, DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
WASHINGTON

MAR 9 1959

Dear Mr. Chairman:

This letter is in response to your request of February 5,
1959, for a report on S.J.Res. 41, a bill “fo establish inthe
Department of Health, Education, and Welfare the National Advisory
Council for International Medical Research, and to establish in
the Public Health Service the National Institute for International
Medical Research, in order to help mébilize the efforts of medical
scientists, research workers,’ technologists, teachers, and members
of the health professions generally, in the United States and
abroad, for assault upon disease, disability and the impairments
of man and for the improvement of the health of man through inter-
national cooperation in research, research training, and research
planning.”

In his last two addresses on the State of the Union the

. President has called for intensified effort in international

, cooperation in the health field, in order to give in this way

' gonerete expression to the desire of the people of the world for —
peace. Thus, in 1958, as an indication of our willingness to
engage in such "works of peace," he offered om behalf of this
Nation to engage in international cooperative “campaigns against
the diseases that are the common enemy of mortals--such as cancer
and heart disease.” And in 1959, again, he proclaimed the Nation's
“wish to be part of a great shared effort toward the trimph of
health,” and declared that by various means we shall “continue and
expand our campaign against the afflictions that now bring needless
suffering and death to so many of the word's people."

First of all, we want to make it clear that we are in accord
with the purposes and objectives of this bill.

As you undoubtedly recognize, all or most of the activities
which $.J.Res. 41 would authorize are now authorized under existing
daws. We believe, however, that it is advantageous to bring these
authorizations together into one law both from the standpoint of
underlining the support of the Executive and Legislative branches
for these activities and also in the interest of coordinating and
improving the administration of these programs.

: In this connection I desire to stress the fact that for the
fiscal year 1960 the President in his annual Budget Message has
requested the appropriation of nearly $100 million for such inter-
national health activities as (a) contributions to the World Health
= 2 w

Organization ,the Pan American Health Organization, United Nations
Children's Fund and the United Nations; (b) the malaria credication
program and assistance to underdeveloped countries in improving
commmity water supplies; (c) health activities carried out through
the International Cooperation Administration under technical
assistence cgreements with 40-odd other governments; and (d) the
National Institutes of Health research and training grant program.

S.J. Res. 41, however, is in our judgment in need of certain
basic revisions, as well as certain modifications and improvements
in the various authorizations specified, in order to furnish a sound
statutory basis for effective programs of international health and
medical research, and research in rehabilitation, within the frame~
work of the total program of the United States in the field of
international health. Our major recommendations to that end are
stated below. Certain additional recommendations of a more detailed
character are outlined in the enclosed memorandum. And, in order to
focus immediate attention on the basic issues, we are leaving sub-
ordinate or merely technical and drafting suggestions to subsequent
staff assistance or communications.

1. We recommend that basic statutory authority under the bill
be vested in the President, with the expectation that it would be
exercised by him through the Secretary of Health, Education, and
Welfare, under the policy guidance of the Secretary of State. ‘This
would insure that the size and certain other basic characteristics
of this program will be determined, and the program operated, in
the context of the total program of this country in the field of
international health, including activities for health programs of an
_ operational nature as contrasted with research and research training.

2. For the same reason, we recommend that instead of authorize
ing appropriations to be made to the several interested agencies of
this Department, section 14 of the bill authorize that appropriations
_ “to carry out the provisions of this joint resolution" be made to
_ the President as a part of the appropriations structure of the special
assistance program. Funds allotted to this Department by the President
under this authority would thus, in line with the preceding recommenda-
tion, be used for carrying out the provisions of this bill wnder such
directions as may be given by the President, and subject to policy
guidence by the Secretary of State.

3- We believe also that the bill should be revised and simpli-
fied by eliminating what we believe to be excessive detail, with
restrictive implications, relative to the manner in which the duties
.. assigned under the bill are to be administered. In this connection,

“while we consider the inclusion of appropriate provisions for a
=~ 3«

National Advisory Council for International Medical Research to
be desirable, we believe that a mandatory provision for the
establishment of a National Institute for International Medical
_ Research is unnecessary and also unsound in that it would intro-
duce undue rigidity into the structure of the program and make
more difficult the evolution of the most desirable pattern and
structure for administration of the program.

Lh. We strongly urge deletion of the specific statutory
authorization of an appropriation of $50 million annually in
section 14 of the bill. The amounts to be recommended to Congress
for carrying out this bill, if enacted, would have to be determined
from time to time in the context of all of the other relevant
activities inthe field of international cooperation and aid. We
do not believe that it would be wise to include a specific authoriza-
tion which could be construed by foreign countries as a commitment
on the part of the United States to appropriate that amout each year.

9° Because of the administrative difficulties and resulting
delay inherent in the processing of research or research-related
project applications emanating from all parts of the world, we believe
that it would be desirable to provide in the bill that annual
appropriations under the Act remain available for obligation for two
years=~i.e., the year for which appropriated and the succeeding year.
The necessity otherwise of obligating the appropriations within the
fiscal year for which made, might result either in a lapse of
eppropriated funds or over-hasty screening and review of research
and training projects.

im conclusion, we recommend enactment of this bill if amended
along the lines suggested above and in the enclosed memorandum. We
should be glad to furnish drafting assistance and towrk with
Committee staff or Legislative Counsel, as the Committee may desire,
. in incorporating these and other improvements in the bill.

‘ The Bureau of the Budget advises that it perceives no objection
to the submission of this report to your Committee.

Sincerely yours »

 

Secretary |

Hon. Lister Hill |
Chairman, Committee on
Labor and Public Welfare
United States Senate
Washington 25, D. C.

Enélosure
Memorandum of Additional Recommendations for Amendment of S. J. Res. Th

le For various reasons, we would prefer to see eliminated
from the National Advisory Council for International Medical
Research created by the bill, the provisions for ex officio members
from the Department, except the provision that the Surgeon General
be chairman of the Council, thus making the Council more clearly a
citizen advisory body. Adequate provision for getting interchange of
ideas between the Council and all interested agencies of the Department
can and will be made administratively in other ways. And assurance
that specific program fields, such as rehabilitation<-within the overe
all progran with which the several operating agencies of the Department
are concerned=-are given adequate weight and consideration by the
Council is, moreover, inherent in the provision of the bill for
representation of various subject-matter fields in the composition
of the Council. In this connection, we would look with sympathy
upon an amendment to the bill calling for inclusion, in the member=
ship of the Council, of a leader or leaders in fields related to
the health of mothers and childrens and whether or not the bill se
requires, we intend to see to it that these interests are not
neglected in the composition of the Council.

2. While the bill (§9) expressly preserves all existing —

_ authority and responsibility of other agencies in the field of
international cooperation in medical or other scientific endeavors,
it is silent on this point as respects already existing authority —
of the Department and its operating agencies. To avoid any doubt
on this score, we suggest that the bill expressly preserve all ar,
existing statutory authority of the Department and its agencies. ~

3. There appears to be no specific authorization for the
conduct or support, in the United States, of research which is
principally directed toward an international, as contrasted with
@ domestic, health objective. Although some domestic research of
this character can be undertaken under existing law, projects for
this type of research would not, of course, enjoy equal priority
with research more directly connected with our own health problems.
Full use of the available research potential in the United States is
important, since some of the medical research needed to shed light
om the solution of health problems in other parts of the world can
best be done in this country. Also, if the bill were enacted,
domestic research having an international objective should properly
be financed from funds made available under the bill.

We would, therefore,’ recommend that §7 be amended by enlarging
paragraphs (1) and (2) to authorize research having international or
extranational health as its principal objective, to be conducted in

the United States as well as in foreign countries. (Incidentally, in
paragraph (2) of §7, on page 10, line 17, of the bill, the cross=
reference to."paragraph 2" should be corrected to read "paragraph (1)".)
8 ao

4, A somewhat similar problema is presented by the provisions
of §7 (5) of the bill relating to research fellowships and other
research training. This clause does not clearly authorize the award
of fellowships or traineeships to research workers or other scientists
from foreign countries for training in laboratories or other research
institutions in foreign countries-«as contrasted with the award of
fellowships and traineeships either to Americans for training abroad,
or to persons from foreign countries for trainiag in the United States.
We believe that occasions may frequently arise where the broad objectives —
of the bill could be significantly advanced by making it possible for
promising research workers from other countries, to take the training
they need to develop their full capabilities in either their own countries
or in other foreign countries.

5. While the statement of purposes in the "whereas" clauses and
in §2 of the bill specifically mentions the encouragement and support
of research planning as one of the objectives of the bill, the provisions
of §7 seem to be limited to research and research training and do not
specifically mention the encouragement and support of research plenning,
as such, as one of the activities authorized. We therefore suggest that
§7 be broadened to include, as one type of activity which may be
supported through funds made available under the bill, research planning
by international or other organizations interested in developing
broad medical ov «chabilitation research programs.

6. Section 7 (4) of the bill, authorizing grants for improvement
or alteration of facilities, including equipment, for research and.
research training, is, we believe, too broadly written. While authority
to make such grants would be most useful in situations where the
unavailability of adequate facilities and equipment would impede accome
plishment of the objectives of the bill, we think that this authority
should be limited to facilities or equipment needed in connection with
some research or training project which has been approved as having
- sufficient priority to warrant support undex the bill. Unless so
limited, §7 (4) could be interpreted as authorizing a large~scale
program of United States aid in the construction of research and treine
ing facilities for which the only parallel, as respects domestic
research, would be the Health Research Facilities Act of 1956 (title VIT
of the Public Health Service Act).

: 7. We would recommend that, notwithstanding any other provisions
of law, the bill be amended to authorize the employment of persons who
are not citizens of the United States to perform services required in
connection with the administration of the program. It is essential that
we be able to utilize fully the services of scientists and other persons
having special knowledge and experience needed for the sound appraisal
‘of research needs and research potentials throughout the world; many of
the persons who can make the greatest contribution in this work will,

of course, be citizens of foreign countries.
lel

8. It is recommended that the word "respectively" be inserted |
after "Council," on page 13, line 15, of the bill, so as.to avoid any
implication that the annual report to Congress may include only such -
- recommendations as are agreed upon by the Secretary and the Council.
The change would make it clear that such recommendations as either
the Secretary or the Council may deem appropriate will be included

in the annual report and attributed to the Secretary and the Council,
or both, as the case may be.