidemiological response
capabilities. The Centers for Disease Control and Prevention (CDC) will
coordinate Federal government efforts to strengthen Federal, State and
local health departments surveillance and response capabilities.
- Strengthen research, training, and technology development for
establishing new and more effective interventions to combat emerging
- The Federal government, in cooperation with State and local
governments, international organizations, the private sector, and public
health, medical and veterinary communities, will establish a national
and international electronic network for surveillance and response
regarding emerging infectious diseases.
- Enhance biomedical and behavioral research efforts on emerging
- The National Institutes of Health (NIH) will lead Federal
government efforts to
strengthen research on the development of new tools to detect
and control emerging infectious diseases and on the biology and
pathology of infectious agents, with particular emphasis on antimicrobial
drug resistance. Research will include the development of new mechanisms
for the control and prevention of zoonotic infectious agents, which are
derived from domesticated and wild animals, and the health effects of
- Federal agencies will coordinate with the private sector, as
appropriate, including representatives of the pharmaceutical industry and
the academic, medical, and public health communities.
- Expand formal training for health care providers.
- Senior United States Government officials will work with health
care provider, health research organizations, and professional
organizations to urge that emerging infectious diseases be given greater
emphasis in fellowship programs and on certifying and re-certifying
- NIH will work with appropriate medical college and public health school
associations, urging them to advise their member institutions to expand
training in emerging infectious diseases and antimicrobial drug
resistance in student curricula.
- Review and update regulations, procedures, and resources for
screening and quarantine at ports of entry into the United States.
- CDC will lead an interagency group to review and update current
screening and quarantine regulations, procedures, and resources aimed at
minimizing the threats
disease outbreaks can pose to national health and security. Issues considered
should include early warning systems abroad, stricter controls at ports
of entry, and improved surveillance after persons, animals, or material
have entered the United States.
- The National Security Council (NSC) will ensure that any recommendations
support counterterrorism measures.
- Make information about ill international travelers with communicable
diseases more accessible to domestic Health authorities.
- CDC will be the lead agency in the development of cooperative
arrangements with the transportation industry to provide needed
information when follow-up of passengers with communicable diseases
arriving at United States ports of entry is required.
- Encourage other nations and international organizations to assign
higher priority to emerging infectious diseases.
- The Department of State and Office of Science and Technology Policy
(OSTP), in consultation with other agencies, will develop and coordinate
a sustained effort to enlist support from other nations and international
bodies. State will raise the
issue of emerging infectious diseases in bilateral, regional, and
multilateral discussions and will negotiate cooperative agreements with
other nations to promote the establishment of a global surveillance and
- Support the World Health Organization (WHO) and other bodies in
playing a stronger role in the surveillance, prevention, and response to
emerging infectious diseases.
- The United States will participate in the WHO-proposed revision of the
International Health Regulations to ensure improved screening and quarantine
- The United States will urge the WHO to develop regional inventories
of resources for combating emerging infectious diseases and will explore
joint steps to strengthen surveillance and response capabilities of WHO
and other international organizations, as appropriate.
- Expand United States agency missions and mandates in order to ensure
that responsible agencies are provided with the authority, emergency
procurement powers, and resources to respond to worldwide disease
outbreaks that have the potential to adversely affect the United States.
- CDC's mandate to protect the Health of United States citizens will
be more clearly stated to allow conduct of surveillance and response
activities, including outbreak investigations and selected responses to
epidemics overseas. In disaster relief
operations involving infectious diseases, CDC will operate as part
of the United States effort, as appropriate.
- The U.S. Agency for International Development (USAID) will continue to
address the root causes of emerging diseases through its ongoing
portfolio of assistance to developing countries.
- The mission of the Department of Defense (DoD) will be expanded to
include support of global surveillance, training, research, and response
to emerging infectious disease threats. DoD will strengthen its global
disease reduction efforts through: centralized coordination; improved
preventive health programs and epidemiological capabilities; and enhanced
involvement with military treatment facilities and United States and
DoD will ensure the availability of diagnostic capabilities at its three
domestic and six overseas laboratories. DoD will make available its
overseas laboratory facilities, as appropriate, to serve as focal points
for the training of foreign technicians and epidemiologists.
Coordination by a Standing Task Force
A standing Task Force of the National Science and Technology Council
(NSTC) is established to provide strategic planning and further
coordination on issues of emerging infectious diseases. The Task Force
will establish action groups as necessary to pursue
specific topics. In particular, the Task Force will act immediately to
realize the objectives and implementing actions described above.
The Task Force will be co-chaired by the Centers for Disease Control and
Prevention and the White House Office of Science and Technology Policy.
The Task Force will seek the views of the private sector and health
service providers in implementing this initiative.
The Task Force will report to the President through the NSTC and will
provide annual reports on the progress realized, including
recommendations for further action.
THE WHITE HOUSE
Office of the Vice President
FOR IMMEDIATE RELEASE
WEDNESDAY, June 12, 1996
VICE PRESIDENT ANNOUNCES POLICY ON INFECTIOUS DISEASES
New Presidential Policy Calls for Coordinated Approach to Global Issue
WASHINGTON -- Calling emerging infectious diseases a growing global
health threat, Vice President Gore today (6/12) announced President
Clinton's new policy to establish a worldwide infectious disease
surveillance and response system, and expand certain federal agency
mandates to better protect American citizens.
"Emerging infectious diseases present one of the most
significant health and security challenges facing the global community,"
Vice President Gore said during
remarks to the annual meeting of the National Council for International
Health in Crystal City, Virginia. "Through President Clinton's
leadership, we now have the first national policy to deal with this
serious international problem.
"We are committed to ensuring that American citizens have the
best protection possible from emerging infectious diseases, and that
means a coordinated, comprehensive approach at both the national and
international levels," Vice President Gore said.
In the United States, the death rate from infectious diseases,
excluding HIV/AIDS, rose by 22 percent between 1980 and 1992.
Contributing factors include climate change, increased movements of
people and goods, and the deterioration of
public health infrastructures. Since most cities in the United States
are within a 36-hour commercial flight of any area of the world -- less
time than the incubation period
of many infectious diseases -- addressing the problem of emerging
infectious diseases requires a global strategy.
Specifically, the presidential policy announced by Vice
President Gore today (6/12) calls for improved domestic and international
surveillance, prevention and response measures to emerging infectious
For example, the policy directs the United States government to
work with other nations and international organizations to establish a
global infectious disease surveillance and response system, based on
regional hubs and linked by modern communications technologies. It also
expands designated federal agency missions and it mandates in order to
ensure that they have tile authority, emergency procurement powers and
resources to respond to worldwide disease outbreaks that have the
potential to impact the United States.
In addition, the policy calls for strengthening research
activities to improve diagnosis, treatment and prevention of emerging
infectious diseases; ensuring the
availability of the drugs, vaccines, and diagnostic tests needed to
combat emerging infectious diseases; and promoting public awareness of
emerging infectious diseases through cooperation with nongovernment
organizations and the private sector. The policy establishes a standing
Task Force of the National Science and Technology Council (NSTC) to
provide strategic planning and further coordination on issues of
emerging infectious diseases.
"The Clinton Administration has made the war against emerging
infectious diseases a priority," said Health and Human Services Secretary
Donna E. Shalala who joined the Vice President at today's announcement.-
"These diseases know no boundaries, and our international pursuit of them
must know no end."
Dr. John H. Gibbons, President Clinton's Science and Technology
Advisor, said, "This is yet another instance where we must pull together
our full range of capabilities -- research, the global information
infrastructure, international engagement -- to meet the challenge to the
security and health of our society."