[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1551 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1551

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 5, 2007

Mr. Brown (for himself, Mrs. Hutchison, Mr. Kennedy, Mrs. Clinton, and 
 Mrs. Murray) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 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 2007''.
    (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. Research and development concerning tuberculosis.
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. 205. Authorization of appropriations.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Each year approximately 9,000,000 people become ill 
        with active tuberculosis ( referred to in this section as 
        ``TB''), and it is estimated that 1,600,000 of those people 
        die, a result of critical underinvestment in quality TB control 
        and the research and development of new TB drugs, diagnostics 
        and a vaccine, as well as the comorbid relationship between TB 
        and HIV/AIDS. Such levels of morbidity and mortality are 
        complicated by the disease having the ability to develop 
        resistance to treatments and to travel easily across borders.
            (2) In 2006, there were 13,767 cases of active TB reported 
        in the United States. The average annual decline in the 
        national TB rate slowed from 7.3 percent per year in the period 
        of 1993 to 2000 to 3.8 percent per year in the period of 2000 
        to 2006.
            (3) In addition to those with active TB, an estimated 
        10,000,000 to 15,000,000 people in the United States have 
        latent TB infection.
            (4) The increasing occurrence of multidrug resistant 
        (``MDR'') TB, including extensively drug resistant (``XDR'') 
        TB--which is resistant to at least almost all drugs used to 
        treat TB, including the two recommended first-line drugs and 
        the recommended second-line medications, raises concerns of a 
        future epidemic of virtually untreatable TB.
            (5) To prevent the spread of extensively drug resistant TB, 
        the immediate strengthening of TB control systems must be a 
        priority. This includes improved case detection, strengthened 
        laboratory capacity, rapid implementation of infection control 
        measures, enhanced treatment programs, and immediate support to 
        existing public sector infrastructure.
            (6) The Centers for Disease Control and Prevention is 
        increasingly relied upon globally for its expertise and 
        technical assistance in global tuberculosis preparedness and 
        outbreak response capacity to identify and investigate 
        outbreaks of multidrug resistant and extensively drug resistant 
        TB.
            (7) 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, 
        especially in children and those co-infected with HIV/AIDS. The 
        newest class of anti-TB drug is over 40 years old, while rates 
        of multidrug resistant TB are rising globally. The existing 
        vaccine confers no protection to adolescents and adults, 
        protecting only against severe forms of TB in infants and young 
        children.

          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, treatment, 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, including drug-resistant tuberculosis, 
                that are suitable for use by patients with HIV/AIDS;
                    ``(B) epidemiological studies of populations at 
                risk for tuberculosis; and
                    ``(C) field studies to evaluate the effectiveness 
                of new drugs, diagnostics, and vaccines, to assess the 
                incidence and prevalence of multidrug resistant and 
                extensively drug resistant strains of tuberculosis.
            ``(2) Demonstration projects for--
                    ``(A) the development of regional capabilities to 
                prevent, control and eliminate tuberculosis and prevent 
                mutidrug resistant and extensively drug resistant 
                strains of tuberculosis;
                    ``(B) the intensification of efforts--
                            ``(i) to prevent, detect, and treat 
                        tuberculosis among African Americans, Hispanic 
                        Americans, Asian Americans, and other United 
                        States-born populations with documented health 
                        disparities; and
                            ``(ii) to reduce or eliminate racial 
                        disparities in the incidence of tuberculosis in 
                        these populations;
                    ``(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;
                    ``(E) providing guidance to Immigration and Customs 
                Enforcement in developing risk-based screening 
                procedures based on current epidemiological data;
                    ``(F) the intensification of efforts to increase 
                targeted testing and treatment of latent tuberculosis 
                infection and drug-resistant tuberculosis; and
                    ``(G) the intensification of efforts to prevent, 
                detect, and treat tuberculosis among other high risk 
                populations and settings, including among children and 
                adolescents, homeless persons, detainees and prisoners, 
                HIV-infected persons, and within health care settings.
            ``(3) A public information and education program to include 
        components that raise awareness regarding tuberculosis among 
        the general population as well as those that target populations 
        documented as having high risk for tuberculosis.
            ``(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, 
        the National Laboratory Training Network, 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 intensifying efforts to prevent, treat, 
        control, and eliminate tuberculosis, including efforts that 
        address risks associated with international travel.
            ``(7) Develop, enhance, and expand information technologies 
        that support tuberculosis control, including surveillance and 
        database management systems with cross-jurisdictional 
        capabilities.''.

                 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);
                    ``(B) responding rapidly and effectively to cases 
                of extensively drug resistant strains of tuberculosis; 
                and
                    ``(C) efficiently utilizing the Federal resources 
                involved.
            ``(3) Comprehensive plan.--
                    ``(A) In general.--In carrying out paragraph (2), 
                the Council shall make recommendations on the 
                development, revision, and implementation of a 
                comprehensive 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, laboratorians, 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 officials;
                    ``(C) individuals who are scientists, physicians, 
                laboratorians, 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, 
        vaccines, and public health interventions.--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, vaccines, and public health 
        interventions, such as directly observed therapy and non-
        pharmaceutical intervention.
            ``(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), 
                including advice regarding the efficient utilization of 
                the Federal resources involved.
                    ``(B) Comprehensive plan for new tools 
                development.--In carrying out paragraph (1), the Task 
                Force shall make recommendations on the development of 
                a comprehensive plan for the creation of new tools for 
                the elimination of tuberculosis, including drugs, 
                diagnostics, and vaccines.
                    ``(C) Consultation.--In developing the 
                comprehensive plan under paragraph (1), the Task Force 
                shall consult with--
                            ``(i) scientists, physicians, 
                        laboratorians, 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, 
                        laboratorians, 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 striking subsection (h) and 
inserting the following:
    ``(h) Authorization of Appropriations.--
            ``(1) General program.--
                    ``(A) In general.--For the purpose of carrying out 
                this section, other than subsections (b) and (g), there 
                are authorized to be appropriated $300,000,000 for 
                fiscal year 2008, and such sums as may be necessary for 
                each of the fiscal years 2009 through 2012.
                    ``(B) Reservation for emergency grants.--Of the 
                amounts appropriated under subparagraph (A) for a 
                fiscal year, the Secretary may reserve not more than 25 
                percent for emergency grants under subsection (a) for 
                any State, political subdivision of a States, or other 
                public entity in which there is, relative to other 
                areas, a substantial number of cases of tuberculosis, 
                multidrug resistant tuberculosis, or extensively drug 
                resistant tuberculosis or a substantial rate of 
                increase in such cases.
                    ``(C) Research, demonstration projects, education, 
                and training.--For the purpose of carrying out 
                subsection (b), there are authorized to be appropriated 
                such sums as may be necessary for each of fiscal years 
                2008 through 2012.
                    ``(D) Priority.--In allocating amounts appropriated 
                under subparagraph (A) and not reserved under 
                subparagraph (B), the Secretary shall give priority to 
                allocating such amounts for grants under subsection 
                (a).
                    ``(E) Allocation of funds.--
                            ``(i) Requirement of formula.--Of the 
                        amounts appropriated under subparagraph (A), 
                        not reserved under subparagraph (B), and 
                        allocated by the Secretary for grants under 
                        subsection (a), the Secretary shall distribute 
                        such amounts to grantees under subsection (a) 
                        on the basis of a formula.
                            ``(ii) Relevant factors.--The formula 
                        developed by the Secretary under clause (i) 
                        shall take into account the level of 
                        tuberculosis morbidity in the respective 
                        geographic area and may consider other factors 
                        relevant to tuberculosis in such area.
                            ``(iii) No change to formula required.--
                        This subparagraph does not require the 
                        Secretary to modify the formula that was used 
                        by the Secretary to distribute funds to 
                        grantees under subsection (a) for fiscal year 
                        2007.
            ``(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 2008, and such sums as may 
                be necessary for each of the fiscal years 2009 through 
                2012.
                    ``(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 2007.''.

                TITLE II--NATIONAL INSTITUTES OF HEALTH

SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING TUBERCULOSIS.

    (a) In General.--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 National Institutes of 
Health 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, including drug resistant tuberculosis; and
            ``(2) expanding research on the relationship between such 
        disease and the human immunodeficiency virus.''.
    (b) Research Education.--Part A of title IV of the Public Health 
Service Act (42 U.S.C. 281 et seq.) is amended by adding at the end the 
following:

``SEC. 404I. TUBERCULOSIS ACADEMIC AWARDS.

    ``(a) Tuberculosis Academic Awards.--The Director of the National 
Institutes of Health may provide awards to faculty of schools of 
medicine, osteopathic medicine, nursing, public health, or related 
fields 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.
    ``(b) Tuberculosis/pulmonary Infection Awards.--The Director of the 
National Institutes of Health 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.''.

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 striking ``In carrying out section 446'' and 
        inserting ``(a) In carrying out section 446''; and
            (2) by inserting at the end the following:
    ``(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.''.

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 2008 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. The Secretary shall have sole 
discretion for the administration of activities under this section.''.

SEC. 205. AUTHORIZATION OF APPROPRIATIONS.

    For the purpose of carrying out this title and the amendments made 
by this title, there are authorized to be appropriated such sums as may 
be necessary. Such authorization of appropriations shall be in addition 
to the authorization of appropriations established by section 402A(a) 
of the Public Health Service Act and any other authorization of 
appropriations available for such purpose.
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