[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 968 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                 S. 968

   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 22, 2007

    Mrs. Boxer (for herself, Mr. Smith, Mr. Durbin, and Mr. Brown) 
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 
2007''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Tuberculosis is one of the greatest infectious causes 
        of death of adults worldwide, killing 1.6 million 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 8.8 million 
        individuals develop active tuberculosis each year.
            (3) Tuberculosis is the leading infectious 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 36 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 both 
        multi-drug resistant tuberculosis (MDR-TB) and extensively drug 
        resistant tuberculosis (XDR-TB), represents both a critical 
        challenge to the global control of tuberculosis and a serious 
        worldwide public health threat. XDR-TB, which is characterized 
        as being MDR-TB with additional resistance to multiple second-
        line anti-tuberculosis drugs, is associated with worst 
        treatment outcomes of any form of tuberculosis. XDR-TB is 
        converging with the HIV epidemic, undermining gains in HIV 
        prevention and treatment programs and requires urgent 
        interventions. Drug resistance surveillance reports have 
        confirmed the serious scale and spread of tuberculosis with 
        XDR-TB strains confirmed on six continents. Demonstrating the 
        lethality of XDR-TB, an initial outbreak in Tugela Ferry, South 
        Africa killed 52 of 53 patients with hundreds more cases 
        reported since. Of the world's regions, sub-Saharan Africa 
        faces the greatest gap in capacity to prevent, find, and treat 
        XDR-TB.
            (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 and extensively drug resistant tuberculosis, which 
        are 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 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 
                extensively drug resistant tuberculosis; and
                    (C) conduct programmatically-relevant clinical and 
                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 Government of the United States has established 
development programs, particularly in countries with the highest burden 
of tuberculosis and other countries with high rates of tuberculosis, 
the United States Government should prioritize the achievement of the 
following goals 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 sputum smear-positive cases of tuberculosis 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--
            (1) in the heading, by striking ``Authorization'' and 
        inserting ``Assistance Required''; and
            (2) 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 and specific 
strategies related to addressing extensively drug resistant 
tuberculosis (XDR-TB).''.
    (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 six-point strategy to reduce tuberculosis developed by the 
        World Health Organization. The strategy is described in the 
        Global Plan to Stop TB 2007-2016: 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 2016.''.
    (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 burden 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 $330,000,000 for fiscal 
year 2008 and not less than $450,000,000 for fiscal year 2009 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 $70,000,000 for fiscal year 2008 and 
$100,000,000 for fiscal year 2009. 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>