[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2465 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 2465

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 28, 2006

  Mrs. Boxer (for herself, Mr. Smith, and Mr. Durbin) introduced the 
 following bill; which was read twice and referred to the Committee on 
                           Foreign Relations

_______________________________________________________________________

                                 A BILL


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

    This Act may be cited as the ``Stop Tuberculosis (TB) Now Act of 
2006''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Tuberculosis is one of the greatest infectious causes 
        of death of adults worldwide, killing nearly 2,000,000 people 
        per year--one person every 15 seconds.
            (2) One-third of the world's population is infected with 
        the tuberculosis bacterium and an estimated 9,000,000 
        individuals develop active tuberculosis each year.
            (3) Tuberculosis is the leading killer among individuals 
        who are HIV-positive due to their weakened immune systems, and 
        it is estimated that one-third of people with HIV infection 
        have tuberculosis.
            (4) Today, tuberculosis is a leading killer of women of 
        reproductive age.
            (5) There are 22 countries that account for 80 percent of 
        the world's burden of tuberculosis. The People's Republic of 
        China and India account for 35 percent of all estimated new 
        tuberculosis cases each year.
            (6) Driven by the HIV/AIDS pandemic, incidence rates of 
        tuberculosis in Africa have more than doubled on average since 
        1990, making it the only region in the world in which 
        tuberculosis rates are not currently stabilized or declining. 
        The problem is so pervasive that in August 2005, African Health 
        Ministers and the World Health Organization (WHO) declared 
        tuberculosis to be an emergency in Africa.
            (7) The wide extent of drug resistance, including multi-
        drug resistant tuberculosis (MDR-TB), in Eastern Europe and 
        other parts of the world represents a critical challenge to the 
        global control of tuberculosis. Drug resistance surveillance 
        reports have confirmed the serious scale and spread of 
        tuberculosis in Eastern Europe with tuberculosis strains often 
        resistant to all first line drugs and also to some second line 
        drugs.
            (8) With more than 50 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. Recent 
        research has shown that to invest in tuberculosis control 
        abroad, where treatment and program costs are significantly 
        cheaper than in the United States, would be a cost-effective 
        strategy to reduce tuberculosis-related morbidity and mortality 
        domestically.
            (9) 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, which is far more deadly, and more difficult and 
        costly to treat.
            (10) DOTS (Directly Observed Treatment Short-course) is one 
        of the most cost-effective health interventions available today 
        and is a core component of the new Stop TB Strategy.
            (11) The Stop TB Strategy, developed by the World Health 
        Organization, builds on the success of DOTS and ongoing 
        challenges so as to serve all those in need and reach targets 
        for prevalence, mortality, and incidence reduction. The Stop TB 
        Strategy includes six components:
                    (A) Pursuing high-quality expansion and enhancement 
                of DOTS coverage.
                    (B) Implementing tuberculosis and HIV collaborative 
                activities, preventing, and controlling multi-drug 
                resistant tuberculosis, and addressing other special 
                challenges.
                    (C) Contributing to the strengthening of health 
                systems.
                    (D) Engaging all health care providers, including 
                promotion of the International Standards for 
                Tuberculosis Care.
                    (E) Empowering individuals with tuberculosis and 
                communities.
                    (F) Enabling and promoting research to develop new 
                diagnostics, drugs, vaccines, and program-based 
                operational research relating to tuberculosis.
            (12) The Global Plan to Stop TB 2006-2015: Actions for Life 
        is a comprehensive plan developed by the Stop TB Partnership 
        that sets out the actions necessary to achieve the millennium 
        development goal of cutting tuberculosis deaths and disease 
        burden in half by 2015 and thus eliminate tuberculosis as a 
        global health problem by 2050.
            (13) While innovations such as the Global Tuberculosis Drug 
        Facility have enabled low-income countries to treat a standard 
        case of tuberculosis with drugs that cost as little as $16 for 
        a full six-month course of treatment, there are still millions 
        of individuals with no access to effective treatment.
            (14) As the global resource investment in fighting 
        tuberculosis increases, partner nations and international 
        institutions must commit to a corresponding increase in the 
        technical and program assistance necessary to ensure that the 
        most effective and efficient tuberculosis treatments are 
        provided.
            (15) The Global Fund to Fight AIDS, Tuberculosis and 
        Malaria is an important global partnership established to 
        combat these three infectious diseases that together kill 
        millions of people a year. Expansion of effective tuberculosis 
        treatment programs constitutes a major component of Global Fund 
        investment, along with integrated efforts to address HIV and 
        tuberculosis in areas of high prevalence.
            (16) The Centers for Disease Control and Prevention (CDC) 
        is actively involved with global tuberculosis control efforts 
        since the global tuberculosis epidemic directly impacts 
        tuberculosis in the United States, and because Congress has 
        strongly urged the CDC each year to increase its involvement 
        with international tuberculosis control efforts.
            (17) The CDC is assisting countries with a high burden of 
        tuberculosis to--
                    (A) implement the World Health Organization-
                recommended control strategies by improving the 
                capacity to diagnose and cure individuals with 
                tuberculosis;
                    (B) improve the capacity to diagnose, treat, and 
                prevent tuberculosis in HIV-infected individuals and 
                individuals with multi-drug resistant tuberculosis; and
                    (C) conduct programmatically-relevant operational 
                research to identify and evaluate new diagnostics, 
                treatment regimes, and interventions to control 
                tuberculosis.

SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS.

    (a) Policy.--Section 104B(b) of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b-3(b)) is amended to read as follows:
    ``(b) Policy.--It is a major objective of the foreign assistance 
program of the United States to control tuberculosis. In all countries 
in which the United States Agency for International Development has 
established development programs, the following goals in the battle 
against tuberculosis should be achieved by not later than December 31, 
2015:
            ``(1) Reduce by half the tuberculosis death and disease 
        burden from the 1990 baseline.
            ``(2) Sustain or exceed the detection of at least 70 
        percent of cases of tuberculosis infection and the cure of at 
        least 85 percent of those cases detected.''.
    (b) Authorization.--Section 104B(c) of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151b-3(c)) is amended by striking ``is authorized 
to'' and inserting ``shall''.
    (c) Priority to Stop TB Strategy.--Section 104B(e) of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b-3(e)) is amended--
            (1) in the heading, to read as follows: ``Priority to Stop 
        TB Strategy.--'';
            (2) in the first sentence, by striking ``In furnishing'' 
        and all that follows through ``, including funding'' and 
        inserting the following:
            ``(1) Priority.--In furnishing assistance under subsection 
        (c), the President shall give priority to--
                    ``(A) activities described in the Stop TB Strategy, 
                including expansion and enhancement of DOTS coverage, 
                treatment for individuals infected with both 
                tuberculosis and HIV and treatment for individuals with 
                multi-drug resistant tuberculosis (MDR-TB), 
                strengthening of health systems, use of the 
                International Standards for Tuberculosis Care by all 
                providers, empowering individuals with tuberculosis, 
                and enabling and promoting research to develop new 
                diagnostics, drugs, and vaccines, and program-based 
                operational research relating to tuberculosis; and
                    ``(B) funding''; and
            (3) in the second sentence--
                    (A) by striking ``In order to'' and all that 
                follows through ``not less than'' and inserting the 
                following:
            ``(2) Availability of amounts.--In order to meet the 
        requirements of paragraph (1), the President--
                    ``(A) shall ensure that not less than'';
                    (B) by striking ``for Directly Observed Treatment 
                Short-course (DOTS) coverage and treatment of multi-
                drug resistant tuberculosis using DOTS-Plus,'' and 
                inserting ``to implement the Stop TB Strategy; and''; 
                and
                    (C) by striking ``including'' and all that follows 
                and inserting the following:
                    ``(B) should ensure that not less than $15,000,000 
                of the amount made available to carry out this section 
                for a fiscal year is used to make a contribution to the 
                Global Tuberculosis Drug Facility.''.
    (d) Assistance for WHO and the Stop Tuberculosis Partnership.--
Section 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-3) 
is amended--
            (1) by redesignating subsection (f) as subsection (g); and
            (2) by inserting after subsection (e) the following new 
        subsection:
    ``(f) Assistance for WHO and the Stop Tuberculosis Partnership.--In 
carrying out this section, the President, acting through the 
Administrator of the United States Agency for International 
Development, is authorized to provide increased resources to the World 
Health Organization (WHO) and the Stop Tuberculosis Partnership to 
improve the capacity of countries with high rates of tuberculosis and 
other affected countries to implement the Stop TB Strategy.''.
    (e) Definitions.--Section 104B(g) of the Foreign Assistance Act of 
1961, as redesignated by subsection (d)(1), is amended--
            (1) in paragraph (1), by adding at the end before the 
        period the following: ``, including low cost and effective 
        diagnosis, treatment, and monitoring of tuberculosis, as well 
        as a reliable drug supply, and a management strategy for public 
        health systems, with health system strengthening, promotion of 
        the use of the International Standards for Tuberculosis Care by 
        all care providers, bacteriology under an external quality 
        assessment framework, short-course chemotherapy, and sound 
        reporting and recording systems''; and
            (2) by adding after paragraph (5) the following new 
        paragraph:
            ``(6) Stop tb strategy.--The term `Stop TB Strategy' means 
        the strategy described in the Global Plan to Stop TB 2006-2015: 
        Actions for Life, a comprehensive plan developed by the Stop 
        Tuberculosis Partnership that sets out the actions necessary to 
        achieve the millennium development goal of cutting tuberculosis 
        deaths and disease burden in half by 2015.''.
    (f) Annual Report.--Section 104A(e)(2)(C)(iii) of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b-2(e)(2)(C)(iii)) is amended by 
adding at the end before the semicolon the following: ``, including the 
percentage of such United States foreign assistance provided for 
diagnosis and treatment of individuals with tuberculosis in countries 
with the highest rates of tuberculosis, as determined by the World 
Health Organization (WHO)''.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated to the President not less than $225,000,000 for fiscal 
year 2007 and not less than $260,000,000 for fiscal year 2008 to carry 
out section 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b-3), as amended by subsections (a) through (e) of this section.

SEC. 4. AUTHORIZATION OF APPROPRIATIONS FOR GLOBAL TUBERCULOSIS 
              ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    For the purpose of carrying out global tuberculosis activities 
through the Centers for Disease Control and Prevention, there are 
authorized to be appropriated $30,000,000 for fiscal year 2007 and such 
sums as may be necessary for fiscal year 2008. Such authorization of 
appropriations is in addition to other authorizations of appropriations 
that are available for such purposes. Amounts appropriated pursuant to 
the authorization of appropriations under this section shall remain 
available until expended.
                                 <all>