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






                                                       Calendar No. 415
110th CONGRESS
  1st Session
                                 S. 968

                          [Report No. 110-193]

   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, Mr. Brown, Ms. 
 Stabenow, Mrs. Murray, Mrs. Clinton, Mr. Bingaman, Mr. Menendez, Ms. 
  Cantwell, Mr. Levin, Mr. Sanders, Mr. Johnson, and Mr. Lautenberg) 
introduced the following bill; which was read twice and referred to the 
                     Committee on Foreign Relations

                            October 9, 2007

  Reported, under authority of the order of the Senate of October 4, 
                 2007, by Mr. Biden, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Stop Tuberculosis (TB) Now 
Act of 2007''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    Congress finds the following:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (4) Today, tuberculosis is a leading killer of 
        women of reproductive age.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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:</DELETED>
                <DELETED>    (A) Pursuing high-quality expansion and 
                enhancement of DOTS coverage.</DELETED>
                <DELETED>    (B) Implementing tuberculosis and HIV 
                collaborative activities, preventing and controlling 
                multi-drug resistant tuberculosis, and addressing other 
                special challenges.</DELETED>
                <DELETED>    (C) Contributing to the strengthening of 
                health systems.</DELETED>
                <DELETED>    (D) Engaging all health care providers, 
                including promotion of the International Standards for 
                Tuberculosis Care.</DELETED>
                <DELETED>    (E) Empowering individuals with 
                tuberculosis and communities.</DELETED>
                <DELETED>    (F) Enabling and promoting research to 
                develop new diagnostics, drugs, vaccines, and program-
                based operational research relating to 
                tuberculosis.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (17) The CDC is assisting countries with a high 
        burden of tuberculosis to--</DELETED>
                <DELETED>    (A) implement the World Health 
                Organization-recommended control strategies by 
                improving the capacity to diagnose and cure individuals 
                with tuberculosis;</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (C) conduct programmatically-relevant 
                clinical and operational research to identify and 
                evaluate new diagnostics, treatment regimes, and 
                interventions to control tuberculosis.</DELETED>

<DELETED>SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS.</DELETED>

<DELETED>    (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:</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) Reduce by half the tuberculosis death and 
        disease burden from the 1990 baseline.</DELETED>
        <DELETED>    ``(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.''.</DELETED>
<DELETED>    (b) Authorization.--Section 104B(c) of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b-3(c)) is amended--</DELETED>
        <DELETED>    (1) in the heading, by striking ``Authorization'' 
        and inserting ``Assistance Required''; and</DELETED>
        <DELETED>    (2) by striking ``is authorized to'' and inserting 
        ``shall''.</DELETED>
<DELETED>    (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--
</DELETED>
        <DELETED>    (1) in the heading, to read as follows: ``Priority 
        To Stop TB Strategy.--'';</DELETED>
        <DELETED>    (2) in the first sentence, by striking ``In 
        furnishing'' and all that follows through ``, including 
        funding'' and inserting the following:</DELETED>
        <DELETED>    ``(1) Priority.--In furnishing assistance under 
        subsection (c), the President shall give priority to--
        </DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) funding''; and</DELETED>
        <DELETED>    (3) in the second sentence--</DELETED>
                <DELETED>    (A) by striking ``In order to'' and all 
                that follows through ``not less than'' and inserting 
                the following:</DELETED>
        <DELETED>    ``(2) Availability of amounts.--In order to meet 
        the requirements of paragraph (1), the President--</DELETED>
                <DELETED>    ``(A) shall ensure that not less 
                than'';</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (C) by striking ``including'' and all that 
                follows and inserting the following:</DELETED>
                <DELETED>    ``(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.''.</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (1) by redesignating subsection (f) as subsection 
        (g); and</DELETED>
        <DELETED>    (2) by inserting after subsection (e) the 
        following new subsection:</DELETED>
<DELETED>    ``(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).''.</DELETED>
<DELETED>    (e) Definitions.--Section 104B(g) of the Foreign 
Assistance Act of 1961, as redesignated by subsection (d)(1), is 
amended--</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (2) by adding after paragraph (5) the following 
        new paragraph:</DELETED>
        <DELETED>    ``(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.''.</DELETED>
<DELETED>    (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)''.</DELETED>
<DELETED>    (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.</DELETED>

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

<DELETED>    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.</DELETED>

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 20 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. 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 United States Agency for International Development 
        (USAID) and the Centers for Disease Control and Prevention 
        (CDC) are actively involved with global tuberculosis control 
        efforts. Because the global tuberculosis epidemic directly 
        impacts tuberculosis in the United States, Congress has urged 
        the CDC each year to increase its involvement with 
        international tuberculosis control efforts.
            (17) USAID is the lead United States Government agency 
        involved in international efforts to prevent, treat, and 
        control tuberculosis, working in close partnership with the CDC 
        and with the President's Emergency Plan for HIV/AIDS Relief. 
        USAID's goal is to contribute to the global reduction of 
        morbidity and mortality associated with tuberculosis by 
        building country capacity to prevent and cure the disease and 
        achieve global targets of 70 percent case detection and 85 
        percent treatment success rates. USAID provides support for 
        tuberculosis programs in countries that have a high burden of 
        tuberculosis, high TB/HIV prevalence, or have high risk of MDR-
        TB.
            (18) 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 $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.--
            (1) In general.--There are authorized to be appropriated to 
        the President up to $400,000,000 for fiscal year 2008 and up to 
        $550,000,000 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.
            (2) Availability for cdc.--Of the amounts appropriated 
        pursuant to the authorization of appropriations under paragraph 
        (1), up to $70,000,000 may be available for fiscal year 2008 
        and up to $100,000,000 may be available for fiscal year 2009 
        for the Centers for Disease Control and Prevention for the 
        purpose of carrying out global tuberculosis activities.
            (3) Availability until expenditure.--Amounts appropriated 
        pursuant to the authorization of appropriations under paragraph 
        (1) shall remain available until expended.
                                                       Calendar No. 415

110th CONGRESS

  1st Session

                                 S. 968

                          [Report No. 110-193]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                            October 9, 2007

                       Reported with an amendment