Bill Frist

Mr. FRIST

Mr. FRIST. Mr. President, I am pleased to join Senator Kennedy today to introduce the International AIDS Treatment and Prevention Act. This legislation is another important bipartisan step in our global battle against AIDS and other infectious diseases. The international crisis of HIV/AIDS, tuberculosis, and malaria threatens the entire world. We have done much here at home through Ryan White and other programs. We must show we can lead the world against these scourges as well. This morning, President Bush again underscored this administration's commitment, and his personal commitment, to reducing the spread of HIV/AIDS and demonstrating consistent, compassionate U.S. leadership in this global struggle. When I first came to the Senate eight years ago, HIV/AIDS was a little understood or recognized problem. In that time I have traveled far from the Senate floor. I have been on seven different medical mission trips to Africa, most recently, in January, to Uganda, Kenya and Tanzania. The trips have helped reveal to me the impact that one single virus-- HIV--is having on the destruction of a continent. Not a family. Not a community. Not a State. Not a country. An entire continent. The statistics of this plague are shocking. Each year, three million people die of AIDS, one every ten seconds. Twice that many, 5.5 million--or two every ten seconds--become infected. That is 15,000 people a day. Even more tragically, 6,000 of those infected each day are between the ages of 15 and 24. Ninety percent of those infected do not know they have the disease. There is no cure. There is no vaccine. And the number of people infected is growing dramatically. The disease toll is incalculable. Thirteen million children have been orphaned by AIDS. Over the next ten years, the orphan population may well grow to 40 million equivalent to the number of American children living east of the Mississippi River. I had the privilege of visiting with Tabu, a 28-year-old prostitute, who was leaving Arusha to return to her village to die. She stayed an extra day to meet with us. I will never forget her cheerful demeanor and mischievous smile as we met in her small stick-framed mud hut, no more than 12 feet by 12 feet. Her two sisters are also infected; a third sister has already died. Tabu will leave behind an eleven-year-old daughter, Adija. Not only do HIV/AIDS, tuberculosis, and malaria produce over 50 percent of the deaths due to infectious diseases each year, they have complex disease patterns that result in facilitating each other's spread. By weakening the immune system, infection with HIV increases susceptibility to both tuberculosis and malaria. Furthermore, the increasing number of multi-resistant tuberculosis cases is largely attributed to resistance developed in HIV-infected patients. Finally, in treating severe anemia that commonly accompanies illness due to malaria, untested blood transfusions create a method of HIV/AIDS spread. At home in Tennessee, or even here in Washington, DC, Uganda and Tanzania feel very far away. But the plague of HIV/AIDS and the chaos, despair and civil disorder it perpetrates only undermines the chance for democracy to flourish. Without civil institutions, there is disorder. Last year in South Africa, one of every 200 teachers died of AIDS. In a recent study in Kenya, 75 percent of deaths on the police force were AIDS-related. HIV-related deaths among hospital workers in Zambia have increased 13 fold in the last decade. These losses devastate local economies. Botswana's economy will shrink by 30 percent in ten years; Kenya's by 15 percent. Family incomes in the Ivory Coast have declined by 50 percent, while health care expenditures have risen by 4000 percent. Africa has lost an entire generation. In Nairobi, Kenya, I visited the Kibera slum. With a population of over 750,000, one out of five of those who live in Kibera are HIV/AIDS positive. As I walked the crowded pathways sandwiched between hundreds of thousands of aluminum shanties, I was amazed that there were only children or elderly individuals. The disease had wiped out the parents the most productive segment of the population teachers, military personnel, hospital workers, and law enforcement officers. African orphans therefore lack teachers, role models and leaders. This leaves them vulnerable to criminal organizations, revolutionary militias, and terrorists. Terrorism and crime could become a way of life for a young generation. Africa is not alone. India, with over 4 million cases of HIV/AIDS, is on the edge of explosive growth. China is estimated to have as many as 10 million infected persons. The Caribbean suffers from one of the highest rates of infection of any region in the world. Eastern Europe and Russia report the fastest growth of AIDS cases. These nations are the next generation in the AIDS crisis they present an opportunity for intervention and success if we act quickly and decisively. Due to the social, economic and political destructive effects of this disease, I'm devoting much of my time to this issue, and in particular, to the impact of HIV/AIDS in Africa. Just as our great nation is the leader in the war on terrorism, we must continue to lead the fight against AIDS in order to build a better, safer world. There is perhaps no greater global issue than the spread of deadly infectious disease. As President Bush said today, the United States must lead the fight in this international crises. We must now provide the leadership to confront the global HIV/AIDS, malaria, and tuberculosis epidemics. History will record how we respond to the call. We fight this battle in two ways: by improving primary prevention and expanding access to treatment. Until science produces a vaccine, prevention through behavioral change and awareness is the key. And once again, cultural stigmas must be overcome. Through a combination of comprehensive national plans, donor support and community-based organizations, we can make progress. We know that prevention and treatment go hand and hand, and that the necessary infrastructure must be present in order to delivery care. I have already introduced legislation with Senator Kerry--the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2002. This act would direct the President to work with foreign governments, the United Nations (UN), the World Bank, and the private sector to establish the Global AIDS and Health Fund to fight HIV/AIDS, malaria, and tuberculosis. This fund would provide grants to governments and non-governmental organizations for implementation of effective and affordable HIV/AIDS, malaria, and tuberculosis programs. Additionally, this legislation requires a comprehensive American strategy for combating these infectious diseases, enhances programs targeted toward empowering women, links debt relief to implementation of health programs, extends military to military prevention activities and establishes an incentive program for American clinicians to provide their expertise abroad. The legislation I am introducing today with Senator Kennedy and others is a companion to the Foreign Relations bill. This bill codifies and expands current authorities of the Department of Health and Human Services, HHS, to participate in appropriate HIV/AIDS prevention, treatment, care, and support activities in resource poor nations that are experiencing an HIV/AIDS crisis. Coupled with S. 2525, the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2002, this legislation would provide a better coordinated, enhanced U.S. response to the global pandemic of HIV/AIDS. Under The International AIDS Treatment and Prevention Act of 2002, the Secretary of Health and Human Services is authorized to implement HIV, tuberculosis, and malaria prevention, treatment, care and support services principally through the Centers for Disease Control and Prevention and, where appropriate, with the assistance and technical expertise of the Health Resources and Services Administration, (HRSA) the Food and Drug Administration, and the National Institutes of Health (NIH). The Secretary is also granted the authority to alter or renovate facilities in foreign countries as is necessary to conduct programs for international health activities and to establish family survival partnership grants for the provision of medical care and support to HIV positive parents and their children. This legislation, coupled with the S. 2525, represents an important step forward in our response to HIV/AIDS, tuberculosis, and malaria. History will judge how we as a nation--how we as a global community-- address and respond to this most devastating and destructive public health crisis we have seen since the bubonic plague ravaged Europe over 600 years ago. The task looms large, but by uniting with leadership and dedication from all--we will succeed in counteracting the devastation of HIV/AIDS and stop its advance.

Mr. FRIST

Mr. FRIST. Madam President, our vulnerability to a bioterrorist attack was highlighted by the events that unfolded last October, when anthrax took the lives of innocent Americans and put thousands more in jeopardy. How we address our vulnerabilities and respond to bioterrorism will be radically improved as a result of new legislation signed by President Bush. The greatest tool that terrorists have in their arsenal is to play on America's vulnerabilities and fears. This legislation makes great strides to significantly improve our ability to respond to bioterrorist threats. Yet it is critical that we provide the appropriate information so that families can prepare and protect themselves in the event of a potential attack. Information is power, and by better preparing ourselves, we can avoid being paralyzed by fear. Many news organizations have already begun to do their part by providing the necessary information for communities to feel safe. Good Housekeeping, which is read by thousands of readers each month, is a good example. In its April edition, Good Housekeeping answered the questions readers often have about bioterrorism, gave suggestions families could use to protect and prepare themselves, and provided information on what Congress is doing to lessen our vulnerability to bioterrorist attack. The magazine went a step further by providing a form readers could fill out urging Congress to act quickly to address bioterrorism. I was pleased that thousands of readers did respond with their views on this issue and the importance of passing legislation that would keep American families safe. Last fall's anthrax attacks changed the way America looked at bioterrorism. Overnight, the fear of bioterrorism moved from a remote possibility, to a reality for which we must be prepared. The bioterrorism bill, which will soon be signed into law, will greatly improve our ability to respond to a biological threat, equipping communities with the tools they need to strengthen our local health centers and educate those first responders, the doctors, nurses and emergency personnel on the front lines. But information for the general public is also key to improving our readiness. I commend the many news organizations that have recognized this fact and continue to get Americans the information they need to feel safe and secure. The unique nature of terrorism requires all of us to work together. While the events of September 11 and the subsequent anthrax attacks have changed the world we live in, coming together to meet a common challenge remains the American way.

Mr. FRIST

Mr. FRIST. Mr. President, under the order, I now call up amendment No. 3725, with a modification now at the desk.

Mr. FRIST. I ask for a clarification. In terms of the time agreement, just so our colleagues will know what has been agreed to, I understand I have 2\1/2\ minutes.

Mr. FRIST. And then the opponents have 2\1/2\ minutes and then 5 minutes for Senator DeWine.

Mr. FRIST. Then Senator Durbin has 2 minutes after that.

Mr. FRIST. Mr. President, Senator Jesse Helms wrote me a letter yesterday regarding the Helms-Frist amendment. In that letter he said: You and I know the stunning facts: Nearly one million children are infected by HIV each year from their mothers during labor, delivery, or breast feeding. Our amendment will prevent hundreds of thousands of innocent young people from being infected in this manner. I wish you and the rest of our colleagues all the best as you deliberate on this important matter. Again, that was Senator Helms in a letter to me yesterday that was entered into the Record earlier tonight. For my colleagues, our amendment very simply strikes, on page 55, lines 10 through 19, and replaces that section with $200 million, $100 million more than in the underlying bill, to add to the U.S. effort to combat the ravages of global HIV/AIDS. The amendment does three things: No. 1, it requires that the new funds be focused on reducing mother- to-child transmission of HIV/AIDS, a problem we know how to respond to, thereby greatly reducing the ravages of HIV/AIDS in innocent newborns. No. 2, it grants flexible authority to the President in spending the money so as to optimize the impact of the AIDS-fighting efforts of our Government. No. 3, it requires that this money be leveraged through funds matched by sources other than the U.S. Government in order to maximize their impact. Mr. President, this is a straightforward amendment that recognizes the travesty, the tragedy, and indeed the challenge we have before us in combating HIV/AIDS globally. Every 10 seconds, one person dies. Every 10 seconds, there are two new infections. Globally we are losing this battle. Finally, in the next several days, the President will introduce a major initiative addressing global HIV/AIDS that will be devoting increased resources with a strategic plan to combat HIV/AIDS. I yield the floor.

Mr. FRIST. Mr. President, we will request a rollcall vote.

Mr. FRIST. Yes.

Mr. FRIST. I ask for the yeas and nays.

Mr. FRIST. I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. FRIST

Mr. FRIST. We initially filed, as the Senator knows, $500 million, which is a sum that I think is appropriate in terms of addressing the issues, having them in the field very shortly.

Mr. FRIST. Madam President, I will quote from the article. This is Senator Helms: In February I said publicly that I was ashamed that I had not done more concerning the world's AIDS pandemic. I told this to a conference organized by Samaritan's Purse, the finest humanitarian organization I know of. Indeed, it is their example of hope and caring for the world's most unfortunate that has inspired action by so many. Samaritan's Purse is led by Franklin Graham, son of Billy Graham--both of whom I count as dearest friends--but the organization was founded by the late Bob Pierce. Dr. Pierce's mission was to ``Let my heart be broken with the things that break the heart of God.'' I know of no more heartbreaking tragedy in the world today than the loss of so many young people to a virus that could be stopped if we simply provided more resources. Those are Senator Helms' words from the Washington Post article. The Helms-Frist amendment provides those resources, focusing on mother-to- child transmission where we know we will have a measurable impact in saving lives. The American public shares the desire to help our fellow men and women across the world. It is a moral imperative of saving innocent lives. We live in a world where drug resistant strains of AIDS, of malaria, and of tuberculosis, all of which are addressed in this Global Fund, are really one economy airline seat away from our shores. There are many reasons for us to fight this fight. It will take more resources. The Helms-Frist amendment, which will be introduced later tonight, is focused on three things: No. 1, a requirement that the new funds be focused on reducing mother to child transmission of AIDS, a problem which lends itself to immediate action with what we know will be an immediate response of saving lives, and that is the emergency component of this legislation. No. 2, a grant of authority to the President to spend the money to optimize the impact of all the AIDS-fighting efforts in our Government. In other words, unlike the Durbin amendment, it does not say that this money goes into just the Global Fund, but it does give the President authority to assess at that point in time how best to spend that money to get the greatest impact. No. 3, the Helms-Frist amendment, which will be coming later tonight, has a requirement that funds not given to the Global Fund--and indeed the President can put these funds into the Global Fund but moneys not put into the Global Fund, indeed have to be matched by sources other than the U.S. Government. The reason being to leverage and maximize our support. I have a letter I would also ask unanimous consent to be printed in the Record. It is to me from Senator Helms, dated June 5.

Mr. FRIST. Madam President, first, the Senator from Illinois has eloquently outlined the challenge, what I consider to be the greatest public health challenge clearly of this generation. I say public health challenge to us as Americans, but equally importantly to us as citizens of the world. The statistics he mentioned are right on target, and they tell the best picture globally of this scourge against which we are fighting a losing battle. Every 10 seconds someone dies of HIV/AIDS, but every 10 seconds there is a new infection in two individuals--two new infections. We have no cure. There is no cure for HIV/AIDS. Second, I agree with the Senator from Illinois, we need to do more. There is absolutely no question in my mind that we have to invest, and we have to invest as the United States, as the global leader. Our leadership is critically important for other nations to see, for private companies to see, and for individuals to see so they will be participants. I agree with the Senator from Illinois that the dollars we spend on HIV/AIDS can do something that really no amendment I have seen on the floor today can with absolute certainty do, and that is to save lives. If resources are handled appropriately when we fight global HIV/AIDS, malaria, and tuberculosis, then each dollar invested, I am absolutely convinced, will save the lives of innocent children who are infected with this virus. This little virus is so adaptable; it moves 100,000 times faster than our own defense systems and tens of thousands of times faster than the best medicines we apply to it. So it is a major challenge for us all. The Senator from Illinois mentioned Senator Helms, and I want to come back to that because I will be offering later tonight a Helms-Frist amendment. Our amendment was initially spelled out, at least its framework, in the editorial in March from which the Senator from Illinois quoted. Our amendment focuses on mother-to-child transmission, and our amendment would, I believe, give greater flexibility to the President than the amendment that is now before the Senate. The Senator from Illinois mentioned Secretary Powell, Secretary Thompson, and Secretary O'Neill, and I will add to that list the President of the United States. We have an opportunity which I think is unheralded, unprecedented, in that we are bringing all elements of modern society together; all political elements, both conservative and liberal; the private sector; the public sector; leaders around the world; the very best of our pharmaceutical companies; the entertainers of the world, all coming together with a spotlight, a focus on a battle we are losing today in a global sense. If there is a point of order later tonight on this underlying amendment, I will support it, but not because of the amount of money in the amendment. The $500 million is too little for where we need to go. The magnitude of the problem is big, and the money we are talking about is tiny. Yet we do need to recognize where the money is coming from, and at what rate it is going to be spent. That $500 million is something that Senator Helms and I both believe in, but, again, we have to recognize what we do tonight is not the answer; it is just another step in a very long journey. I am going to support the point of order against this amendment, but not because of lack of support for the Global Fund. I think it is the best, most innovative, most creative way to pull together the international community. It is not a U.S. fund. It is not a United Nations fund. It is not a World Bank fund. It is a Global Fund independently administered. It was started a year ago. We need to raise a lot of money for it and have it distributed with good peer review. A lot of that money is going out today. I will be asking my colleagues to support the point of order on this amendment, and then I will ask for their support of an amendment by Senator Helms and myself which will be offered after we dispense with this amendment. Why? Because I believe our amendment is more focused. It centers, though it does not commit all the money to, mother-to-child transmission. Secondly, our amendment gives greater flexibility over the use of these funds. The funds will be under the direct control of the President of the United States. And thirdly, these funds will have a more direct impact on saving lives. I am convinced of that. By focusing on mother-to-child transmission, which the Helms-Frist amendment does, we can calculate this impact. The story goes like this: There are 800,000 innocent children born every year into a world of HIV/AIDS, and they become infected. Of every 1,000 pregnant, HIV-infected women who go through delivery, about 200 HIV/AIDS babies will be delivered infected with HIV. If you use nevirapine, a single dose for the mother and one for the child, that number is cut in half. That is why I know a program focused on mother- to-child transmission will ultimately save lives. For every one thousand births to 1,000 HIV positive women, 100 children can be saved from HIV infection. That is why I can say this and be so definite. I mentioned the team that is in place in this administration, and I will reinforce what the Senator from Illinois said when he mentioned Secretaries Powell, Thompson, and O'Neill. The President's commitment is there to provide more resources, not just to the Global Fund, which is important, but resources for our much more comprehensive approach for fighting HIV/AIDS, multilateral and unilateral efforts that include prevention, response, care, and treatment. I do believe we have to link all of those approaches for an effective response; no longer can we say just prevention. The President has increased financing dramatically in the year and a half he has been President. He has promised to do more. He has shown a real empathy for the victims of HIV/AIDS, and he has shown a detailed understanding, to me in our conversations, of the treatments available. He is surrounded, as the Senator said, with people who share that commitment and that desire to do everything possible given the technology, given our understanding, given what we have learned over the last 20 years. Twenty years ago, we did not even know the virus existed. Now we are saying it is the No. 1 problem. Amazing. Twenty years ago, in 1981, nobody had ever heard of HIV/AIDS. But with the President of the United States, under his leadership and with this team, with our support and through such cooperative efforts as the Helms-Frist amendment to increase funding on mother-to-child transmission, we can make a difference. Why are we here today? We agree--Senator Durbin, Senator Specter, and the cosponsors of the bill--we all agree and the reason is simple. The global requirements to combat HIV/AIDS are far greater than the international level of commitment. But it cannot be solved with just a U.S. commitment. It has to be an international commitment. Part of the Helms-Frist amendment will require a matching from other countries and entities to leverage the money we invest. We need to lead, and we will lead, but we will lead the global community together. The amendment which I am offering tonight is the work of Senator Helms. He could not be with us tonight. He recently underwent open heart surgery. And I am please to report that he is recovering well. I know he wanted to be here tonight to offer this amendment. He first announced our intention to take this initiative on March 24 in a Washington Post article. Part of it has been quoted tonight. I ask unanimous consent that the article be printed in the Record.

Mr. FRIST. Basically he says: Obviously, I cannot be in the Senate to introduce our amendment to add $500 million to the fight against HIV. On matters relating to global disease, your demonstrable leadership in the Senate and in Africa has made us more aware of the great needs around the world. The rest of the letter I will refer my colleagues to.

Mr. FRIST. Because of limited time, let me get through and then I will come back to answer the question.

Mr. FRIST. In summary, we have worked together on how to increase funding above the level in the underlying bill in a way that we know in part will be a first step of what has to be done with leadership by the United States in this global endeavor. I have been working over the last several days with the staff of the President of the United States, and I am delighted that sometime over the next several weeks--or next several days--a major initiative will be introduced by this administration addressing many of the issues that are the underlying reason for proceeding with this amendment. Again, I will leave it to the administration to talk about this new commitment that they will unveil shortly, a multiyear plan to bring substantial new resources to this effort. This is not the final word. The amendment offered tonight, whether it is the Helms-Frist amendment or the Durbin amendment, is not the final word on AIDS. We are going to be coming back to this again and again. This is not an easy problem. This is not an easy challenge. I am absolutely convinced, working in this body, working with the House in a bicameral, bipartisan way, which is represented tonight, with this administration, that we can pull the very best out of the United States of America and the global community in order to defeat this little tiny virus, a challenge and a fight that currently we have not quite been able to do.

Mr. FRIST. Absolutely.

Mr. FRIST. That is correct, $200 million totally. We will be striking $100 million in the bill, replacing $200 million. The Senator will strike $100 million and will have $500 million.

Mr. FRIST. It is $100 million in addition to $100 million that is in the underlying bill.

Mr. FRIST. The amendment in the underlying bill, not your amendment or mine, as the Senator pointed out earlier, is $100 million. As I understand it, the amendment of the Senator would take that up to a total of $500 million. Our amendment will take $100 million on top of that with an understanding, as I said earlier, that funds comparable to that $500 million will be laid out by the administration over the next 2 weeks.

Mr. FRIST. I will be offering an amendment later tonight related to this amendment. I would like about 15 minutes, in which case I could handle both of them.

Mr. FRIST. Yes, 15 minutes.

Mr. FRIST. I can handle both of mine later tonight in a 15-minute period.

Mr. FRIST

Mr. FRIST. Madam President, I will be very brief. I have had the opportunity to sit on the Board of Regents of the Smithsonian Institution. I have been in numerous meetings, especially since September and October, addressing this very specific issue. Having listened to the presentation of the people who have studied this issue most carefully inside the Smithsonian Institution, I am very hesitant to back away from the recognition that we have over 730,000 gallons of highly flammable alcohol within about 150 yards of where we are sitting right now. I don't want to overstate or understate, and I read what has been written about this in the last several days. Let me make several points. We are talking about the National Museum of Natural History located on the National Mall, right outside the door. It currently holds tens of thousands of specimens. These specimens are placed in highly flammable alcohol jars. The collections today occupy about 50,000 square feet of space in various areas of the museum. They do not today comply with the fire code that has been written locally in this area, in this region, in this district, in this part of the country. They do not comply with the fire code. They are stacked under a stairwell where we have thousands of people walking over the course of a month. The National Museum of Natural History has 1,200 staff and 25,000 visitors on a weekday who are walking either over, because it is stored under a stairwell there, or around the flammable jars. This issue has been a concern of the Smithsonian. I have been a regent for about 6 years, for some time. For my colleagues who have not been in the room, recent national security reviews highlighting the vulnerability of highly visited public buildings indicate this problem should be resolved as soon as possible. The Smithsonian, as mentioned before, has planned to build a specially designed storage facility at the research and storage complex in Maryland, removing the collections from The Mall area where we have so many people coming from all over the United States of America to visit. We need to remove this as soon as we possibly can. If the Smithsonian can plan it, it is in the underlying plan. If they do that--it will not be done in 2002--those 730,000 gallons will be over there in 2002 and in 2003 and in 2004 and they will be removed in the year 2005. Failure to address this issue now would be a huge mistake on behalf of this body.