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

Senate Joint Resolution 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 framework 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 subordinate 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 authorizing 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 recommendation, be used for carrying out the provisions of this bill under such directions as may be given by the President, and subject to policy guidance by the Secretary of State.

3. We believe also the bill should be revised and simplified 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 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 introduce 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.

4. 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 in the field of international cooperation and aid. We do not believe that it would be wise to include a specific authorization which could be construed by foreign countries as a commitment on the part of the United States to appropriate that amount each year.

5. 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 2 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 appropriated funds or overhasty screening and review of research and training projects.

In 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 to work 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,

ARTHUR S. FLEMMING, Secretary.

MEMORANDUM OF ADDITIONAL RECOMMENDATIONS FOR AMENDMENT OF SENATE JOINT RESOLUTION 41

1. For various reasons, we would prefer to see eliminated from the National Advisory Council for International Melen 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 overall program with which the several operating agencies of the Department are concernedare 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 membership of the Council, of a leader or leaders in fields related to the health of mothers and children; and whether or not the bill so requires, we intend to see to it that these interests are not neglected in the composition of the Council.

2. While the bill (sec. 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 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 a 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 on 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 section 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 (1) of section 7, on page 10, line 17, of the bill, the cross reference to "paragraph 2" should be corrected to read "paragraph (1)”.

4. A somewhat similar problem is presented by the provisions of section 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 training 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 section 2 of the bill specifically mentions the encouragement and support of research planning as one of the objectives of the bill, the provisions of section 7 seem to be limited to research and research training and do not specifically mention the encouragement and support of research planning, as such, as one of the activities authorized. We therefore suggest that section 7 be broadened to in

clude, 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 or rehabilitation 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 accomplishment 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 under the bill. Unless so limited section 7(4) could be interpreted as authorizing a large-scale program of U.S. aid in the construction of research and training facilities for which the only parallel, as respects domestic research, would be the Health Research Facilities Act of 1956 (title VII 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

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.

EXECUTIVE OFFICE OF THE PRESIDENT,

BUREAU OF THE BUDGET, Washington, D.C., March 9, 1959.

Hon. LISTER HILL,

Chairman, Committee on Labor and Public Welfare,
U.S. Senate, Washington, D.C.

MY DEAR MR. CHAIRMAN: This is submitted as a preliminary response to your request for the views of the Bureau of the Budget with respect to Senate Joint Resolution 41, "To establish in the 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 mobilize 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 international cooperation in research, research training, and research planning."

If enacted, this resolution would

(1) Create a new institute within the National Institutes of Health to be known as the National Institute of International Health.

(2) Establish, within the Department of Health, Education, and Welfare, a National Advisory Council for International Medical Research which would consist of the Surgeon General as Chairman, a representative of the Secretary of State, and 16 public members to be appointed by the Secretary of Health, Education, and Welfare.

(3) Authorize annual appropriations of $50 million for grants, loans, and other activities designed to encourage and stimulate research into a broad variety of health problems.

The resolution's broad objective of helping to "mobilize 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 international cooperation in research, research training, and research planning" is consistent with the objective the President outlined his state of the Union message when he stated, "We shall continue and ex

pand our campaign against the afflictions that now bring needless suffering and death to so many of the world's people. We wish to be part of a great shared effort toward the triumph of health.” This Bureau recognizes the importance of international health activities in improving relations among the countries of the world. There are, however, certain aspects of the subject bill which cause us concern.

In the first place, the organizational arrangements established under the legislation would, we believe, further add to the diffusion within the Government of responsibility for dealing with international problems. The arrangements provided the bill complicate the President's efforts to maintain integrated United States establishments overseas, and also contribute to the problem of providing effective coordination of international programs.

A second area of concern involves the manner in which the bill would increase the complexity of United States efforts in the field of international health. The authorities contained in the bill parallel many authorities already in existence. For example, the National Institutes of Health, other parts of the Department of Health, Education, and Welfare, and several agencies outside of that Department also conduct extensive programs in these and related fields. Several important health programs are being carried out pursuant to Presidential authorities contained in the Mutual Security legislation and Public Law 480. The diverse nature of these programs would make it more difficult to avoid duplication as required by section 9 of the bill, unless basic authority is reposed in the President as is the case in the Mutual Security and Public Law 480 programs.

Thirdly, we do not believe that it would be desirable to establish a statutory institute to conduct international health research. Establishment of such an institute might create a serious problem in terms of its relationships to other institutes which are based upon specialized fields of medicine and would even have the same problems vis-a-vis other elements of the Department, as well as programs outside of the Department. Even within the Public Health Service, not all the interests and competencies relating to international health and medical research are centered in the National Institutes of Health.

Finally, we believe the specific statutory authorization of $50 million annually in section 14 of the resolution to be inappropriate. In view of the authorizations already available and the uncertainties regarding any additional amounts that may be needed, a specific authorization appears inappropriate.

In view of the above considerations, the Bureau of the Budget would recommend that Senate Joint Resolution 41 not be enacted in its present form. It would be our hope that the final results of legislation in this area would be to simplify our existing machinery, rather than making it even more complicated. The Bureau agrees with the statements made by several sponsors of Senate Joint Resolution 41 that greater coordination of this country's efforts on behalf of world health is needed. Several alternatives for handling this problem of coordination have been explored. The President's forthcoming Mutual Security Message will contain recommendations for continuing and expanding these programs.

The Bureau of the Budget would not object to enactment of Senate Joint Resolution 41 if it were amended in the indicated respects.

Sincerely yours,

MAURICE H. STANS, Director. The CHAIRMAN. Before we hear our first witness, I want to read a letter to me from the most remarkable person in this world, Miss Helen Keller. Writing from her home at Westport, Conn., under date of February 17, 1959, she says:

It is my heartfelt desire that the bill now before Congress for the creation of an International Center for Medical and Health Research as one of the National Institutes of Health shall be passed, and benefit the world.

I have traveled in many countries as a representative of the American Foundation for Overseas Blind-Japan and Korea, Africa, the Far East, and the Middle East. I have met their people and their governments, urging them to assist the blind and the deaf of the world, and I know from personal experience how beneficial an international research institute can be for all mankind. A civilization is truly great only when its name pronounced illuminates progressive thought, a horizon of constructive humanity. It is strong and uplifting when its thoughts germinate ideas that will prevail everywhere and compel the world upward.

Heartily I thank you in behalf of all our citizens for your great, wise leadership in raising the levels of medical research, education, and services, and for the establishment of many desperately needed hospitals through the Hill-Burton bill. Then she has a personal word for the chairman, since we were both born in the State of Alabama. And she closes with these words:

With cordial greetings and earnest prayers for the success of the resolution, I am Sincerely Yours

HELEN KELLER.

Our first witness this morning certainly needs no introduction to any American audience. He is the chairman of the Committee on Health for Peace, a great soldier, a great patriot, and a great AmericanGen. Omar Bradley.

General, we welcome you here. We feel honored and privileged to have you. And we will now be delighted to have you proceed, sir, and make any statement you see fit.

STATEMENT OF GENERAL OF THE ARMY OMAR N. BRADLEY

General BRADLEY. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, I am pleased to be asked to appear before your committee in such a worthwhile cause.

The speech made by your chairman to the Senate on August 13, 1958, stated very clearly the purposes of this proposed legislation. I am in hearty accord with these purposes. While I am not so well qualified to comment on the provisions of this resolution as are some others who will appear before you, I have had some experience in the conduct of medical and rehabilitation research and in some phases of international relations.

For over 2 years, as Administrator of Veterans' Affairs in 1945 to 1947, I was charged with the establishment and maintenance of proper medical care for over 100,000 hospitalized veterans. We also had a major problem of assisting in the rehabilitation of disabled veterans. During this period I was fortunate in having the assistance of several outstanding men either full time or as consultants.

I remember that we tried to increase the laboratory facilities of our hospitals, and encouraged the most up-to-date techniques in medicine and surgery.

More recently, in 1954 to 1957, I was associated with the California Institute for Cancer Research.

In international relations I have had some experience in working with people of other countries, particularly those of NATO. Thus I know something of the value of having common interests.

While the dangers of armed conflict between nations are due primarily to conflicts of interests or differences in ideology, I believe that any field of common interest, or common effort, or exchange of ideas, tends to a better understanding of each other's views and contributes to an eventual lessening of tensions.

We spend large sums to help the peoples of countries that have less of the material things than ourselves. Probably one of the greatest contributions we could make would be assistance in solving the health and rehabilitation problems of our neighbors-and today with the progress in means of travel, every nation in the world is our neighbor. Some peoples have been unable to avail themselves of cures or preive means already developed.

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