[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4057 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4057

   To amend the Foreign Assistance Act of 1961 to provide increased 
foreign assistance for tuberculosis prevention, treatment, and control.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 22, 2000

 Mr. Brown of Ohio (for himself, Mrs. Morella, Ms. Pelosi, Mr. Waxman, 
 Mr. Bonior, Mr. Coburn, Mr. Stark, Mr. Lantos, Mr. Hall of Ohio, Mr. 
Greenwood, Mr. English, Mr. Neal of Massachusetts, Mr. George Miller of 
    California, Mr. Hinojosa, Mr. Inslee, Mr. Bentsen, Mrs. Meek of 
  Florida, Mr. Green of Texas, Mr. Lewis of Georgia, Mr. Andrews, Mr. 
 Wynn, Mrs. Thurman, Mrs. Wilson, Mr. Frost, Mr. Gonzalez, Mr. Filner, 
   Ms. Jackson-Lee of Texas, Mrs. Capps, Mrs. Lowey, Mr. Baird, Ms. 
 Rivers, Mr. McDermott, Mr. Traficant, and Mr. Bilbray) introduced the 
 following bill; which was referred to the Committee on International 
                               Relations

_______________________________________________________________________

                                 A BILL


 
   To amend the Foreign Assistance Act of 1961 to provide increased 
foreign assistance for tuberculosis prevention, treatment, and control.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Stop Tuberculosis (TB) Now Act''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1)(A) Tuberculosis is one of the greatest infectious 
        causes of death of adults worldwide, killing 2,000,000 people 
        per year--one person every 15 seconds.
            (B) Globally, tuberculosis is the leading cause of death of 
        young women and the leading cause of death of people with HIV/
        AIDS.
            (2) The World Health Organization estimates that one-third 
        of the world's population is infected with the bacteria that 
        causes tuberculosis, including an estimated 10,000,000 to 
        15,000,000 individuals in the United States.
            (3) An estimated 8,000,000 individuals develop active 
        tuberculosis each year.
            (4) Tuberculosis is spreading as a result of inadequate 
        treatment and it is a disease that knows no national borders.
            (5) The threat that tuberculosis poses for Americans 
        derives from the global spread of tuberculosis and the 
        emergence and spread of strains of multi-drug resistant 
        tuberculosis (MDR-TB).
            (6) With over 40 percent of tuberculosis cases in the 
        United States attributable to foreign-born individuals and with 
        the increase in international travel, commerce, and migration, 
        elimination of tuberculosis in the United States depends on 
        efforts to control the disease in developing countries.
            (7) Multi-drug resistant tuberculosis, defined as 
        resistance to the 2 most important anti-tuberculosis drugs, 
        isoniazid and rifampicin, is caused by incorrect or incomplete 
        treatment--where patients do not take all of their medicines 
        regularly for the required period, doctors and health workers 
        prescribe the wrong drugs or the wrong combination of drugs, or 
        the drug supply is unreliable.
            (8) Up to 50,000,000 individuals may be infected with 
        multi-drug resistant tuberculosis.
            (9) The incidence of multi-drug resistant tuberculosis is 
        particularly high in certain regions and populations, such as 
        Russian prisons where an estimated 5 percent of prisoners have 
        active multi-drug resistant tuberculosis.
            (10) In the United States, tuberculosis treatment, normally 
        about $2,000 per patient, skyrockets to as much as $250,000 per 
        patient to treat multi-drug resistant tuberculosis, and 
        treatment may not even be successful.
            (11) Multi-drug resistant tuberculosis kills more than one-
        half of those individuals infected in the United States and 
        other industrialized nations and it is a virtual death sentence 
        in the developing world.
            (12) Tuberculosis is an immense economic drain on families 
        and on nations and is a significant cause of poverty.
            (13) Most cases of tuberculosis and deaths caused by 
        tuberculosis occur among individuals in their most productive 
        years of life, ages 15 to 50.
            (14) Children bear the brunt of the tuberculosis of their 
        parents. Often they are taken out of school to care for a sick 
        parent or to earn money when their parent can no longer work, 
        and few other infectious diseases create as many orphans as 
        tuberculosis.
            (15) There is a highly effective and inexpensive treatment 
        for tuberculosis. Recommended by the World Health Organization 
        as the best curative method for tuberculosis, this strategy, 
        known as Directly Observed Treatment, Short Course (DOTS), 
        includes low-cost effective diagnosis, treatment, monitoring, 
        and recordkeeping, as well as a reliable drug supply. A 
        centerpiece of DOTS is observing patients to ensure that they 
        take their medication and complete treatment.
            (16) DOTS produces high cure rates, prevents the further 
        spread of infection, and prevents development of strains of 
        multi-drug resistant tuberculosis, yet fewer than 1 in 5 of 
        those ill with tuberculosis are receiving DOTS treatment.
            (17) Few public health expenditures provide so much value 
        for so little money as expenditures for the prevention and 
        treatment of tuberculosis. A full course of DOTS drugs costs as 
        little as $11-$20 in developing countries.
            (18) Based on World Bank estimates, DOTS treatment is one 
        of the most cost-effective health interventions available--
        costing just $20-$100 to save a life, and DOTS can produce cure 
        rates of up to 95 percent even in the poorest countries.
            (19) In order to control tuberculosis in the United States 
        in a more effective manner, it is necessary to ensure the 
        effectiveness of tuberculosis control programs worldwide.
            (20) A total of 22 countries contain an estimated 80 
        percent of the tuberculosis cases worldwide. Implementing DOTS 
        programs in these countries must be a global priority. In 
        addition, implementing strategies to treat multi-drug resistant 
        tuberculosis in these countries must also be a global priority.
            (21) Tuberculosis experts estimate that it will cost an 
        additional $1,000,000,000 annually worldwide to control this 
        disease.
            (22) The STOP TB Initiative, under the auspices of the 
        World Health Organization, has established a global goal of 
        reducing tuberculosis deaths by one-half by 2005, reducing the 
        tuberculosis burden by one-half by 2010, and has further 
        established the targets of successfully treating 85 percent of 
        detected infectious cases and detecting 70 percent of such 
        cases by 2005.

SEC. 3. ASSISTANCE FOR TUBERCULOSIS PREVENTION, TREATMENT, AND CONTROL.

    Section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b(c)) is amended by adding at the end the following:
    ``(4)(A) Congress recognizes the growing international problem of 
tuberculosis and the threat its continued existence poses for the 
United States and other nations which had previously largely controlled 
the disease. Congress further recognizes that a cost-effective strategy 
exists to control and treat tuberculosis, but that this treatment 
regime is currently reaching fewer than one in five of those ill with 
the disease, and that it is a major objective of the foreign assistance 
program of the United States to control this disease. To this end 
Congress expects the agency primarily responsible for administering 
this part--
            ``(i) to focus its efforts on the implementation of 
        Directly Observed Treatment, Short Course (DOTS), or other 
        internationally accepted primary tuberculosis control 
        strategies developed in consultation with the World Health 
        Organization, at the local level with the intention of reaching 
        the targets of (I) detection of at least 70 percent of the 
        cases of infectious tuberculosis, (II) the cure of at least 85 
        percent of the cases detected, and (III) the reduction in 
        tuberculosis deaths by one-half, by 2005;
            ``(ii) to focus the efforts described in clause (i) on the 
        highest burden countries identified by the World Health 
        Organization as containing 80 percent of tuberculosis cases 
        globally; and
            ``(iii) to work in collaboration with the World Health 
        Organization, the STOP TB Initiative, the United States Centers 
        for Disease Control, the National Institutes of Health, the 
        International Union Against TB and Lung Disease, and other 
        organizations toward the development and implementation of 
        effective tuberculosis control programs, including strategies 
        to address multi-drug resistant tuberculosis (MDR-TB), at the 
        local level, especially in the highest burden countries.
    ``(B) In conjunction with the submission of the annual request for 
enactment of authorizations and appropriations for foreign assistance 
programs for each fiscal year, the President shall include a report 
that contains an estimate of the detection and cure rates of each 
program, project, or activity to be carried out under the authority of 
subparagraph (A) and progress on reaching the targets described in 
subclauses (I) through (III) of subparagraph (A)(i).
    ``(C)(i) There is authorized to be appropriated for fiscal year 
2001 $100,000,000 to carry out this paragraph.
    ``(ii) Of the amount appropriated pursuant to the authorization of 
appropriations under clause (i), not less than 80 percent of such 
amount shall be used for the diagnosis and treatment of tuberculosis 
for at-risk and affected populations utilizing Directly Observed 
Treatment, Short Course (DOTS), or other internationally accepted 
primary tuberculosis control strategies developed in consultation with 
the World Health Organization. An appropriate percentage of the 
remaining amount appropriated pursuant to the authorization of 
appropriations under clause (i) should be made available for 
implementation of Directly Observed Treatment, Short Course (DOTS-
PLUS), or other internationally accepted tuberculosis control 
strategies, to treat multi-drug resistant tuberculosis, and for global 
tuberculosis coordination and surveillance efforts. In addition, 
assistance provided using amounts appropriated pursuant to the 
authorization of appropriations under clause (i) shall be primarily 
used in those developing countries identified by the World Health 
Organization as having the highest incidence of tuberculosis, with 
special emphasis given to the poorest regions of such countries.
    ``(iii) Amounts appropriated pursuant to the authorization of 
appropriations under this subparagraph are authorized to remain 
available until expended.''.
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