[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.

                          ____________________