[Congressional Record Volume 153, Number 170 (Monday, November 5, 2007)]
[House]
[Pages H12459-H12462]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STOP TUBERCULOSIS (TB) NOW ACT OF 2007
Mr. ENGEL. Mr. Speaker, I move to suspend the rules and pass the bill
(H.R. 1567) to amend the Foreign Assistance Act of 1961 to provide
increased assistance for the prevention, treatment, and control of
tuberculosis, and for other purposes, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 1567
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 ``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, in 2006 killed 52 of 53 patients with hundreds
more cases reported since that time. 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
and the Centers for Disease Control and Prevention are
actively involved with global tuberculosis control efforts.
Because the global tuberculosis epidemic directly impacts
tuberculosis in the United States, Congress has urged the
Centers for Disease Control and Prevention each year to
increase its involvement with international tuberculosis
control efforts.
(17) The United States Agency for International Development
is the lead United
[[Page H12460]]
States Government agency for international tuberculosis
efforts, working in close partnership with the Centers for
Disease Control and Prevention and with the President's
Emergency Plan for HIV/AIDS Relief. The goal of the United
States Agency for International Development is to contribute
to the global reduction of morbidity and mortality associated
with tuberculosis by building country capacity to prevent and
cure tuberculosis and achieve global targets of 70 percent
case detection and 85 percent treatment success rates. The
United States Agency for International Development provides
support for tuberculosis programs in countries that have a
high burden of tuberculosis, a high prevalence of
tuberculosis and HIV, and a high risk of MDR-TB.
SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Policy.--Subsection (b) of section 104B of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-3) 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.--Subsection (c) of such section 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.--Subsection (e) of such
section 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 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
Partnership.--Such section is further 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.--Subsection (g) of such section, 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 and evaluation of treatment regimes, vaccines, 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.--Clause (iii) of section 104A(e)(2)(C)
of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-
2(e)(2)(C)) 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 not more than $400,000,000 for fiscal year 2008
and not more than $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) Funding for cdc.--Of the amounts appropriated pursuant
to the authorization of appropriations under paragraph (1),
not more than $70,000,000 for fiscal year 2008 and not more
than $100,000,000 for fiscal year 2009 shall be made
available for the purpose of carrying out global tuberculosis
activities through the Centers for Disease Control and
Prevention.
(3) Additional provisions.--Amounts appropriated pursuant
to the authorization of appropriations under paragraph (1)
and amounts made available pursuant to paragraph (2)--
(A) are in addition amounts otherwise made available for
such purposes; and
(B) are authorized to remain available until expended.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New
York (Mr. Engel) and the gentleman from Arkansas (Mr. Boozman) each
will control 20 minutes.
The Chair recognizes the gentleman from New York.
General Leave
Mr. ENGEL. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days to revise and extend their remarks and include
extraneous material on the bill under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New York?
There was no objection.
Mr. ENGEL. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise in strong support of this bill. H.R. 1567, the
Stop TB Now Act, which I introduced with my colleagues, the gentlewoman
from New Mexico (Mrs. Wilson) and the gentleman from Washington (Mr.
Smith), has 106 bipartisan cosponsors, and I am proud it is moving
forward today. It is a very, very important and timely bill.
International tuberculosis control has become an important issue to
me. It is remarkable in this day and age, with treatment available,
that TB is the biggest infectious killer of young women in the world.
In fact, TB kills more women worldwide than all causes of maternal
mortality. As you know, tuberculosis is also the biggest killer of
people with AIDS worldwide. Someone in the world is newly infected with
TB every second, and TB counts for more than one-quarter of all
preventable adult deaths in developing countries.
I strongly believe that the global community, with the United States
in the lead, must do more to adequately address this disease by
investing in quality TB control programs, using the groundbreaking
Global Plan to Stop TB as a guide. It is for this reason that I have
introduced this bill, the Stop TB Now Act, which will set forth the
U.S. fair share towards achieving the goals of the Global Plan.
I believe if we don't make bold and wise investments in international
tuberculosis control, not only will we fail to save millions of lives
and miss out on the many accompanying benefits of controlling this
killer, but also that this disease will become far more difficult and
costly to treat.
Extremely drug-resistant TB, or XDR-TB for short, highlights this
danger. It has been found on six continents, is a growing epidemic in
southern Africa, and is already reported to be here in the U.S.
Regular, or non-drug-resistant, TB is curable with drugs that cost just
$16 in most developing countries.
{time} 1415
Cases of drug-resistant TB, however, can cost thousands of dollars to
cure,
[[Page H12461]]
with treatment that is far more difficult for patients and
practitioners. Drug-resistant tuberculosis is a man-made problem and is
caused by poor TB treatment. We, the global community, have the power
to prevent drug-resistant TB and the power to treat and control regular
TB, and yet, unfortunately, we have chosen not to do so by our
inaction.
Through aggressive, committed leadership, the U.S. has proven that it
is feasible to massively scale-up our investment to fight HIV/AIDS and
malaria, and well we should. We have increased funding to fight AIDS
from $840 million in 2001 to $2.9 billion in 2004, to over $4.4 billion
in the House Foreign Operations bill in fiscal year 2008.
U.S. funding for malaria efforts increased from $100 million in 2006
to an administration request of $387 million for fiscal year 2008, with
a House Foreign Operations level of $350 million.
Even our response to the potential threat of avian flu has been
aggressive, from just $4 million a few years ago to $100 million in the
Foreign Operations budget for fiscal year 2008 and an additional $160
million in the fiscal year 2007 supplemental.
However, only tuberculosis, the greatest curable infectious killer on
the planet, has been left behind, and we must correct that, and that's
the purpose of this legislation.
Because of our chronic neglect of tuberculosis, this disease is not
only responsible for the preventable deaths of some 4,000 people every
day, it is undermining our enormous efforts and billions in investments
to fight AIDS. Tuberculosis is the leading killer of people with AIDS.
Through U.S. leadership, we are seeing increasing numbers of AIDS
patients access life-saving antiretroviral therapy, but they're not
dying of AIDS. They're dying instead of tuberculosis. And what a shame
that is and how ridiculous it is when we have the power to stop and end
it. And more recently, people have been dying in large numbers in
southern Africa due to drug-resistant TB.
While the President's AIDS initiative has made commendable scale-ups
in TB and HIV efforts, they are still, in my opinion, grossly
insufficient. Much of PEPFAR's scale-up supports testing tuberculosis
patients for HIV and ensuring that TB and AIDS programs work together.
It's very important. I'm glad we're doing it, but it's not addressing
the core TB program needs. And PEPFAR's TB-HIV efforts are focused on
those co-infected with both diseases and mostly in Africa, again, while
commendable, but TB is a global problem and we need to combat it
everywhere.
The costs of inaction are greater than the costs laid out in this
bill. This past spring, it became clearer than ever that tuberculosis
knows no border when a gentleman named Andrew Speaker, an attorney from
Atlanta, traveled across the globe and came back to the United States
with a highly resistant form of TB. We all remember that. Many of us
were shocked by it.
Being from New York, I'm very familiar with what happens when TB
control is neglected. In the late 1980s to the early 1990s, the City of
New York paid a dear price for its failure to invest adequately in
tuberculosis control. The city, along with many other areas of the
country at the time, experienced an epidemic of tuberculosis. In this
case, the epidemic was a multidrug-resistant TB, which inevitably
develops in the absence of basic TB control. New York City launched an
aggressive tuberculosis control campaign and brought down its burden of
drug-resistant TB. The cost to the city? Over $1 billion to control
some 300 cases, far higher than it would have been and it would have
cost to prevent the situation in the first place. Tuberculosis is not
just a global issue, but as we can see, it's certainly a local one as
well.
When it comes to tuberculosis, Mr. Speaker, we simply cannot afford
to maintain the status quo. The resources authorized in this bill
represent a realistic and urgently needed increase in funding for
global TB control based on the needs laid out in a costed-out,
comprehensive business plan. The cost of inaction is much, much
greater.
In conclusion, I would especially like to pay tribute to our former
colleague, Senator Sherrod Brown, who was a champion of global
tuberculosis efforts during his time in the House. He's doing this
great work as well now in the Senate.
I would also like to thank the many groups whose advocacy helped
bring the Stop TB Now Act to the floor, particularly RESULTS and the
American Thoracic Society.
Finally, I would like to thank Chairman Lantos, Congressman Payne and
their staffs for their unfailing support for tuberculosis control and
this legislation and to the Energy and Commerce Committee and Mr.
Dingell for expediting consideration of this bill. I'm proud to serve
on both the Foreign Affairs and the Energy and Commerce Committee, the
two committees that have jurisdiction on this bill.
Again, this is truly a bipartisan bill. I wish to thank the ranking
member, Ms. Ros-Lehtinen, and all the people, all the colleagues who
have cooperated on both sides of the aisle because only by working
together can we get at the scourge of TB.
Mr. Speaker, I reserve the balance of my time.
Mr. BOOZMAN. Mr. Speaker, I yield myself such time as I may consume.
The bill before us, H.R. 1567, the Stop Tuberculosis Act of 2007, has
been put forward by its supporters to provide a very significant
increase in our foreign aid spending on anti-TB programs abroad.
If we rely on figures gathered with the assistance of the
Congressional Research Service, the bill would raise our spending on
such programs through the U.S. Agency for International Development by
about six times in the next 2 years.
According to a brief letter received late last week from the
Congressional Budget Office, the bill would increase such spending
somewhat less, by somewhere between two and three times in the next 2-
year period.
Although it is possible that the latter estimate by CBO may
inadvertently have included in its baseline comparison current funding
levels for some anti-TB programs outside of the scope of this bill, it
is clear that this measure seeks a major increase in the AID programs
it covers.
Along those lines, the bill strongly encourages, if not directs, the
President to ensure that the funds that would be provided under this
bill will be transferred to the World Health Organization's ``Stop TB
Partnership'' plan.
Finally, the funding amounts in the bill have apparently been
formulated using a calculation meant to reflect what the United States'
fair share might be in funding that international plan.
Mr. Speaker, I recognize the determination of the supporters of this
measure to do more to combat TB overseas.
On a personal note, my mother was afflicted with tuberculosis when
she was in her mid to late teens and was on her back for a year, just
didn't get out of bed. So we understand the importance of eradicating
TB, not only worldwide but in the United States. She's done well,
though. By coincidence, this is her 86th birthday, and so she recovered
fully.
I also want to thank Congressman Engel for his work on this. I know
that he's worked very, very hard, and also Congresswoman Heather Wilson
of New Mexico.
With that, we don't have any more speakers, and if you all don't, I
will yield back.
Do you have some more speakers?
Mr. ENGEL. I have no further speakers, but I would like to respond a
bit to some of the points that you made.
Mr. BOOZMAN. Mr. Speaker, I yield back the balance of my time.
Mr. ENGEL. Mr. Speaker, I yield myself as much time as I may consume.
I thank my colleague, and I just want to let him know and let my
colleagues know that we worked together with Senator Lugar, who's the
ranking member of the Senate Foreign Relations Committee, and we
specified that the funding would be a ceiling, not a floor.
The bill appropriates up to $400 million in 2008 and up to $550
million in 2009, including global activities to be carried out by USAID
and CDC. So that's what we did. We negotiated it so we wouldn't
necessarily spend all the money. We would spend up to that amount of
money, and that would be the limit, but it would not be the
[[Page H12462]]
money that we would spend if we didn't need to spend it.
We worked closely with WHO, CDC and USAID, and the overall global
number is derived from Stop TB Partnership's Global Plan to Stop TB
2006 through 2015, of which WHO is a partner and USAID is the current
Chair of the Stop TB Partnership's coordinating board. The plan is well
documented, detailed, costed out, and again, builds up from country
estimates and was reviewed in an exhaustive process.
Finally and furthermore, the World Health Organization developed and
released a ``Global MDR-TB and XDR-TB Response Plan'' that supplements
the need calculated by the Global Plan's need in light of the outbreak
of drug-resistant TB.
USAID and the CDC work together globally and both have agreed to this
coordination of funding, and again, we have a ceiling of what we spend
and not a floor.
So, again, I thank my colleague.
Mr. Speaker, we have no further speakers, and I yield back the
balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from New York (Mr. Engel) that the House suspend the rules
and pass the bill, H.R. 1567, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
____________________