[Congressional Record Volume 148, Number 34 (Thursday, March 21, 2002)]
[Senate]
[Pages S2266-S2268]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. BOXER (for herself and Mr. Smith of Oregon):
  S. 2045. A bill to amend the Foreign Assistance Act of 1961 to take 
steps to control the growing international problem of tuberculosis; to 
the Committee on Foreign Relations.
  Mrs. BOXER. Mr. President, today, Senator Smith and I are proud to 
introduce the International Tuberculosis Control Act of 2002. This bill 
will provide $200 million during each of the next three years for U.S. 
efforts to combat international TB.
  Our bill also sets as a goal the detection of at least 70 percent of 
the cases of infectious tuberculosis, and the cure of at least 85 
percent of the cases detected by the end of 2005 for those countries 
with the highest tuberculosis burden.
  Why is this bill important? Consider the facts: Tuberculosis kills 2 
million people each year; someone in the world is newly infected with 
TB every second; nearly one percent of the world's population is newly 
infected with TB each year; TB is the single leading cause of death 
among women between the age of 15-44; and half of all people living 
with HIV-AIDS will develop TB because of suppressed immune systems.
  TB is an airborne disease. You can get it when someone coughs or 
sneezes. And with the increased immigration and travel to the United 
States, we are seeing it re-emerge in many of our communities. That is 
why it is in the national interest here in the United States to fight 
TB throughout the world.
  This is especially true when you consider that in the year 2000, 46 
percent of TB cases detected in the U.S. occurred to foreign-born 
persons, up from 22 percent in 1986. In California, of the 3,297 cases 
detected in 2000, 72 percent were among foreign born individuals.
  Two years ago, Senator Smith and I teamed up to triple TB funding and 
get the authorization level up to $60 million. We are teaming up again 
so that USAID can work with its international partners like the World 
Health Organization to expand the most effective program to stop the 
spread of TB--DOTS or Directly Observed Treatment Short-Course.
  DOTS is so effective because it reduces the chance of Multi-Drug 
Resident TB from developing. In the early 1990s, New York City spent 
nearly $1 billion to control an outbreak of drug-resistant TB. However, 
a 6-month course of TB drugs under the DOTS programs can cost just $10.
  That is why we feel that our bill is a wise investment that will 
reduce the cost of treating TB over the long run and, most important, 
save lives throughout the world.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2045

       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 ``International Tuberculosis 
     Control Act of 2002''.

     SEC. 2. FINDINGS.

       Congress finds that:
       (1) Tuberculosis is a great health and economic burden to 
     impoverished nations and a health and security threat to the 
     United States and other industrialized countries.
       (2) Tuberculosis kills 2,000,000 people each year (a person 
     every 15 seconds) and is second only to HIV/AIDS as the 
     greatest infectious killer of adults worldwide.
       (3) Tuberculosis is today the leading killer of women of 
     reproductive age and of people who are HIV-positive.
       (4) One-third of the world's population is currently 
     infected with the tuberculosis bacterium, including 
     10,000,000 through 15,000,000 persons in the United States, 
     and someone in the world is newly infected with tuberculosis 
     every second.

[[Page S2267]]

       (5) With 46 percent of tuberculosis cases in the United 
     States in the year 2000 found in foreign-born persons, as 
     compared to 24 percent in 1990, it is clear that the only way 
     to control tuberculosis in the United States is to control it 
     worldwide.
       (6) Left untreated, a person with active tuberculosis can 
     infect an average of 10 through 15 people in one year.
       (7) Pakistan and Afghanistan are among the 22 countries 
     identified by the World Health Organization as having the 
     highest tuberculosis burden globally.
       (8) More than one-quarter of all adult deaths in Pakistan 
     are due to tuberculosis, and Afghan refugees entering 
     Pakistan have very high rates of tuberculosis, with refugee 
     camps, in particular, being areas where tuberculosis runs 
     rampant.
       (9) The tuberculosis and AIDS epidemics are inextricably 
     linked. Tuberculosis is the first manifestation of AIDS in 
     more than 50 percent of cases in developing countries and is 
     responsible for 40 percent or more of deaths of people with 
     AIDS worldwide.
       (10) An effective, low-cost cure exists for tuberculosis: 
     Directly Observed Treatment Short-course or DOTS. Expansion 
     of DOTS is an urgent global priority.
       (11) DOTS is one of the most cost-effective health 
     interventions available today. A full course of DOTS drugs 
     costs as little as US$10 in low-income countries.
       (12) Proper DOTS treatment is imperative to prevent the 
     development of dangerous multidrug resistant tuberculosis 
     (MDR-TB) that arises through improper or incomplete 
     tuberculosis treatment.
       (13) The Global Fund to fight AIDS, Tuberculosis, and 
     Malaria is an important new global partnership established to 
     combat these 3 infectious diseases that together kill 
     6,000,000 people a year. Expansion of effective tuberculosis 
     treatment programs should constitute a major component of 
     Global Fund investment.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) DOTS.--The term ``DOTS'' or ``Directly Observed 
     Treatment Short-course'' means the World Health Organization-
     recommended strategy for treating standard tuberculosis.
       (2) Global alliance for tuberculosis drug development.--The 
     term ``Global Alliance for Tuberculosis Drug Development'' 
     means the public-private partnership that brings together 
     leaders in health, science, philanthropy, and private 
     industry to devise new approaches to tuberculosis and to 
     ensure that new medications are available and affordable in 
     high tuberculosis burden countries and other affected 
     countries.
       (3) Global plan to stop tuberculosis.--The term ``Global 
     Plan to Stop Tuberculosis'' means the plan developed jointly 
     by the Stop Tuberculosis Partnership Secretariat and Partners 
     in Health that lays out what needs to be done to control and 
     eliminate tuberculosis.
       (4) Global tuberculosis drug facility.--The term ``Global 
     Tuberculosis Drug Facility (GDF)'' means the new initiative 
     of the Stop Tuberculosis Partnership to increase access to 
     high-quality tuberculosis drugs to facilitate DOTS expansion.
       (5) Stop tuberculosis partnership.--The term ``Stop 
     Tuberculosis Partnership'' means the partnership of the World 
     Health Organization, donors including the United States, high 
     tuberculosis burden countries, multilateral agencies, and 
     nongovernmental and technical agencies committed to short- 
     and long-term measures required to control and eventually 
     eliminate tuberculosis as a public health problem in the 
     world.

      SEC. 4. ASSISTANCE FOR TUBERCULOSIS PREVENTION, TREATMENT, 
                   CONTROL, AND ELIMINATION.

       Section 104(c) of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b(c)) is amended by adding at the end the 
     following:
       ``(7)(A) Congress recognizes the growing international 
     problem of tuberculosis and the impact its continued 
     existence has on those countries that had previously largely 
     controlled the disease. Congress further recognizes that the 
     means exist to control and treat tuberculosis by implementing 
     the Global Plan to Stop Tuberculosis and by adequately 
     investing in newly created mechanisms, including the Global 
     Tuberculosis Drug Facility, and that it is therefore a major 
     objective of the foreign assistance program to control the 
     disease. To this end, Congress expects the agency primarily 
     responsible for administering this part--
       ``(i) to coordinate with the World Health Organization, the 
     Centers for Disease Control, the National Institutes of 
     Health, and other organizations with respect to the 
     development and implementation of a comprehensive 
     tuberculosis control program; and
       ``(ii) to set as a goal the detection of at least 70 
     percent of the cases of infectious tuberculosis, and the cure 
     of at least 85 percent of the cases detected, by December 31, 
     2005, in those countries classified by the World Health 
     Organization as among the highest tuberculosis burden, and by 
     December 31, 2010, in all countries in which the agency has 
     established development programs.
       ``(B)(i) There is authorized to be appropriated 
     $200,000,000 for each of the fiscal years 2003 through 2005 
     for carrying out this paragraph.
       ``(ii) Funds appropriated under this paragraph are 
     authorized to remain available until expended.
       ``(C) In carrying out subparagraph (A), not less than 75 
     percent of the amount authorized to be appropriated under 
     subparagraph (B) shall be expended for antituberculosis 
     drugs, supplies, patient services, and training in diagnosis 
     and care, in order to increase directly observed treatment 
     shortcourse (DOTS) coverage, including funding for the Global 
     Tuberculosis Drug Facility.
       ``(D) In carrying out subparagraph (A), of the amount 
     authorized to be appropriated under subparagraph (B)--
       ``(i) not less than 10 percent shall be used for funding of 
     the Global Tuberculosis Drug Facility;
       ``(ii) not less than 7.5 percent shall be used for funding 
     of the Stop Tuberculosis Partnership; and
       ``(iii) not less than 2.5 percent shall be used for funding 
     of the Global Alliance for Tuberculosis Drug Development.
       ``(E) The President shall submit a report to Congress 
     annually specifying the increases in the number of people 
     treated and the increases in number of tuberculosis patients 
     cured through each program, project, or activity receiving 
     United States foreign assistance for tuberculosis control 
     purposes.''.

  Mr. SMITH of Oregon. Mr. President, I am pleased to again join my 
colleague Senator Boxer in introducing important tuberculosis control 
legislation today on the floor of the Senate. Today we are introducing 
The International Tuberculosis Control Act--this important legislation 
is designed to address the growing international problem of 
tuberculosis, (TB). We are introducing this legislation to coincide 
with World Tuberculosis Day, this Sunday, March 24. World TB Day is an 
occasion for countries around the world to raise awareness about the 
threat to the world's health caused by tuberculosis.
  As many of us know TB is a global health crisis. Over two million 
people will die from TB this year, and it is the leading killer of 
young women and of people with AIDS worldwide. Further, TB anywhere is 
a threat everywhere in our highly mobile world. The Center for Disease 
Control CDC reports that in the year 2000, nearly 50 percent of all TB 
cases in the US occurred in foreign-born persons. We will not be safe 
from TB until we control the disease globally.
  TB and HIV form a deadly co-epidemic. TB is responsible for more than 
40 percent of all AIDS deaths worldwide. An HIV-positive person is 30 
times more likely to develop active tuberculosis and become infectious 
to others. Many countries in sub-Saharan Africa have seen TB rates 
increase 4-fold due to the HIV-TB co-epidemic, decimating a whole 
generation of adults in many communities. In Eastern Europe and Asia, 
TB infection is widespread and HIV rates are rising rapidly. These 
areas are poised to see the TB-HIV co-epidemic explode.
  TB also flourishes in and causes poverty. About 98 percent of the 
annual deaths from TB are in poor countries. Those who fall ill are 
often their family's primary breadwinner. When that person cannot work, 
children must often leave school to work or care for a sick relative. 
The World Health Organization reported in 2000 that 75 percent of TB 
patients are men and women between the ages of 15-54, the most 
economically productive years of life. Stopping TB will help fight 
poverty.
  I strongly believe we must act to control TB now or pay later. Rising 
drug resistance is a time bomb that could make TB virtually 
uncontrollable. Multi-drug resistant TB is far more dangerous and 
difficult to treat, can cost up to $1 million per patient to cure, and 
kills over half of its victims, even in the U.S.
  There is a plan for controlling TB. The new, internationally agreed-
upon ``Global Plan to Stop TB'' provides a much-needed roadmap. It 
describes the resources needed, country-by-country, to meet 
international TB control targets by 2005. Complementary National TB 
control plans exist for nearly all of the 22 high-burden TB countries.
  The world must invest less than $1 billion in additional funds per 
year to control TB, about what New York City spent to control an 
outbreak of drug-resistant TB in the early 1990s! And I believe that 
$200 million is a reasonable US share of the $1 billion needed globally 
to control this killer.
  We have the tools to stop TB. ``The Global Plan to Stop TB'' is built 
around expanding access to DOTS treatment worldwide, a proven, and very 
cost-effective treatment system that uses just $10 worth of drugs to 
cure a patient in 6 months. Currently

[[Page S2268]]

just one in four of those who needs DOTS have access to it. Another 
tool for fighting TB is the new Global TB Drug Facility, which can 
provide the steady supply of affordable drugs needed to cure patients 
and prevent the further spread of drug-resistance.
  My colleague, Barbara Boxer, and I have been leading the way (along 
with Foreign Operations Chairman Patrick Leahy and Ranking Senator 
Mitch McConnell) in increasing US funding for international TB control, 
from virtually zero in 1997 to $75 million in 2002. The President's 
2003 Budget proposes to cut TB funding by one-third, but I feel that we 
must do more in this area, not less. Just $200 million annually from 
the U.S. would save tens of thousands of lives around the world and 
would protect US citizens from TB and from the growing threat of drug-
resistant TB. Investing in TB control is not only the right thing to 
do; it is a wise U.S. investment.
                                 ______