[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2481 Introduced in Senate (IS)]
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116th CONGRESS
1st Session
S. 2481
To facilitate effective research on and treatment of neglected tropical
diseases through coordinated domestic and international efforts.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 17, 2019
Mr. Brown (for himself and Mr. Wicker) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
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 for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Statement of policy.
Sec. 4. Findings.
Sec. 5. Definitions.
Sec. 6. Rule of construction.
TITLE I--FOREIGN AFFAIRS
Sec. 101. United States Agency for International Development Neglected
Tropical Diseases 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 of all people.
SEC. 4. FINDINGS.
Congress finds the following:
(1) The Centers for Disease Control and Prevention have
identified 17 neglected tropical diseases (referred to in this
section as ``NTDs''). Approximately 2,000,000,000 people are at
risk of contracting an NTD, and more than 1,040,000,000 people
are currently afflicted with 1 or more NTDs.
(2) In 2012, the London Declaration on Neglected Tropical
Diseases identified 10 NTDs with the potential to be
controlled, eliminated, or eradicated by 2020.
(3) In 2013, the World Health Organization (referred to in
this section as ``WHO'') adopted a comprehensive resolution on
NTDs, recognizing that increased national and international
investments in prevention and control of these diseases have
succeeded in improving health and social well-being in many
countries. WHO's World Health Assembly maintains and updates a
list of the diverse NTDs across the world.
(4) In its fourth Update Report, published in 2017, WHO
reported significant progress in expanding NTD interventions
worldwide, but challenges continue in--
(A) developing improved evaluation and surveillance
tools; and
(B) maintaining sufficient funding to ensure that
progress is sustained.
(5) NTDs have an enormous impact in terms of disease burden
and quality of life. NTDs cause the loss of up to 185,000 lives
and up to 2,500,000,000 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, in addition to
significant morbidity and mortality, leading to stigma, social
discrimination, and societal marginalization.
(6) 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 1 NTD (hookworm) in
children can result in a 43 percent increase in future wage
earnings.
(7) 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 2 endemic NTD burdens, and 30 countries
carry six or more endemic NTDs. All low-income countries are
affected by at least 5 NTDs, and 149 countries and territories
are affected by at least 1 NTD.
(8) NTDs are not confined to the developing world. Several
NTDs have been reported in the United States and other
developed countries. In the United States, NTDs
disproportionately affect communities of color and the poor,
with up to 2,850,000 African Americans suffering from
toxocariasis and at least 300,000 people, who are mostly
Hispanic Americans, are afflicted with Chagas disease.
(9) 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.
(10) Research and development efforts are immediately
needed for all NTDs, especially to advance next-generation
treatments, interventions, and diagnostics to ensure that
countries endemic for NTDs are able to implement and sustain
NTD control programs.
(11) Epidemiological data that identify at-risk populations
and ensure that these populations receive consistent and
sufficient doses of treatment for their diseases are critical
to developing robust NTD control strategies.
(12) The benefits of deworming are immediate. 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 \1/2\ of a year of
schooling.
(13) Improved access to water, sanitation, and hygiene can
also reduce the transmission of NTDs, particularly NTDs caused
by parasites.
SEC. 5. DEFINITIONS.
In this Act:
(1) Global fund.--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.
(2) Neglected tropical diseases; ntds.--The terms
``neglected tropical diseases'' and ``NTDs''--
(A) mean infections caused by pathogens, including
viruses, bacteria, protozoa, and helminths, that
disproportionately impact individuals living in extreme
poverty, especially in developing countries; and
(B) include--
(i) Buruli ulcer;
(ii) Chagas disease;
(iii) Cysticercosis;
(iv) Dengue fever;
(v) Dracunculiasis (Guinea worm disease);
(vi) Echinococcosis;
(vii) Fascioliasis;
(viii) Human African trypanosomiasis
(sleeping sickness);
(ix) Leishmaniasis;
(x) Leprosy (Hansen's disease);
(xi) Lymphatic filariasis (elephantiasis);
(xii) Onchocerciasis (river blindness);
(xiii) Rabies;
(xiv) Schistosomiasis;
(xv) Soil-transmitted Helminthiases (STH),
such as round worm, whip worm, and hook worm;
(xvi) Trachoma; and
(xvii) Yaws.
SEC. 6. RULE OF CONSTRUCTION.
Nothing in this Act may be construed to increase the authorization
of appropriations for--
(1) the United States Agency for International Development;
or
(2) the Department of Health and Human Services.
TITLE I--FOREIGN AFFAIRS
SEC. 101. UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT NEGLECTED
TROPICAL DISEASES PROGRAM.
(a) Findings.--Congress finds the following:
(1) Since fiscal year 2006, the United States Agency for
International Development (referred to in this title as
``USAID'') has been an essential leading partner in advancing
control and elimination efforts for 5 targeted neglected
tropical diseases: lymphatic filariasis (elephantiasis),
onchocerciasis (river blindness), schistosomiasis, soil-
transmitted helminthiases (round worm, whip worm, and hook
worm), and trachoma.
(2) USAID is an original endorser of the ``London
Declaration on Neglected Tropical Diseases'', signed in London
on January 30, 2012, which represents a new, coordinated
international push to accelerate progress toward eliminating or
controlling 10 NTDs by 2020.
(3) The USAID Neglected Tropical Diseases Program has made
important and substantial contributions to the global fight to
control and eliminate the 5 targeted NTDs. Leveraging more than
$19,000,000,000 in donated medicines, USAID has supported the
distribution of more than 2,300,000,000 treatments in 31
countries across Africa, Asia, Latin America, and the
Caribbean.
(4) Since 2014, the USAID Neglected Tropical Diseases
Program has been investing in gathering research and
development for the treatment of certain NTDs to ensure that
promising new breakthrough diagnostics and medicines can be
rapidly evaluated, registered, and made available to patients.
(5) The USAID Neglected Tropical Diseases Program--
(A) is a clear example of a successful public-
private partnership between the Government and the
private sector; and
(B) already has contributed to the elimination of
at least 1 NTD in 9 different countries.
(b) Sense of Congress.--It is the sense of Congress that the USAID
Neglected Tropical Diseases Program, as in effect on the date of the
enactment of this Act--
(1) should be continued and may be judiciously expanded, as
practicable and appropriate;
(2) should continue to provide treatment to as many
individuals suffering from an NTD or at risk of acquiring an
NTD, including individuals displaced by manmade and natural
disasters, as logistically feasible;
(3) should integrate NTD control, treatment tools, and
approaches into complementary development and global health
programs by coordinating, to the extent practicable and
appropriate, across multiple sectors, including sectors
relating to HIV/AIDS, malaria, tuberculosis, education,
nutrition, other infectious diseases, maternal and child
health, and water, sanitation, and hygiene;
(4) should continue to conduct low-cost, high-impact
community and school-based NTD programs to reach large at-risk
populations, including school-age children, with integrated
drug treatment packages, as feasible;
(5) should engage in research and development of new tools
and approaches, as opportunities emerge and resources allow, to
reach the goals relating to the elimination of NTDs set forth
by the World Health Organization; and
(6) should monitor research on and developments in the
prevention and treatment of other NTDs so breakthroughs can be
incorporated into the USAID Neglected Tropical Diseases
Program, as practicable and appropriate.
(c) Program Priorities.--The Administrator of USAID should
incorporate the following priorities into USAID's Neglected Tropical
Diseases Program (as in effect on the date of the enactment of this
Act):
(1) Planning for, and conducting robust monitoring and
evaluation of, program investments in order to accurately
measure impact, identify and share lessons learned, and inform
future NTD control and elimination strategies.
(2) Coordinating program activities with complementary
USAID development and global health programs, including
programs relating to water, sanitation, and hygiene, food and
nutrition security, and primary and secondary education in
order to advance the goals of the London Declaration on
Neglected Tropical Diseases.
(3) Including morbidity management in National NTD Master
Plans.
(4) Incorporating NTDs included in the Global Burden of
Disease Study 2010 into the program as opportunities emerge, to
the extent practicable and appropriate.
(5) Continuing investments in the research and development
of new tools and approaches that--
(A) complement existing research investments; and
(B) ensure that new discoveries make it through the
pipeline and become available to individuals who need
them.
SEC. 102. ACTIONS BY DEPARTMENT OF STATE.
(a) Sense of Congress.--It is the sense of Congress that the
Coordinator of United States Government Activities to Combat HIV/AIDS
Globally should fully consider, as necessary and appropriate, evolving
research on the impact of neglected tropical diseases on efforts to
control HIV/AIDS when making future programming decisions.
(b) Global Programming.--The Secretary of State should encourage
the Global Fund to consider, as necessary and appropriate, evolving
research on the impact of NTDs on efforts to control HIV/AIDS,
tuberculosis, and malaria when making programming decisions,
particularly with regard to female genital schistosomiasis, which
studies suggest may be a significant co-factor in the AIDS epidemic in
Africa.
(c) G-20 Countries.--The Secretary of State, acting through the
Office of Global Health Diplomacy, should encourage G-20 countries to
significantly increase their role in the control and elimination of
NTDs.
SEC. 103. MULTILATERAL DEVELOPMENT AND HEALTH INSTITUTIONS.
(a) Finding.--Congress finds that the treatment of NTDs, including
community and school-based deworming programs, can be a highly cost-
effective education intervention and schools can serve as an effective
delivery mechanism for reaching large numbers of children with safe
treatment for soil-transmitted helminthiases (round worm, whip worm,
and hook worm).
(b) Sense of Congress.--The President should 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 and the United Nations Development Programme--
(1) to 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) to highlight impacts of community and school-based
deworming programs on children's health and education,
emphasizing the cost-effectiveness of such programs;
(3) to encourage governments to establish and implement
national NTD programs;
(4) to consider designating a portion of grant funds of the
institutions to deworming initiatives and cross-sectoral
collaboration with water, sanitation, and hygiene efforts and
nutrition or education programming, as practicable and
appropriate;
(5) to encourage accurate monitoring and evaluation of NTD
programs, including deworming programs; and
(6) to engage governments in cross-border initiatives for
the treatment, control, prevention, and elimination of NTDs,
and assist in developing transnational agreements, when and
where 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 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services,
acting through relevant agencies of the Department of Health and Human
Services, shall submit a report to the Congress on neglected tropical
diseases in the United States.
(b) Contents.--The report required under 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 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-6 (42 U.S.C. 280g-17) the following:
``SEC. 399V-7. NEGLECTED TROPICAL DISEASE CENTERS OF EXCELLENCE.
``(a) Cooperative Agreements and Grants.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, may
enter into cooperative agreements with, and award 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, including tools to support elimination by
building capacity for sustainable prevention efforts once
epidemiology has been characterized and initial control
achieved.
``(2) Eligibility.--To be eligible for a cooperative
agreement or grant under this section, an entity must--
``(A) have demonstrated expertise in research on,
or the epidemiology and surveillance of, major
neglected tropical diseases that are endemic to the
United States, such as Chagas disease, dengue,
leishmaniasis, West Nile virus, and helminth
infections; and
``(B) participate in one or more not-for-profit
product development partnerships.
``(b) Policies.--A cooperative agreement or grant under subsection
(a) shall be entered into or awarded in accordance with established
policies.
``(c) Coordination.--The Secretary shall ensure that activities
under this section are coordinated with similar activities of the
Department of Health and Human Services relating 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 patient care costs that 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.--Except as provided in paragraph (2),
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 each if--
``(A) the operations of the center of excellence
involved have been reviewed by an appropriate technical
and scientific peer review group; and
``(B) group referred to in subparagraph (A) has
recommended to the Secretary that such period should be
extended.
``(f) Definitions.--In this section:
``(1) The term `neglected tropical diseases' has the
meaning given 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.''.
SEC. 204. PANEL ON WORM INFECTION SOLUTIONS.
(a) Establishment.--The Secretary of Health and Human Services
shall establish a panel to conduct an evaluation of issues relating to
worm infections, including potential solutions such as deworming
medicines.
(b) Strategies.--The panel established pursuant to subsection (a)
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.--In addition to representatives from
the Centers for Disease Control and Prevention and other relevant
agencies working on neglected tropical diseases, the Secretary of
Health and Human Services shall appoint, as members of the panel
established pursuant to subsection (a), 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 a report to Congress and to the
Secretary of Health and Human Services that includes--
(1) the findings and recommended strategies of the panel;
and
(2) 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 the submission of the report required under subsection (d).
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