(No. 161) (Approved November 9, 2007) AN ACT STATEMENT OF MOTIVES

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1 (S. B. 952) (No. 161) (Approved November 9, 2007) AN ACT To provide that the Department of Health of Puerto Rico shall develop, approve and publish a plan for Puerto Rico in order to prevent, face, and attempt to control the dengue virus in Puerto Rico, as well as any other mosquito-borne diseases, to coordinate the efforts of the Municipalities of Puerto Rico to control the propagation of mosquitoes, to provide the minimum requirements for the plans to be established by the municipalities, to provide that all municipalities shall develop and formulate municipal plans, to create the Commonwealth and Municipal Fund for the Control of the Dengue Virus and other Mosquito-borne Diseases, to appropriate funds, and for other purposes. STATEMENT OF MOTIVES Puerto Rico was affected by a great dengue epidemic in In said year, approximately 27,000 cases of said disease were reported. By 1969, Puerto Rico suffered another great outbreak of the disease. After 1975, frequent outbreaks of the dengue virus began to appear, including various cases of dengue hemorrhagic fever. To control such epidemics in the seventies and the eighties, campaigns on the use of insecticides and home inspections were implemented in Puerto Rico. However, these strategies proved not to be completely effective. It was concluded that it was necessary to implement in the Island a program for reducing the sources of the virus, with a broader base that would involve individual homes and emphasize on the elimination

2 of the breeding sites of the Aedes Aegypti, the mosquito that carries the dengue virus. Towards the mid-eighties, the Centers for Disease Control and Prevention (CDC) and the Department of Health of Puerto Rico addressed the problem by designing public health strategies directed to prevent and control dengue. Said strategies include, among other measures, a proactive surveillance for the disease based in laboratories, a plan for the control of the mosquito through rapid emergency responses, training for the medical community for clinical diagnosis, and the treatment of dengue hemorrhagic fever, contingency plans for emergency hospitalizations, and the integrated control of the Aedes Aegypti, based in the community, attained through the mobilization of social communities and the communications media. The main purpose of said campaigns was to raise public awareness on dengue, its transmission, and on the actions that citizens must take to take control or prevent the reproduction in their own backyards of the mosquito that carries the virus. During the 1986 dengue virus epidemic, 10,659 cases and 3 deaths were reported. Since 1993, the Dengue Control Program of the Department of Health established an active surveillance system that allows predicting Dengue epidemics. In 1994, another dengue epidemic occurred in which 24,252 suspicious cases were reported, laboratory tests confirmed 5,390 actual cases of which 3 resulted in death. During 1995, laboratory tests confirmed 2,046 cases of dengue and 1,804 cases during Type III Dengue has not reappeared since According to a study entitled Development of Pilot Programmes for Dengue Prevention in Puerto Rico: A Case Study, authored by Gary G. Clark, Duane J. Gubler, Hilda Seda and Carmen Pérez, many lessons have

3 been learned from the initiatives historically developed in Puerto Rico to fight the dengue virus. In accordance with said study, the administration of the Dengue Program in Puerto Rico shall count with the strong commitment of agencies associated to the Program. It is likewise necessary that all the participants of said prevention initiatives learn their roles and be adequately equipped and trained to conduct the tasks entrusted to them. Puerto Rico has a policy implemented by the Department of Health, in performing its salubrious role, directed to address the problem and prevent the propagation of this terrible virus. The Department of Health has a Dengue Division that visits sensitive zones during the seasons more prone to dengue episodes, provides orientation to the residents of the most vulnerable areas, and gives out educational brochures on the preventive measures to be taken to prevent contagion. Unfortunately, these efforts have resulted ineffective, since a public policy has not been established formally, nor any type of regulations requiring the establishment of a broad and comprehensive initiative throughout Puerto Rico directed to the prevention and eradication of this disease that compels a formal integration of all components of public health and environmental control existing at Commonwealth and municipal level as an effective mechanism. The incidence of dengue cases in Puerto Rico continues to increase, with the risk of becoming an epidemic. By August 2004, only 244 dengue cases were reported, whereas by August suspicious cases of dengue were reported. By September 2005, the dengue cases reported in Puerto Rico summed up to approximately 3,000, a number that should concern the population because it is an indication that we are all at risk of

4 contagion. Of these cases, 1552 were reported on the last week of June and the end of August, a period in which a significant increase of cases has been noted. The Secretary of Health has declared a regional dengue outbreak in Arecibo, San Juan, and Bayamón. The authorities of the Department of Health have stated that if the increasing tendency continues, very soon it shall be necessary to declare a dengue epidemic in the Island. This Legislature believes that it is urgent to compel the participation of all components available at Commonwealth and municipal level, to allow for the creation of an integrated dengue prevention and control program in Puerto Rico. It is important to say that, for example, the Department of Health has outlined coordinated strategies of prevention and fumigation with municipalities such as Bayamón, Dorado, Aguadilla, Moca, and Patillas, and is looking forward to join efforts with the municipalities of Guaynabo, Arecibo, Carolina, and San Juan. Through the present legislation it is established that the Department of Health of Puerto Rico shall be compelled to develop, approve, and publish a plan for Puerto Rico to prevent, face, control and attempt to eradicate the dengue virus from Puerto Rico, as well as any other mosquito-borne disease and to coordinate the efforts of the Municipalities of Puerto Rico to control the propagation of mosquitoes. The Department of Health shall establish as well the minimum requirements which shall be contained in the plans to be established by the municipalities. Furthermore, the present legislation compels the municipalities to develop and prepare municipal plans directed to prevent, face, control and attempt to eradicate the dengue virus from said municipality, as well as any other mosquito-borne disease. Said plans shall be approved by the

5 Department of Health, provided that said plans meet the minimum requirements contained in the Commonwealth plan. Since this is a matter of great importance, due to its impact on the general health of the People of Puerto Rico and due to the fact that it is an imminent threat against the life of our citizens, this Legislature deems it necessary and convenient to appropriate resources to be deposited in the fund created herein in order to implement the purposes of this Act. BE IT ENACTED BY THE LEGISLATURE OF PUERTO RICO: Section 1.- Commonwealth Plan for the Management of the Dengue Virus and other Mosquito-borne Diseases. (a) Within ninety (90) days after the date of effectiveness of this Act, the Department of Health, with the advice and cooperation of the Environmental Quality Board, the Puerto Rico Mayors Association, the Puerto Rico Federation of Municipalities and the Department of Education shall develop, approve and publish a plan for Puerto Rico to prevent, face, control and attempt to eradicate the dengue virus in Puerto Rico, as well as any other mosquito-borne diseases and coordinate the efforts of the Municipalities of Puerto Rico to control the propagation of mosquitoes. As part of said Commonwealth plan, the Department of Health shall establish the minimum requirements which shall be contained in the plans to be created by the municipalities to control the dengue virus and other mosquito-borne diseases. Said minimum requirements shall include without being limited to plans to reduce propagation sources, water management,

6 surveillance, public education, mosquito notice and integrated mosquito management, among others. (b) The Department of Health may provide the municipalities with any human, technical, professional and budgetary resources available for them to develop and implement the municipal plans required by Section 2 of this Act, as well as training, acquisition of equipment, and other services required by the municipalities to implement the mosquito-control plan. The Secretary of Health shall establish through regulations the applicable procedures for the allocation of funds to the municipalities as well as the terms and conditions for receiving and administering said funds by the municipalities. Section 2.- Municipal Plans for the Management of the Dengue Virus and other Mosquito-borne Diseases. Adoption. (a) Within one hundred and eighty (180) days after the date of effectiveness of this Act, every municipality shall develop and formulate a plan to prevent, face, control and attempt to eradicate the dengue virus in said municipality, as well as any other mosquito-borne diseases. Said plan shall include a cost estimate of the plan implementation and a report stating the municipal funds that are being used to address said matter, as well as a report on any necessary supplementary funds, if required, for the implementation of the municipal plan. Said municipal plan shall provide a thorough description of all measures in effect in the municipality and any proposed control measures to be followed by the municipality, the identification of personnel, as well as the budgetary resources appropriated for pest management, the funds

7 available, and any necessary additional funds, as well as the time needed for the implementation of the plan. The plan adopted by the municipality shall also include provisions for remitting to the Department of Health periodical reports regarding the monitoring of mosquito-control activities conducted by the municipality as well as any other information required by the Department of Health. (b) The plan adopted by a municipality shall be submitted to the Department of Health for its approval. The Department of Health shall review the plan and approve or disapprove the same within a term not to exceed forty-five (45) days as of its submittal by the municipality. If the Department of Health concludes that the plan adopted by the municipality meets the minimum requirements established by the Department of Health pursuant to Section 1 of this Act, the Department of Health shall approve the plan. If the Department of Health disapproves the plan adopted by the municipality, the Department shall return the same to the municipality, indicating the deficiencies found therein and suggesting any modifications necessary for the approval thereof by the Department. Provided, that any modification to the original plan submitted by a municipality shall be ratified by the Municipal Legislature of said municipality, before submitting the plan again to the Department of Health for approval.

8 Section 3.- The Commonwealth and Municipal Fund for the Control of the Dengue Virus and other Mosquito-borne Diseases. Creation. A non-recurring fund is hereby established in the Department of Health to be administered by the Secretary and separate from any other funds or accounts of the Department of Health, which shall be known as the Commonwealth and Municipal Fund for the Control of the Dengue Virus and other Mosquito-borne Diseases. The moneys deposited in said Fund shall be used exclusively to develop and implement the Commonwealth Plan for the Management of the Dengue Virus and other Mosquito-borne Diseases established by this Act, to review and approve Municipal Plans for the Management of the Dengue Virus and other Mosquito-borne Diseases, to provide supplementary funds to the municipalities for the development and implementation of said plans pursuant to Section 2 of this Act, for training, to acquire equipment and other necessary services so that the municipalities may be able to implement their corresponding plans, and to conduct research related to dengue and any other mosquito-borne diseases. The matching of Fund moneys with any other resources originating from the Commonwealth government, any municipality, federal agencies or private companies is hereby authorized. Section 4.- Budget Appropriation The sum of two million dollars ($2,000,000.00) from unencumbered funds of the Commonwealth Treasury is hereby appropriated, to be covered into the Commonwealth and Municipal Fund for the Control of the Dengue Virus and other Mosquito-borne Diseases, established pursuant to the provisions of Section 3 of this Act. From the sum above, the amount of two hundred fifty thousand dollars ($250,000.00) shall be appropriated to the University of Puerto Rico Graduate School of Public Health, to be used for

9 research related to the dengue virus and other mosquito-borne diseases. The remaining amount of one million seven hundred fifty thousand dollars ($1,750,000.00) shall be covered into the Fund created by this Act and shall be used to comply with its purposes. Section 5.- This Act shall take effect as of Fiscal Year

10 CERTIFICATION I hereby certify to the Secretary of State that the following Act No. 161 (S.B. 952) of the 6 th Session of the 15 th Legislature of Puerto Rico: AN ACT to provide that the Department of Health of Puerto Rico shall develop, approve and publish a plan for Puerto Rico in order to prevent, face, and attempt to control the dengue virus in Puerto Rico, as well as any other mosquito-borne diseases, to coordinate the efforts of the Municipalities of Puerto Rico to control the propagation of mosquitoes, to provide the minimum requirements for the plans to be established by the municipalities, to provide that all municipalities shall develop and formulate municipal plans, to create the Commonwealth and Municipal Fund for the Control of the Dengue Virus and other Mosquito-borne Diseases, to appropriate funds, and for other purposes, has been translated from Spanish to English and that the English version is correct. In San Juan, Puerto Rico, today 15 th of April of Francisco J. Domenech Director