[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5836 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 5836

To amend the Public Health Service Act with respect to making progress 
  toward the goal of eliminating tuberculosis, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 19, 2006

     Mr. Brown of Ohio (for himself and Mrs. Wilson of New Mexico) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act with respect to making progress 
  toward the goal of eliminating tuberculosis, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Comprehensive 
Tuberculosis Elimination Act of 2006''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
          TITLE I--CENTERS FOR DISEASE CONTROL AND PREVENTION

      Subtitle A--National Program for Elimination of Tuberculosis

Sec. 101. National program.
                 Subtitle B--Interagency Collaboration

Sec. 111. Advisory council for elimination of tuberculosis.
           Subtitle C--New Tools for Tuberculosis Elimination

Sec. 121. New tools.
              Subtitle D--Authorizations of Appropriations

Sec. 131. Authorizations of appropriations.
                TITLE II--NATIONAL INSTITUTES OF HEALTH

Sec. 201. Activities of National Heart, Lung, and Blood Institute.
Sec. 202. Activities of National institute of Allergy and Infectious 
                            Diseases.
Sec. 203. John E. Fogarty International Center for Advanced Study in 
                            the Health Sciences.
Sec. 204. Loan repayment programs regarding research on tuberculosis.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Each year approximately 9 million people become ill 
        with active tuberculosis (``TB'') and 2 million of those people 
        die. This is a direct result of the disease having the ability 
        to develop resistance to treatments and to travel easily across 
        borders.
            (2) In 2005, there were 14,093 cases of active TB reported 
        in the United States. However, the decline of 3.8 percent in 
        the national TB case rate from 2004 to 2005 was one of the 
        smallest declines in more than a decade.
            (3) In addition to those with active TB, an estimated 10 to 
        15 million people in the United States have latent TB.
            (4) The increasing occurrence of multidrug resistant TB, 
        including extensively drug-resistant TB--which is resistant to 
        at least two main first-line drugs and additionally to three or 
        more of the six classes of second-line drugs--raises concerns 
        of a future epidemic of virtually untreatable TB.
            (5) New tools are needed to more effectively prevent, 
        diagnose, and treat TB. The standard method of diagnosing TB is 
        over 100 years old, and fails to adequately detect TB in 
        children and those coinfected with HIV/AIDS. The newest class 
        of anti-TB drug is 40 years old, while rates of multidrug 
        resistant TB are rising globally.

          TITLE I--CENTERS FOR DISEASE CONTROL AND PREVENTION

      Subtitle A--National Program for Elimination of Tuberculosis

SEC. 101. NATIONAL PROGRAM.

    Section 317E of the Public Health Service Act (42 U.S.C. 247b-6) is 
amended--
            (1) by striking the heading for the section and inserting 
        the following: ``national program for elimination of 
        tuberculosis''; and
            (2) by amending subsection (b) to read as follows:
    ``(b) Research and Development; Demonstration Projects; Education 
and Training.--With respect to the prevention, control and elimination 
of tuberculosis, the Secretary may, directly or through grants to 
public or nonprofit private entities, carry out the following:
            ``(1) Research, with priority given to research and 
        development concerning--
                    ``(A) clinical trials to evaluate the safety and 
                effectiveness of new drugs, diagnostics, and vaccines 
                for latent tuberculosis infection and active 
                tuberculosis;
                    ``(B) epidemiological studies of populations at 
                risk of tuberculosis; and
                    ``(C) field studies to evaluate the effectiveness 
                of new drugs, diagnostics, and vaccines, and evaluation 
                of efforts to eliminate the disease.
            ``(2) Demonstration projects for--
                    ``(A) the development of regional capabilities to 
                prevent, control and eliminate tuberculosis;
                    ``(B) the intensification of efforts to prevent, 
                detect, and treat tuberculosis among African Americans 
                and reduce or eliminate the racial disparity in the 
                incidence of tuberculosis in that population;
                    ``(C) the intensification of efforts to control 
                tuberculosis along the United States-Mexico border and 
                among United States-Mexico binational populations;
                    ``(D) the intensification of efforts to prevent, 
                detect, and treat tuberculosis among foreign-born 
                persons who are in the United States; and
                    ``(E) collaboration with Immigration and Customs 
                Enforcement to identify and treat immigrants with 
                active or latent tuberculosis infection.
            ``(3) A public information and education program.
            ``(4) Education, training and clinical skills improvement 
        activities for health professionals, including allied health 
        personnel and emergency response employees.
            ``(5) Provide support for the Tuberculosis Trials 
        Consortium, the Tuberculosis Epidemiologic Studies Consortium, 
        and Regional Training and Medical Consultation Centers to carry 
        out activities under paragraphs (1) through (4).
            ``(6) Collaboration with international organizations and 
        foreign countries in carrying out such activities.''.

                 Subtitle B--Interagency Collaboration

SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF TUBERCULOSIS.

    (a) In General.--Section 317E(f) of the Public Health Service Act 
(42 U.S.C. 247b-6(f)) is amended--
            (1) by redesignating paragraph (5) as paragraph (6); and
            (2) by striking paragraphs (2) through (4), and inserting 
        the following:
            ``(2) Duties.--The Council shall provide advice and 
        recommendations regarding the elimination of tuberculosis to 
        the Secretary, the Assistant Secretary for Health, and the 
        Director of the Centers for Disease Control and Prevention. In 
        addition, the Council shall, with respect to eliminating such 
        disease, provide to the Secretary and other appropriate Federal 
        officials advice on--
                    ``(A) coordinating the activities of the Public 
                Health Service and other Federal agencies that relate 
                to the disease, including activities under subsection 
                (b); and
                    ``(B) efficiently utilizing the Federal resources 
                involved.
            ``(3) National plan.--
                    ``(A) In general.--In carrying out paragraph (2), 
                the Council shall make recommendations on the 
                development, revision, and implementation of a national 
                plan to eliminate tuberculosis in the United States.
                    ``(B) Consultation.--In carrying out subparagraph 
                (A), the Council shall consult with public and private 
                entities, including--
                            ``(i) individuals who are scientists, 
                        physicians, and other health professionals, who 
                        are not officers or employees of the Federal 
                        Government and who represent the disciplines 
                        relevant to tuberculosis elimination;
                            ``(ii) members of public-private 
                        partnerships established to address the 
                        elimination of tuberculosis ;
                            ``(iii) members of national and 
                        international nongovernmental organizations 
                        established to address tuberculosis 
                        elimination; and
                            ``(iv) members from the general public who 
                        are knowledgeable with respect to tuberculosis 
                        elimination including individuals who have or 
                        have had tuberculosis.
                    ``(C) Certain components of plan.--In carrying out 
                subparagraph (A), the Council shall--
                            ``(i) consider the recommendations of the 
                        Institute of Medicine regarding the elimination 
                        of tuberculosis;
                            ``(ii) consider recommendations for the 
                        involvement of the United States in continuing 
                        global and cross-border tuberculosis control 
                        activities in countries where a high incidence 
                        of tuberculosis directly affects the United 
                        States such as Mexico; and
                            ``(iii) review the extent to which progress 
                        has been made toward eliminating tuberculosis.
            ``(4) Annual report.--The Council shall annually submit to 
        Congress and the Secretary a report on the activities carried 
        under this section, other than subsection (g). Each such report 
        shall include the opinion of the Council on the extent to which 
        its recommendations regarding the elimination of tuberculosis 
        have been implemented, including with respect to--
                    ``(A) activities under subsection (b); and
                    ``(B) the national plan referred to in paragraph 
                (3).
            ``(5) Composition.--The Council shall be composed of--
                    ``(A) representatives from the Centers for Disease 
                Control and Prevention, the National Institutes of 
                Health, the United States Agency for International 
                Development, the Agency for Healthcare Research and 
                Quality, the Health Resources and Services 
                Administration, the United States-Mexico Border Health 
                Commission, and other Federal departments and agencies 
                that carry out significant activities related to 
                tuberculosis;
                    ``(B) State and local tuberculosis control and 
                public health and officials;
                    ``(C) individuals who are scientists, physicians, 
                laboritorians, and other health professionals who 
                represent disciplines relevant to tuberculosis 
                elimination;
                    ``(D) members of national and international 
                nongovernmental organizations established to address 
                the elimination of tuberculosis; and
                    ``(E) members from the general public who are 
                knowledgeable with respect to the elimination of 
                tuberculosis, including individuals who have or have 
                had tuberculosis.''.
    (b) Rule of Construction Regarding Current Membership.--With 
respect to the advisory council under section 317E(f) of the Public 
Health Service Act, the amendments made by subsection (a) may not be 
construed as terminating the membership on such council of any 
individual serving as such a member as of the day before the date of 
the enactment of this Act.

           Subtitle C--New Tools for Tuberculosis Elimination

SEC. 121. NEW TOOLS.

    Section 317E of the Public Health Service Act (42 U.S.C. 247b-6) is 
amended--
            (1) by redesignating subsection (g) as subsection (h); and
            (2) by inserting after subsection (f) the following 
        subsection:
    ``(g) New Tools for Elimination of Tuberculosis.--
            ``(1) Research and development on drugs, diagnostics, and 
        vaccines .--The Secretary, acting through the Director of the 
        Centers for Disease Control and Prevention, shall expand, 
        intensify, and coordinate research and development and related 
        activities of such Centers to develop new tools for the 
        elimination of tuberculosis, including drugs, diagnostics, and 
        vaccines.
            ``(2) Federal tuberculosis task force.--
                    ``(A) Duties.--The Federal Tuberculosis Task Force 
                (established in December 2001 as part of the Centers 
                for Disease Control and Prevention) (in this subsection 
                referred to as the `Task Force') shall provide to the 
                Secretary and other appropriate Federal officials 
                advice on the implementation of paragraph (1), include 
                advice regarding the efficient utilization of the 
                Federal resources involved.
                    ``(B) National plan for new tools development.--In 
                carrying out paragraph (1), the Task Force shall make 
                recommendations on the development of a national plan 
                for the development of new tools for the elimination of 
                tuberculosis, including drugs, diagnostics, and 
                vaccines.
                    ``(C) Consultation.--In developing the national 
                plan under paragraph (1), the Task Force shall consult 
                with--
                            ``(i) scientists, physicians, and other 
                        health professionals and who represent the 
                        specialties and disciplines relevant to the 
                        research under consideration;
                            ``(ii) members from public-private 
                        partnerships or foundations (or both) engaged 
                        in research relevant to research under 
                        consideration;
                            ``(iii) members of national and 
                        international nongovernmental organizations 
                        established to address tuberculosis 
                        elimination;
                            ``(iv) members from the general public who 
                        are knowledgeable with respect to tuberculosis, 
                        including individuals who have or have had 
                        tuberculosis; and
                            ``(v) scientists, physicians, and other 
                        health professionals who reside in a foreign 
                        country with a substantial incidence or 
                        prevalence of tuberculosis, and who represent 
                        the specialties and disciplines relevant to the 
                        research under consideration.
            ``(3) Grants and contracts.--The Secretary shall carry out 
        paragraph (1) directly and through awards of grants, 
        cooperative agreements, and contracts to public and private 
        entities, including--
                    ``(A) public-private partnerships;
                    ``(B) academic institutions, including institutions 
                of higher education;
                    ``(C) research institutions; and
                    ``(D) the Tuberculosis Trials Consortium and the 
                Tuberculosis Epidemiologic Studies Consortium.''.

              Subtitle D--Authorizations of Appropriations

SEC. 131. AUTHORIZATIONS OF APPROPRIATIONS.

    Section 317E of the Public Health Service Act, as amended by 
section 121(1) of this Act, is amended by amending subsection (h) to 
read as follows:
    ``(h) Authorization of Appropriations.--
            ``(1) General program.--
                    ``(A) In general.--For the purpose of carrying out 
                this section, other than subsection (g), there are 
                authorized to be appropriated $528,000,000 for fiscal 
                year 2007, and such sums as may be necessary for each 
                of the fiscal years 2008 through 2011.
                    ``(B) Priority in expenditure of funds.--In 
                expending amounts appropriated under subparagraph (A), 
                the Secretary shall give priority to making grants 
                under subsection (a) to States, which Core grants to 
                States and local tuberculosis programs shall be 
                distributed on the basis of a formula developed by the 
                Secretary that takes into account the level of 
                tuberculosis morbidity in each State, and other 
                relevant factors in each State regarding the disease. 
                The preceding sentence does not require the Secretary 
                to modify the formula that was used by the Secretary 
                for such grants for fiscal year 2006.
            ``(2) New tools.--
                    ``(A) In general.--For the purpose of carrying out 
                subsection (g), there are authorized to be appropriated 
                $100,000,000 for fiscal year 2007, and such sums as may 
                be necessary for each of the fiscal years 2008 through 
                2011.
                    ``(B) Limitation.--The authorization of 
                appropriations established in subparagraph (A) for a 
                fiscal year is effective only if the amount 
                appropriated under paragraph (1) for such year equals 
                or exceeds the amount appropriated to carry out this 
                section for fiscal year 2006.''.

                TITLE II--NATIONAL INSTITUTES OF HEALTH

SEC. 201. ACTIVITIES OF NATIONAL HEART, LUNG, AND BLOOD INSTITUTE.

    Subpart 2 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285b et seq.) is amended by inserting after section 424B the 
following section:

``SEC. 424C. TUBERCULOSIS.

    ``(a) In General.--The Director of the Institute shall expand, 
intensify, and coordinate research and development and related 
activities of the Institute with respect to tuberculosis, including 
activities toward the goal of eliminating such disease.
    ``(b) Certain Activities.--Activities under subsection (a) shall 
include--
            ``(1) enhancing basic and clinical research on 
        tuberculosis; and
            ``(2) expanding research on the relationship between such 
        disease and the human immunodeficiency virus.
    ``(c) Research Education.--
            ``(1) Tuberculosis academic awards.--The Director of the 
        Institute may provide awards to faculty of schools of medicine 
        or osteopathic medicine to assist such faculty in developing 
        high quality curricula in such schools designed to 
        significantly increase the opportunities for interested 
        individuals, including students of the school and practicing 
        physicians and nurses, to learn the principles and practices of 
        preventing, managing, and controlling tuberculosis.
            ``(2) Tuberculosis/pulmonary infection awards.--The 
        Director of the Institute may provide awards to support the 
        career development of clinically trained professionals who are 
        committed to research regarding pulmonary infections and 
        tuberculosis by providing for supervised study and research.
            ``(3) Authorization of appropriations.--
                    ``(A) Tuberculosis academic awards.--For the 
                purpose of carrying out paragraph (1), there are 
                authorized to be appropriated $5,000,000 for fiscal 
                year 2007, and such sums as may be necessary for each 
                of the fiscal years 2008 through 2011.
                    ``(B) Tuberculosis/pulmonary infection awards.--For 
                the purpose of carrying out paragraph (2), there are 
                authorized to be appropriated $5,000,000 for fiscal 
                year 2007, and such sums as may be necessary for each 
                of the fiscal years 2008 through 2011.''.

SEC. 202. ACTIVITIES OF NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS 
              DISEASES.

    Section 447A of the Public Health Service Act (42 U.S.C. 285f-2) is 
amended--
            (1) by redesignating subsection (b) as subsection (c);
            (2) by inserting after subsection (a) the following 
        subsection:
    ``(b) Activities under subsection (a) shall include activities to 
develop a tuberculosis vaccine. Such activities shall be carried out in 
accordance with the blueprint for tuberculosis vaccine development 
described in the report prepared pursuant to the workshop convened in 
March 1998 by the Advisory Council for Elimination of Tuberculosis, the 
Director of the National Vaccine Program, and the Director of the 
Institute.''; and
            (3) in subsection (c) (as so redesignated), in the first 
        sentence--
                    (A) by striking ``and'' after ``1994,''; and
                    (B) by inserting before the period the following: 
                ``, $240,000,000 for fiscal year 2007, and such sums as 
                may be necessary for each of the fiscal years 2008 
                through 2011''.

SEC. 203. JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN 
              THE HEALTH SCIENCES.

    Section 482 of the Public Health Service Act (42 U.S.C. 287b) is 
amended--
            (1) by inserting ``(a) in general.--'' before ``The general 
        purpose'';
            (2) in subsection (a) (as so designated), by inserting 
        after ``Health Sciences'' the following: ``(in this subpart 
        referred to as the `Center')''; and
            (3) by adding at the end the following subsection:
    ``(b) Tuberculosis.--
            ``(1) In general.--In carrying out subsection (a) with 
        respect to tuberculosis, the Center shall expand, intensify, 
        and coordinate international activities of the Center for 
        research and training.
            ``(2) International training program.--In carrying out 
        paragraph (1), the Center shall carry out an international 
        training program regarding tuberculosis. Such program shall be 
        modeled after the international training program carried out by 
        the Center with respect to the human immunodeficiency virus.''.

SEC. 204. LOAN REPAYMENT PROGRAMS REGARDING RESEARCH ON TUBERCULOSIS.

    Part G of title IV of the Public Health Service Act (42 U.S.C. 288 
et seq.) is amended--
            (1) by redesignating the second section 487F as section 
        487G; and
            (2) by inserting after section 487G (as so redesignated) 
        the following section:

          ``loan repayments regarding research on tuberculosis

    ``Sec. 487H.  In carrying out sections 487C, 487E, and 487F, the 
Secretary shall seek to ensure that, for fiscal year 2007 and 
subsequent fiscal years, a portion of amounts appropriated to carry out 
such sections is reserved for the purpose of entering into contracts 
under which (in accordance with the section involved) individuals will 
conduct research on tuberculosis.''.
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