[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4847 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4847

To facilitate effective research on and treatment of neglected tropical 
    diseases through coordinated domestic and international efforts.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 11, 2014

 Mr. Smith of New Jersey (for himself, Mr. Meeks, Mr. Salmon, and Mr. 
 Johnson of Georgia) introduced the following bill; which was referred 
    to the Committee on Energy and Commerce, and in addition to the 
 Committees on Foreign Affairs and Financial Services, for a period to 
      be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To facilitate effective research on and treatment of neglected tropical 
    diseases through coordinated domestic and international efforts.

    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 ``End Neglected Tropical Diseases 
Act''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Statement of policy.
Sec. 4. Findings.
Sec. 5. Definition.
Sec. 6. Rule of construction.
                        TITLE I--FOREIGN AFFAIRS

Sec. 101. Expansion of USAID NTDs Program.
Sec. 102. Actions by Department of State.
Sec. 103. Multilateral development and health institutions.
           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

Sec. 201. Promoting efforts through interagency working groups and 
                            international forums.
Sec. 202. Report on neglected tropical diseases in the United States.
Sec. 203. Centers of excellence.
Sec. 204. Panel on worm infection solutions.

SEC. 3. STATEMENT OF POLICY.

    It is the policy of the United States to support a broad range of 
implementation and research and development activities that work toward 
the achievement of cost-effective and sustainable treatment, control 
and, where possible, elimination of neglected tropical diseases for the 
economic and social well-being for all people.

SEC. 4. FINDINGS.

    Congress finds the following:
            (1) The World Health Organization (WHO) has identified 17 
        neglected tropical diseases (NTDs). Approximately two billion 
        people--almost one-third of the world's population--are at risk 
        of contracting an NTD, and more than 1.4 billion people are 
        currently afflicted with one or more NTDs.
            (2) In 2013, WHO adopted a comprehensive resolution on NTDs 
        recognizing that increased national and international 
        investments in prevention and control of neglected tropical 
        diseases have succeeded in improving health and social well-
        being in many countries.
            (3) NTDs have an enormous impact in terms of disease burden 
        and quality of life. NTDs cause the loss of up to 534,000 lives 
        and 57 million disability-adjusted life years each year. NTDs 
        surpass both malaria and tuberculosis in causing greater loss 
        of life-years to disability and premature death. Many NTDs 
        cause disfigurement and disability, leading to stigma, social 
        discrimination, and societal marginalization.
            (4) NTDs create an economic burden of billions of dollars 
        through the loss of productivity and high costs of health care 
        required for treatment. People afflicted by NTDs are less 
        productive than their healthy counterparts. NTDs jeopardize the 
        ability of people to attend work and school, or to produce at 
        full capacity. For example, controlling one NTD, hookworm, in 
        children can result in a 43-percent increase in future wage 
        earnings.
            (5) The social, economic, and health burden of NTDs falls 
        primarily on low- and middle-income countries, where access to 
        safe water, sanitation, and health care is limited. At least 
        100 countries face two endemic NTD burdens, and 30 countries 
        carry six or more endemic NTDs.
            (6) NTDs are not confined to the developing world, however. 
        Several NTD outbreaks have been reported in the United States 
        and other developed countries, especially among the poor. In 
        the United States, NTDs disproportionately affect people living 
        in poverty, and especially minorities, including up to 2.8 
        million African-Americans with toxocariasis and 300,000 or more 
        people, mostly Hispanic-Americans, with Chagas disease.
            (7) Many NTDs can be controlled, prevented, and even 
        eliminated using low-cost, effective, and feasible solutions. 
        Understanding the economic burden of NTDs on productivity and 
        health care costs can help to assure governments and donors 
        that the resources directed toward NTDs represent a good 
        investment.
            (8) Research and development efforts are immediately needed 
        for all NTDs, especially those for which limited or no 
        treatment currently exists.
            (9) Critical to developing robust NTD control strategies 
        are epidemiological data that identify at-risk populations, 
        ensure appropriate treatment frequency, and inform decisions 
        about when treatment can be reduced or stopped.
            (10) Of the 14 most common NTDs, roughly 80 percent of 
        infections are caused by soil-transmitted helminths (STH) and 
        schistosomiasis. STH are a group of three parasitic worms 
        (roundworms, whipworms, and hookworms) that afflict more than 
        one billion people worldwide, including 600 million school-age 
        children, of whom more than 300 million suffer from severe 
        morbidity. Schistosomiasis is another helminth infection 
        affecting at least 200 million people in developing countries, 
        but some estimates indicate that the true number of people 
        affected may be double or even triple that number.
            (11) The main health problems caused by STH are related to 
        their negative effect on childhood nutritional status, which 
        can cause stunting and wasting. For example, STH infection may 
        lead to anemia, malabsorption of nutrients, loss of appetite, 
        nausea, abdominal pain, diarrhea, and reduced food intake. When 
        such health problems are experienced in early childhood, a peak 
        growth and development period, the mental and physical damage--
        and loss of future productivity and wage-earning potential--
        will likely be irreversible. Schistosomiasis causes end-organ 
        damage to the urinary tract, female genital tract, liver and 
        intestines. It also results in chronic health conditions in 
        children.
            (12) STH and schistosomiasis are also particularly 
        detrimental to the health of women of reproductive age and 
        pregnant women. Their underlying poor iron status makes these 
        women most susceptible to developing anemia. Iron deficiency 
        anemia resulting from hookworm infection during pregnancy has 
        been linked to poor pregnancy outcomes such as prematurity, low 
        birth weight, and impaired lactation. Female genital 
        schistosmiasis may be one of the most common gynecologic 
        conditions in Africa leading to genital pain, itching, and 
        bleeding and markedly increased susceptibility to HIV/AIDS.
            (13) Fortunately, there is a simple, cost-effective 
        solution to STH and schistosomiasis infections: single-dose 
        deworming pills that can be safely administered once or twice 
        annually to those at risk. Pharmaceutical companies have 
        committed to donate the drugs needed to treat all at-risk, 
        school-age children in developing countries. Regular 
        administration of deworming pills reduces morbidity associated 
        with STH and schistosomiasis infections by reducing prevalence 
        and transmission rates.
            (14) The benefits of deworming are immediate and enduring. 
        A rigorous randomized controlled trial has shown school-based 
        deworming treatment to reduce school absenteeism by 25 percent. 
        School-based deworming also benefits young siblings and other 
        children who live nearby but are too young to be treated, 
        leading to large cognitive improvements equivalent to half a 
        year of schooling.

SEC. 5. DEFINITION.

    In this Act, the term ``neglected tropical diseases'' or ``NTDs''--
            (1) means infections caused by pathogens, including 
        viruses, bacteria, protozoa, and helminths that 
        disproportionately impact individuals living in extreme 
        poverty, especially in developing countries; and
            (2) includes--
                    (A) Buruli ulcer (Mycobacterium Ulcerans 
                infection);
                    (B) Chagas disease;
                    (C) dengue or severe dengue fever;
                    (D) dracunculiasis (Guinea worm disease);
                    (E) echinococcosis;
                    (F) foodborne trematodiases;
                    (G) human African trypanosomiasis (sleeping 
                sickness);
                    (H) leishmaniasis;
                    (I) leprosy;
                    (J) lymphatic filariasis (elephantiasis);
                    (K) onchocerciasis (river blindness);
                    (L) rabies;
                    (M) schistosomiasis;
                    (N) soil-transmitted helminthiases (STH) (round 
                worm, whip worm, and hook worm);
                    (O) taeniasis/cysticercosis;
                    (P) trachoma; and
                    (Q) yaws (endemic treponematoses).

SEC. 6. RULE OF CONSTRUCTION.

    Nothing in this Act shall be construed to increase authorizations 
of appropriations for the United States Agency for International 
Development or authorizations of appropriations for the Department of 
Health and Human Services.

                        TITLE I--FOREIGN AFFAIRS

SEC. 101. EXPANSION OF USAID NTDS PROGRAM.

    (a) Findings.--Congress finds the following:
            (1) Since fiscal year 2006, the United States Government 
        has been an essential leading partner in advancing control and 
        elimination efforts for seven targeted neglected tropical 
        diseases: lymphatic filariasis (elephantiasis), onchocerciasis 
        (river blindness), schistosomiasis, soil-transmitted 
        helminthiases (STH) (round worm, whip worm, and hook worm), and 
        trachoma. Additional information suggests that such efforts 
        could also produce collateral benefits for at least three other 
        NTDs: foodborne trematodiases, rabies, and yaws (endemic 
        treponematoses).
            (2) The United States Agency for International Development 
        (USAID) Neglected Tropical Diseases Program has made important 
        and substantial contributions to the global fight to control 
        and eliminate the seven most common NTDs. Leveraging more than 
        $6.7 billion in donated medicines, USAID has supported the 
        distribution of more than one billion treatments in 25 
        countries across Africa, Asia, and Latin America and the 
        Caribbean.
            (3) United States Government leadership has been 
        instrumental in maintaining the global fight against NTDs and 
        is a partner in the 2012 London Declaration on NTDs, which 
        represents a new, coordinated push to accelerate progress 
        toward eliminating or controlling 10 neglected tropical 
        diseases by 2020.
            (4) The USAID NTDs Program is a clear example of a 
        successful public-private partnership between the Government 
        and the private sector and should be judiciously expanded.
    (b) Sense of Congress.--It is the sense of Congress that the USAID 
NTDs Program (as in effect on the date of the enactment of this Act) 
should be modified as follows:
            (1) Provide rapid impact package treatments to as many 
        individuals suffering from NTDs or at risk of acquiring NTDs as 
        logistically feasible.
            (2) Better integrate rapid impact package treatments with 
        programs to control and eliminate HIV/AIDS and malaria, 
        including--
                    (A) by coordinating HIV/AIDS programs with the 
                control of female genital schistosomiasis, now revealed 
                as one of Africa's most important co-factors in its 
                AIDS epidemic; and
                    (B) by coordinating malaria programs with programs 
                to control schistosomiasis and hook worm--together 
                these diseases produce profound and severe anemia.
            (3) Establish school-based NTD programs to provide an 
        opportunity to reach large numbers of school-age children who 
        require treatments for NTDs, including rapid impact package 
        treatments as feasible and at very low cost.
            (4) For other NTDs, such as human African trypanosomiasis 
        (sleeping sickness), chagas disease, leishmaniasis, and dengue 
        fever, develop new approaches to reach the goals relating to 
        the elimination of NTDs as set forth in the World Health 
        Organization (WHO) NTD Roadmap.
    (c) Expansion of Program.--The Administrator of USAID shall expand 
the USAID NTDs Program (as in effect on the date of the enactment of 
this Act) as follows:
            (1) Carry out monitoring and evaluation to provide accurate 
        measurements to inform future NTD control and elimination 
        strategies.
            (2) Coordinate with USAID development sectors, such as 
        sectors relating to water and sanitation, hygiene, food 
        security and nutrition, and education (both primary and 
        preprimary), to establish programs that address NTDs and 
        advance the goals of the 2012 London Declaration on NTDs.
            (3) Include morbidity management in treatment plans for 
        high-burden NTDs, such as lymphatic filariasis (elephantiasis).
            (4) Include NTDs that are recognized as high-burden 
        diseases in the Global Burden of Disease Study 2010, including 
        foodborne trematodiases, human African trypanosomiasis 
        (sleeping sickness), chagas disease, leishmaniasis, and dengue 
        fever and related arbovirus infections.
            (5) Include research and development, consistent with other 
        USAID disease prevention programs, to ensure the tools required 
        for elimination of these diseases are available, such as drugs, 
        diagnostics, vaccines.
    (d) Research and Development.--
            (1) Establishment.--The Administrator of USAID shall 
        establish a research and development program within the USAID 
        NTDs Program (as in effect on the date of the enactment of this 
        Act).
            (2) Priority.--The research and development program shall 
        focus on the prevention and control of those diseases with the 
        highest need for new treatments, diagnostics, and vaccines, 
        including soil-transmitted helminthiases (STH) (round worm, 
        whip worm, and hook worm), schistosomiasis, chagas disease, 
        human African trypanosomiasis (sleeping sickness), 
        leishmaniasis, and dengue fever and other arbovirus infections.

SEC. 102. ACTIONS BY DEPARTMENT OF STATE.

    (a) Office of the Global AIDS Coordinator.--Section 1(f)(2)(B)(ii) 
of the State Department Basic Authorities Act of 1956 (22 U.S.C. 
2651a(f)(2)(B)(ii)) is amended by adding at the end the following:
                                    ``(XIV) Neglected tropical 
                                diseases.--
                                            ``(aa) In general.--
                                        Ensuring coordination of 
                                        activities of the United States 
                                        (including funding) relating to 
                                        combatting HIV/AIDS with 
                                        activities of the United States 
                                        (including funding) relating to 
                                        combatting neglected tropical 
                                        diseases to include the control 
                                        and elimination of neglected 
                                        tropical diseases, particularly 
                                        in countries and regions that 
                                        are highly endemic for female 
                                        genital schistosomiasis.
                                            ``(bb) Definition.--In this 
                                        subclause, the term `neglected 
                                        tropical diseases' has the 
                                        meaning given the term in 
                                        section 5 of the End Neglected 
                                        Tropical Diseases Act.''.
    (b) Global Fund.--
            (1) In general.--The Secretary of State should seek to 
        engage the Global Fund in discussions on whether to expand the 
        authority of the Global Fund for the control and elimination of 
        neglected tropical diseases.
            (2) Global fund.--In this subsection, the term ``Global 
        Fund'' means the public-private partnership known as the Global 
        Fund to Fight AIDS, Tuberculosis and Malaria established 
        pursuant to Article 80 of the Swiss Civil Code.
    (c) G-20 Countries.--The Secretary of State, acting through the 
Office of Global Health Diplomacy, should engage G-20 countries to 
significantly increase their role in the control and elimination of 
neglected tropical diseases, particularly Argentina, Brazil, China, 
India, Indonesia, Mexico, the Republic of Korea, Saudi Arabia, and 
South Africa.

SEC. 103. MULTILATERAL DEVELOPMENT AND HEALTH INSTITUTIONS.

    (a) Congressional Finding.--Congress finds that the treatment of 
high burden neglected tropical diseases, including school-based 
deworming programs, has proven to be a highly cost-effective education 
intervention and schools can serve as the best delivery mechanism for 
reaching large numbers of children with safe treatment for soil-
transmitted helminthiases (STH) (round worm, whip worm, and hook worm) 
in particular.
    (b) United Nations.--The President shall direct the United States 
permanent representative to the United Nations to use the voice, vote, 
and influence of the United States to urge the World Health 
Organization, the United Nations Educational, Scientific and Cultural 
Organization, and the United Nations Development Programme to take the 
actions described in subsection (d).
    (c) World Bank Institute.--The President shall direct the United 
States Executive Director at the International Bank for Reconstruction 
and Development to use the voice, vote, and influence of the United 
States to urge the World Bank Institute to take the actions described 
in subsection (d).
    (d) Actions Described.--The actions described in this subsection 
are the following:
            (1) Ensure the dissemination of best practices and 
        programming on NTDs to governments and make data accessible to 
        practitioners in an open and timely fashion.
            (2) Highlight impacts of school-based deworming programs on 
        children's health and education, emphasizing the cost-
        effectiveness of such programs.
            (3) Encourage governments to implement deworming campaigns 
        at the national level.
            (4) Designate a portion of grant funds of the institutions 
        to deworming initiatives and cross-sectoral collaboration with 
        water and sanitation and hygiene efforts and nutrition or 
        education programming.
            (5) Encourage accurate monitoring and evaluation of NTD 
        programs, including deworming programs.
            (6) Engage governments in cross-border initiatives for the 
        treatment, control, prevention, and elimination of NTDs, and 
        assist in developing transnational agreements, when necessary.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

SEC. 201. PROMOTING EFFORTS THROUGH INTERAGENCY WORKING GROUPS AND 
              INTERNATIONAL FORUMS.

    The Secretary of Health and Human Services shall continue to 
promote the need for robust programs and activities to diagnose, 
prevent, control, and treat neglected tropical diseases--
            (1) through interagency working groups on health; and
            (2) through relevant international forums on behalf of the 
        United States, including the post-2015 United Nations 
        development agenda.

SEC. 202. REPORT ON NEGLECTED TROPICAL DISEASES IN THE UNITED STATES.

    (a) In General.--Not later than 12 months after the date of 
enactment of this Act, the Secretary of Health and Human Services, 
acting through the Director of the Centers for Disease Control and 
Prevention, shall submit to the Congress a report on neglected tropical 
diseases in the United States.
    (b) Contents.--The report required by this section shall--
            (1) assess the epidemiology of, impact of, and appropriate 
        funding required to address neglected tropical diseases in the 
        United States; and
            (2) include the information necessary--
                    (A) to guide future health policy with respect to 
                such diseases;
                    (B) to accurately evaluate the current state of 
                knowledge concerning such diseases; and
                    (C) to define gaps in such knowledge.

SEC. 203. CENTERS OF EXCELLENCE.

    Part P of title III of the Public Health Service Act is amended by 
inserting after section 399V-5 of such Act (42 U.S.C. 280g-16) the 
following:

``SEC. 399V-6. NEGLECTED TROPICAL DISEASE CENTERS OF EXCELLENCE.

    ``(a) Cooperative Agreements and Grants.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the National Institute of Allergy and Infectious 
        Diseases or the Administrator of the Health Resources and 
        Services Administration, as appropriate, may enter into 
        cooperative agreements with, and make grants to, public or 
        private nonprofit entities to pay all or part of the cost of 
        planning, establishing, or strengthening, and providing basic 
        operating support for, one or more centers of excellence for 
        research into, training in, and development of diagnosis, 
        prevention, control, and treatment methods for neglected 
        tropical diseases.
            ``(2) Eligibility.--To be eligible for a cooperative 
        agreement or grant under this section, an entity must--
                    ``(A) have demonstrated expertise in research on, 
                and the epidemiology and surveillance of, the major 
                neglected tropical diseases that are endemic to the 
                United States, such as Chagas disease, dengue, 
                leishmaniasis, and West Nile virus infection, and 
                helminth infections; and
                    ``(B) participate in one or more not-for-profit 
                product development partnerships.
    ``(b) Policies.--A cooperative agreement or grant under paragraph 
(1) shall be entered into or awarded in accordance with policies 
established by the Director of the National Institutes of Health or the 
Health Resources and Services Administration, as applicable.
    ``(c) Coordination With Other Institutes.--The Secretary shall 
coordinate the activities under this section with similar activities 
conducted by other national research institutes, centers, and agencies 
of the National Institutes of Health to the extent that such 
institutes, centers, and agencies have responsibilities that are 
related to neglected tropical diseases.
    ``(d) Uses of Funds.--A cooperative agreement or grant under 
subsection (a) may be used for--
            ``(1) staffing, administrative, and other basic operating 
        costs, including such patient care costs as are required for 
        research;
            ``(2) clinical training, including training for allied 
        health professionals, continuing education for health 
        professionals and allied health professions personnel, and 
        information programs for the public with respect to neglected 
        tropical diseases; and
            ``(3) research and development programs.
    ``(e) Period of Support; Additional Periods.--
            ``(1) In general.--Support of a center of excellence under 
        this section may be for a period of not more than 5 years.
            ``(2) Extensions.--The period specified in paragraph (1) 
        may be extended by the Secretary for additional periods of not 
        more than 5 years if--
                    ``(A) the operations of the center of excellence 
                involved have been reviewed by an appropriate technical 
                and scientific peer review group; and
                    ``(B) such group has recommended to the Secretary 
                that such period should be extended.
    ``(f) Definitions.--In this section:
            ``(1) The term `neglected tropical disease' has the meaning 
        given to that term in section 5 of the End Neglected Tropical 
        Diseases Act.
            ``(2) The term `product development partnership' means a 
        partnership to bring together public and private sector 
        researchers to develop new, or improve on current, global 
        health tools, such as drugs, diagnostics, insecticides, 
        vaccines, and vector management strategies--
                    ``(A) that are for neglected tropical diseases; and
                    ``(B) for which there is generally no profitable 
                market.
    ``(g) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for each of the fiscal years 2015 through 2019.''.

SEC. 204. PANEL ON WORM INFECTION SOLUTIONS.

    (a) Establishment.--The Director of the National Institutes of 
Health, in consultation with the Administrator of the United States 
Agency for International Development, shall establish a panel to 
conduct an evaluation of issues relating to worm infections, including 
potential solutions such as deworming medicines (in this section 
referred to as the ``panel'').
    (b) Strategies.--The panel shall develop recommendations for 
strategies for solutions with respect to--
            (1) repeat infections;
            (2) vector control;
            (3) clean water solutions;
            (4) identifying incentives to encourage basic research for 
        less toxic, more effective medicines; and
            (5) improving the success and cost efficiency of current 
        programs in these areas, based on a thorough scan of 
        initiatives already underway in both the public and private 
        sectors.
    (c) Appointment of Members.--The Director of the National 
Institutes of Health shall appoint as members of the panel individuals 
from the public and private sectors who are knowledgeable about or 
affected by worm infections, including--
            (1) at least 2 representatives of nongovernmental 
        organizations;
            (2) at least 2 representatives of private industry involved 
        in the development of de-worming medications;
            (3) at least 2 representatives from academia; and
            (4) representatives of industries relating to sanitation, 
        clean water, and vector control.
    (d) Report.--Not later than 1 year after the date of the enactment 
of this Act, the panel shall submit to Congress and the Director of the 
National Institutes of Health a report on its findings and recommended 
strategies, including recommendations for such administrative action 
and legislation as the panel determines to be appropriate.
    (e) Termination.--The panel shall terminate not later than 6 months 
after submitting the report required by subsection (d).
                                 <all>