1.This Act may be cited as the
Stop Tuberculosis (TB) Now Act of
2007
.
2.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.
3.Assistance to
combat tuberculosis
(a)Section
104B(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–3(b)) is amended
to read as follows:
(b)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)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 StrategySection 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)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)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 PartnershipSection 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 PartnershipIn 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)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)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)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
appropriationsThere 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.
4.Authorization of
appropriations for global tuberculosis activities of the Centers for Disease
Control and PreventionFor 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.
1.This Act may be cited as the
Stop Tuberculosis (TB) Now Act of
2007
.
2.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.
3.Assistance to combat
tuberculosis
(a)Section
104B(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–3(b)) is amended
to read as follows:
(b)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)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
StrategySection 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)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)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 PartnershipSection 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 PartnershipIn 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)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)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)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)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)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
expenditureAmounts appropriated pursuant to the authorization of
appropriations under paragraph (1) shall remain available until
expended.
October 9, 2007
Reported with an amendment