[House Report 113-573]
[From the U.S. Government Publishing Office]
113th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 113-573
======================================================================
TICK-BORNE DISEASE RESEARCH ACCOUNTABILITY AND TRANSPARENCY ACT OF 2014
_______
September 8, 2014.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 4701]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 4701) to provide for scientific frameworks with
respect to vector-borne diseases, having considered the same,
report favorably thereon with amendments and recommend that the
bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 4
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 7
Duplication of Federal Programs.................................. 7
Disclosure of Directed Rule Makings.............................. 7
Advisory Committee Statement..................................... 7
Applicability to Legislative Branch.............................. 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill, as Reported............ 8
Amendment
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Tick-Borne Disease Research
Accountability and Transparency Act of 2014''.
SEC. 2. LYME DISEASE AND OTHER TICK-BORNE DISEASES.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is
amended by adding at the end the following new part:
``PART W--LYME DISEASE AND OTHER TICK-BORNE DISEASES
``SEC. 399OO. RESEARCH.
``(a) In General.--The Secretary shall conduct or support
epidemiological, basic, translational, and clinical research regarding
Lyme disease and other tick-borne diseases.
``(b) Biennial Reports.--The Secretary shall ensure that each
biennial report under section 403 includes information on actions
undertaken by the National Institutes of Health to carry out subsection
(a) with respect to Lyme disease and other tick-borne diseases,
including an assessment of the progress made in improving the outcomes
of Lyme disease and such other tick-borne diseases.
``SEC. 399OO-1. WORKING GROUP.
``(a) Establishment.--The Secretary shall establish a permanent
working group, to be known as the Interagency Lyme and Tick-Borne
Disease Working Group (in this section and section 399OO-2 referred to
as the `Working Group'), to review all efforts within the Department of
Health and Human Services concerning Lyme disease and other tick-borne
diseases to ensure interagency coordination, minimize overlap, and
examine research priorities.
``(b) Responsibilities.--The Working Group shall--
``(1) not later than 24 months after the date of enactment of
this part, and every 24 months thereafter, develop or update a
summary of--
``(A) ongoing Lyme disease and other tick-borne
disease research related to causes, prevention,
treatment, surveillance, diagnosis, duration of
illness, intervention, and access to services and
supports for individuals with Lyme disease or other
tick-borne diseases;
``(B) advances made pursuant to such research;
``(C) the engagement of the Department of Health and
Human Services with persons that participate at the
public meetings required by paragraph (5); and
``(D) the comments received by the Working Group at
such public meetings and the Secretary's response to
such comments;
``(2) ensure that a broad spectrum of scientific viewpoints
is represented in each such summary;
``(3) monitor Federal activities with respect to Lyme disease
and other tick-borne diseases;
``(4) make recommendations to the Secretary regarding any
appropriate changes to such activities; and
``(5) ensure public input by holding annual public meetings
that address scientific advances, research questions,
surveillance activities, and emerging strains in species of
pathogenic organisms.
``(c) Membership.--
``(1) In general.--The Working Group shall be composed of a
total of 14 members as follows:
``(A) Federal members.--Seven Federal members,
consisting of one or more representatives of each of--
``(i) the Office of the Assistant Secretary
for Health;
``(ii) the Food and Drug Administration;
``(iii) the Centers for Disease Control and
Prevention;
``(iv) the National Institutes of Health; and
``(v) such other agencies and offices of the
Department of Health and Human Services as the
Secretary determines appropriate.
``(B) Non-federal public members.--Seven non-Federal
public members, consisting of representatives of the
following categories:
``(i) Physicians and other medical providers
with experience in diagnosing and treating Lyme
disease and other tick-borne diseases.
``(ii) Scientists or researchers with
expertise.
``(iii) Patients and their family members.
``(iv) Nonprofit organizations that advocate
for patients with respect to Lyme disease and
other tick-borne diseases.
``(v) Other individuals whose expertise is
determined by the Secretary to be beneficial to
the functioning of the Working Group.
``(2) Appointment.--The members of the Working Group shall be
appointed by the Secretary, except that of the non-Federal
public members under paragraph (1)(B)--
``(A) one shall be appointed by the Speaker of the
House of Representatives; and
``(B) one shall be appointed by the Majority Leader
of the Senate.
``(3) Diversity of scientific perspectives.--In making
appointments under paragraph (2), the Secretary, the Speaker of
the House of Representatives, and the Majority Leader of the
Senate shall ensure that the non-Federal public members of the
Working Group represent a diversity of scientific perspectives.
``(4) Terms.--The non-Federal public members of the Working
Group shall each be appointed to serve a 4-year term and may be
reappointed at the end of such term.
``(d) Meetings.--The Working Group shall meet as often as necessary,
as determined by the Secretary, but not less than twice each year.
``(e) Reporting.--Not later than 24 months after the date of
enactment of this part, and every 24 months thereafter, the Working
Group--
``(1) shall submit a report on its activities, including an
up-to-date summary under subsection (b)(1) and any
recommendations under subsection (b)(4), to the Secretary, the
Committee on Energy and Commerce of the House of
Representatives, and the Committee on Health, Education, Labor
and Pensions of the Senate;
``(2) shall make each such report publicly available on the
website of the Department of Health and Human Services; and
``(3) shall allow any member of the Working Group to include
in any such report minority views.
``SEC. 399OO-2. STRATEGIC PLAN.
``Not later than 3 years after the date of enactment of this section,
and every 5 years thereafter, the Secretary shall submit to the
Congress a strategic plan, informed by the most recent summary under
section 399OO-1(b)(1), for the conduct and support of Lyme disease and
tick-borne disease research, including--
``(1) proposed budgetary requirements;
``(2) a plan for improving outcomes of Lyme disease and other
tick-borne diseases, including progress related to chronic or
persistent symptoms and chronic or persistent infection and co-
infections;
``(3) a plan for improving diagnosis, treatment, and
prevention;
``(4) appropriate benchmarks to measure progress on achieving
the improvements described in paragraphs (2) and (3); and
``(5) a plan to disseminate each summary under section 399OO-
1(b)(1) and other relevant information developed by the Working
Group to the public, including health care providers, public
health departments, and other relevant medical groups.''.
Amend the title so as to read:
A bill to provide for research with respect to Lyme disease
and other tick-borne diseases, and for other purposes.
Purpose and Summary
H.R. 4701, the ``Tick-Borne Disease Research Accountability
and Transparency Act of 2014'' was introduced on May 21, 2014,
by Rep. Christopher Gibson (R-NY) and referred to the Committee
on Energy and Commerce.
The legislation would establish a working group at the
Department of Health and Human Services to review Federal
efforts concerning Lyme and other tick-borne diseases.
Background and Need for Legislation
Lyme disease is caused by a bacterium and is transmitted to
humans through the bite of an infected tick. Lyme symptoms can
include a skin rash along with fever, headache, and fatigue.
When left untreated, the infection can spread and affect the
joints, heart, and nervous system.Diagnosis is based on
physical symptoms, lab testing, and exposure.\1\ Approximately 10 to
20% of patients treated for Lyme disease can have lingering symptoms
beyond antibiotic treatment. The exact cause of these lingering
symptoms is not known.\2\
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\1\http://www.cdc.gov/lyme/stats/index.html
\2\http://www.cdc.gov/lyme/postLDS/index.html
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Prior to 2012, the Centers for Disease Control and
Prevention (CDC) reported about 30,000 new cases each year in
the U.S., with 95% of those cases in 13 States concentrated in
the Northeast and upper Midwest. Using more indicators,
including medical insurance claims, the CDC now estimates that
around 300,000 people in the U.S. are diagnosed each year with
Lyme disease, making it a substantial and vexing public health
problem.\3\
---------------------------------------------------------------------------
\3\http://www.cdc.gov/media/releases/2013/p0819-lyme-disease.html
---------------------------------------------------------------------------
H.R. 4701, the ``Tick-Borne Disease Research Accountability
and Transparency Act of 2014'' would help to accelerate
improved methods for prevention, diagnosis, and treatment of
Lyme disease. The bill would establish a working group to
prepare a report that would summarize Federal research efforts
related to Lyme disease and other tick-borne diseases. Informed
by the report prepared by the working group, the Secretary of
Health and Human Services (HHS) would develop a strategic plan
to improve health outcomes.
Hearings
The Committee on Energy and Commerce has not held hearings
on the legislation.
Committee Consideration
On June 19, 2014, the Subcommittee on Health met in open
markup session and forwarded H.R. 4701, as amended, to the full
Committee consideration, by a voice vote. On July 30, 2014, the
Committee met in open markup session and approved H.R. 4701, as
amended, by a voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
approved H.R. 4701. A motion by Mr. Upton to order H.R. 4701
reported to the House, with amendment, was agreed to by a voice
vote.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee has not held hearings
on this legislation.
Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(1) of rule XIII of the House of
Representatives, the goal of the legislation is the
continuation of research and the establishment of working group
on Lyme disease and other tick-borne diseases.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
4701 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI,
the Committee finds that H.R. 4701 contains no earmarks,
limited tax benefits, or limited tariff benefits.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
H.R. 4701--Tick-Borne Disease Research Accountability and Transparency
Act of 2014
Summary: H.R. 4701 would amend the Public Health Service
Act to require the Secretary of the Department of Health and
Human Services (HHS) to conduct or support research of Lyme and
other tick-borne diseases. The National Institutes of Health
(NIH) currently administers research programs related to such
diseases. The authority for discretionary research programs at
the NIH expired at the end of fiscal year 2009. For each year
from 2010 through 2014, however, the Congress appropriated
funds for the NIH to continue operating its discretionary
programs across all areas of research.
The bill also would require that the Secretary of HHS (in
its biennial reports to the Congress) describe actions taken by
NIH to support research of Lyme and other tick-borne diseases
and report on the progress toward improving the outcomes of
such diseases. In addition, the bill would require the
Secretary to establish a permanent interagency working group on
Lyme and tick-borne diseases and to periodically submit to the
Congress a strategic plan for the conduct and support of tick-
borne disease research.
CBO estimates that implementing H.R. 4701 would cost $338
million over the 2015-2019 period, assuming appropriation of
amounts similar to appropriations provided in recent years for
NIH activities related to Lyme and other tick-borne diseases.
Pay-as-you-go procedures do not apply to this legislation
because it would not affect direct spending or revenues.
H.R. 4701 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 4701 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------------
2015 2016 2017 2018 2019 2015-2019
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Levela.......................... 83 85 86 88 90 432
Estimated Outlays....................................... 24 65 78 84 88 338
----------------------------------------------------------------------------------------------------------------
Note: Numbers may not add to totals because of rounding.
a.The amounts shown in the table are roughly equivalent to estimated funding provided in recent years for NIH
activities related to Lyme and other tick-borne diseases, with adjustments for anticipated inflation.
Basis of estimate: For this estimate, CBO assumes that H.R.
4701 will be enacted early in fiscal year 2015, that the
necessary amounts will be appropriated each year, and that
outlays will follow historical spending patterns for the
affected programs.
CBO estimates that implementing H.R. 4701 would cost $338
million over the 2015-2019 period, assuming the appropriation
of the necessary amounts. The NIH currently administers
research programs related to Lyme and other tick-borne
diseases. Authority for discretionary research programs at NIH
expired at the end of fiscal year 2009. However, since 2009 the
Congress has appropriated funds for NIH to continue operating
its research programs. The Congress appropriated about $30
billion to NIH for fiscal year 2014. CBO estimates that, of
that total, NIH allocated $82 million for activities related to
Lyme and other tick-borne diseases. The agency plans to
allocate a similar amount to such activities in 2015.
H.R. 4701 would direct NIH to conduct or support research
activities related to Lyme and other tick-borne diseases.
Because authority for discretionary research programs funded by
NIH has expired under section 402A of the Public Service Act,
estimated changes in discretionary costs associated with
implementing H.R 4701 reflect the total costs of all NIH-funded
research activities related to Lyme and tick-borne diseases for
fiscal years 2015 through 2019, assuming the availability of
appropriated funds. CBO estimates that the annual costs for
such research activities in each of years 2015 through 2019
would be similar to appropriated funds allocated for research
on Lyme and tick-borne diseases at NIH in recent years. CBO
expects that the bill would primarily affect research
activities supported by NIH. However, the legislation could
also affect programs administered by other HHS agencies, such
as the Centers for Disease Control and Prevention.
H.R. 4701 also would establish a permanent interagency
working group on Lyme and tick-borne diseases by expanding an
existing working group within HHS to consist of 14 individuals
(including nonfederal members of the public). The working group
would be required to meet at least twice a year and to submit a
report to the Congress on its activities every 24 months. The
bill would also require that the Secretary submit to the
Congress a strategic plan for the conduct and support of
research relating to Lyme and other tick-borne diseases every
five years (starting the third year after the date of enactment
of the bill). CBO estimates that those activities would cost
about $1 million a year, subject to the availability of
appropriated funds.
Pay-As-You-Go considerations: None.
Intergovernmental and private-sector impact: H.R. 4701
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal costs: Jamease Miles; Impact
on state, local, and tribal governments: J'nell L. Blanco;
Impact on the private sector: Alexia Diorio.
Estimate approved by: Peter H. Fontaine, Assistant Director
for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Duplication of Federal Programs
No provision of H.R. 4701 establishes or reauthorizes a
program of the Federal government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Disclosure of Directed Rule Makings
The Committee estimates that enacting H.R. 4701 would not
specifically direct a rulemaking within the meaning of 5 U.S.C.
551.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 states the legislation may be cited as the
``Tick-Borne Disease Research Accountability and Transparency
Act of 2014''.
Section 2. Lyme disease and other tick-borne diseases
Section 2 would authorize the Secretary of HHS to conduct
or support research regarding Lyme disease and other tick-borne
diseases and include information on Lyme disease in the
National Institutes of Health (NIH) biennial report.
The section would establish a permanent working group known
as the Interagency Lyme and Tick-Borne Disease Working Group
and include Federal and non-Federal members appointed by the
Secretary of HHS and Congress. The working group would prepare
a report that summarizes Federal activities related to Lyme
disease and other tick-borne diseases and submit the results to
the Secretary and Congress within 24 months.
The Committee believes it is important to form an
Interagency Lyme and Tick-Borne Disease Working Group to
examine Lyme and tick-borne disease research that complies with
Federal Advisory Committee Act (FACA) and facilitates an
opportunity to ensure people work together to improve patient
health outcomes. To that end, the Working Group should
represent a balanced set of viewpoints. Members should be
highly qualified Lyme disease experts whose interests do not
conflict with the goals of the working group. The Committee
intends that the non-Federal public physicians and other
medical providers, scientists, or researchers appointed to
serve on the Working Group shall have appropriate expertise,
education, and scientific credentials to be qualified and
experienced in diagnosing, treating, or researching Lyme
disease and other tick-borne diseases.
To ensure compliance with applicable conflict of interest
requirements, the Committee expects that the Secretary will
deem all non-Federal employee appointees to the Working Group
as Special Government Employees (SGEs). As such, the Committee
strongly urges the Secretary to identify a balanced and
qualified working group and avoid conflicts of interest that
would not improve health outcomes for patients with Lyme or
other tick-borne diseases. In determining whether a potential
appointee to the Working Group has a financial conflict of
interest, the Committee strongly encourages the Secretary to
examine issues related to significant financial gain from
treating patients diagnosed with Lyme disease.
The Committee intends that the Working Group examine Lyme
disease and other tick-borne diseases, including Rocky Mountain
Spotted Fever, ehrlichia, anaplasma, babesiosis, Borrelia
miyamotoi, Ehrlichia muris, Rickettsia parkeri, and Powassan
virus.
The Committee would like the report of the Working Group to
be shared with Congress at the same time that it is shared with
the Secretary.
The Committee supports the current research efforts at HHS
and urges communication and coordination among all working
groups at HHS that work on Lyme disease and other tick-borne
diseases. Therefore, the Committee encourages HHS to review the
work of any other Lyme working groups that operate at HHS and
share that information with the working group established in
this legislation.
The section would authorize the Secretary of HHS to submit
a strategic plan, informed by the report of the working group,
to improve health outcomes for those suffering from Lyme
disease and other tick-borne diseases.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
PART W--LYME DISEASE AND OTHER TICK-BORNE DISEASES
SEC. 399OO. RESEARCH.
(a) In General.--The Secretary shall conduct or support
epidemiological, basic, translational, and clinical research
regarding Lyme disease and other tick-borne diseases.
(b) Biennial Reports.--The Secretary shall ensure that each
biennial report under section 403 includes information on
actions undertaken by the National Institutes of Health to
carry out subsection (a) with respect to Lyme disease and other
tick-borne diseases, including an assessment of the progress
made in improving the outcomes of Lyme disease and such other
tick-borne diseases.
SEC. 399OO-1. WORKING GROUP.
(a) Establishment.--The Secretary shall establish a permanent
working group, to be known as the Interagency Lyme and Tick-
Borne Disease Working Group (in this section and section 399OO-
2 referred to as the ``Working Group''), to review all efforts
within the Department of Health and Human Services concerning
Lyme disease and other tick-borne diseases to ensure
interagency coordination, minimize overlap, and examine
research priorities.
(b) Responsibilities.--The Working Group shall--
(1) not later than 24 months after the date of
enactment of this part, and every 24 months thereafter,
develop or update a summary of--
(A) ongoing Lyme disease and other tick-borne
disease research related to causes, prevention,
treatment, surveillance, diagnosis, duration of
illness, intervention, and access to services
and supports for individuals with Lyme disease
or other tick-borne diseases;
(B) advances made pursuant to such research;
(C) the engagement of the Department of
Health and Human Services with persons that
participate at the public meetings required by
paragraph (5); and
(D) the comments received by the Working
Group at such public meetings and the
Secretary's response to such comments;
(2) ensure that a broad spectrum of scientific
viewpoints is represented in each such summary;
(3) monitor Federal activities with respect to Lyme
disease and other tick-borne diseases;
(4) make recommendations to the Secretary regarding
any appropriate changes to such activities; and
(5) ensure public input by holding annual public
meetings that address scientific advances, research
questions, surveillance activities, and emerging
strains in species of pathogenic organisms.
(c) Membership.--
(1) In general.--The Working Group shall be composed
of a total of 14 members as follows:
(A) Federal members.--Seven Federal members,
consisting of one or more representatives of
each of--
(i) the Office of the Assistant
Secretary for Health;
(ii) the Food and Drug
Administration;
(iii) the Centers for Disease Control
and Prevention;
(iv) the National Institutes of
Health; and
(v) such other agencies and offices
of the Department of Health and Human
Services as the Secretary determines
appropriate.
(B) Non-federal public members.--Seven non-
Federal public members, consisting of
representatives of the following categories:
(i) Physicians and other medical
providers with experience in diagnosing
and treating Lyme disease and other
tick-borne diseases.
(ii) Scientists or researchers with
expertise.
(iii) Patients and their family
members.
(iv) Nonprofit organizations that
advocate for patients with respect to
Lyme disease and other tick-borne
diseases.
(v) Other individuals whose expertise
is determined by the Secretary to be
beneficial to the functioning of the
Working Group.
(2) Appointment.--The members of the Working Group
shall be appointed by the Secretary, except that of the
non-Federal public members under paragraph (1)(B)--
(A) one shall be appointed by the Speaker of
the House of Representatives; and
(B) one shall be appointed by the Majority
Leader of the Senate.
(3) Diversity of scientific perspectives.--In making
appointments under paragraph (2), the Secretary, the
Speaker of the House of Representatives, and the
Majority Leader of the Senate shall ensure that the
non-Federal public members of the Working Group
represent a diversity of scientific perspectives.
(4) Terms.--The non-Federal public members of the
Working Group shall each be appointed to serve a 4-year
term and may be reappointed at the end of such term.
(d) Meetings.--The Working Group shall meet as often as
necessary, as determined by the Secretary, but not less than
twice each year.
(e) Reporting.--Not later than 24 months after the date of
enactment of this part, and every 24 months thereafter, the
Working Group--
(1) shall submit a report on its activities,
including an up-to-date summary under subsection (b)(1)
and any recommendations under subsection (b)(4), to the
Secretary, the Committee on Energy and Commerce of the
House of Representatives, and the Committee on Health,
Education, Labor and Pensions of the Senate;
(2) shall make each such report publicly available on
the website of the Department of Health and Human
Services; and
(3) shall allow any member of the Working Group to
include in any such report minority views.
SEC. 399OO-2. STRATEGIC PLAN.
Not later than 3 years after the date of enactment of this
section, and every 5 years thereafter, the Secretary shall
submit to the Congress a strategic plan, informed by the most
recent summary under section 399OO-1(b)(1), for the conduct and
support of Lyme disease and tick-borne disease research,
including--
(1) proposed budgetary requirements;
(2) a plan for improving outcomes of Lyme disease and
other tick-borne diseases, including progress related
to chronic or persistent symptoms and chronic or
persistent infection and co-infections;
(3) a plan for improving diagnosis, treatment, and
prevention;
(4) appropriate benchmarks to measure progress on
achieving the improvements described in paragraphs (2)
and (3); and
(5) a plan to disseminate each summary under section
399OO-1(b)(1) and other relevant information developed
by the Working Group to the public, including health
care providers, public health departments, and other
relevant medical groups.