[Congressional Record Volume 165, Number 46 (Thursday, March 14, 2019)]
[Senate]
[Pages S1909-S1910]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 SENATE RESOLUTION 119--SUPPORTING THE GOALS OF WORLD TUBERCULOSIS DAY 
                 TO RAISE AWARENESS ABOUT TUBERCULOSIS

  Mr. BROWN (for himself and Mr. Sullivan) submitted the following 
resolution; which was referred to the Committee on Health, Education, 
Labor, and Pensions:

                              S. Res. 119

       Whereas \1/4\ of the population of the world is infected 
     with the tuberculosis bacterium (commonly referred to as 
     ``TB'');
       Whereas the World Health Organization (commonly referred to 
     as the ``WHO'') estimates that 10,000,000 people developed TB 
     in 2017, nine percent of whom were also infected with the 
     human immunodeficiency virus (commonly referred to as 
     ``HIV'');
       Whereas, in 2017, TB killed an estimated 1,600,000 people, 
     causing more deaths worldwide than any other single 
     infectious agent;
       Whereas \2/3\ of new TB infections in 2017 occurred in 
     India, China, Indonesia, the Philippines, Pakistan, Nigeria, 
     Bangladesh, and South Africa;
       Whereas TB is a leading killer of people infected with HIV, 
     and 300,000 people with HIV died of TB in 2017;
       Whereas additional vulnerable populations at high risk for 
     developing TB include pregnant women and newborns;
       Whereas TB is one of the six leading causes of death among 
     adult women between the ages of 15 and 49 in low-income 
     countries, and women with TB can face stigma, discrimination, 
     and in some settings ostracization by their families and 
     communities;
       Whereas the global TB epidemic and the spread of drug-
     resistant TB present a persistent public health threat to the 
     United States because the disease does not recognize borders;
       Whereas antibiotic-resistant pathogens are a growing 
     problem worldwide, and drug-resistant TB can occur when the 
     drugs used to treat TB are misused or mismanaged;
       Whereas studies have demonstrated direct person-to-person 
     transmission of drug-resistant TB;
       Whereas multi-drug resistant TB (commonly referred to as 
     ``MDR-TB'') is caused by bacteria with resistance to rifampin 
     and isoniazid, the two most potent treatments for TB 
     infection;
       Whereas, according to the 2018 WHO Global Tuberculosis 
     Report, in 2017 an estimated 3.5 percent of all new TB cases 
     and 18 percent of previously treated cases were MDR-TB or 
     rifampin-resistant TB;
       Whereas, in 2017, an estimated 558,000 people around the 
     world developed MDR-TB or rifampin-resistant TB, yet only 
     approximately 25 percent of those individuals have been 
     identified and treated;
       Whereas extensively drug-resistant TB (commonly referred to 
     as ``XDR-TB'') is a rare type of TB that is resistant to 
     nearly all medicines, and therefore can be very difficult and 
     expensive to treat, especially among patients with HIV and 
     acquired immune deficiency syndrome (commonly referred to as 
     ``AIDS'');
       Whereas, according to the 2018 WHO Global Tuberculosis 
     Report, in 2017, 127 countries reported at least one case of 
     XDR-TB;
       Whereas, in 2017, the Centers for Disease Control and 
     Prevention estimated that the cost of treating a single 
     patient with MDR-TB in the United States averaged $164,000, 
     and the average cost of treating a patient with XDR-TB was 
     even higher at $526,000, compared with $19,000 to treat a 
     patient with drug-susceptible TB;
       Whereas MDR-TB and XDR-TB cases in the United States 
     between 2005 and 2007 collectively cost the health care 
     system an estimated $53,000,000, according to an analysis by 
     the Centers for Disease Control and Prevention;
       Whereas the Centers for Disease Control and Prevention 
     estimates that costs resulting from all forms of TB in the 
     United States totaled more than $460,000,000 in 2017;
       Whereas, in a 2000 report, the Institute of Medicine found 
     that a decrease in TB control funding and the spread of HIV 
     and AIDS caused a resurgence of TB in the late 1980s and 
     early 1990s;
       Whereas a total of 9,105 TB cases were reported in the 
     United States in 2017, representing all 50 States and the 
     District of Columbia, and up to 13,000,000 people in the 
     United States are estimated to be living with latent TB 
     infection;
       Whereas 75 percent of States have reported an increase in 
     the proportion of complex cases of TB in recent years due to 
     factors such as homelessness, HIV infection, drug resistance, 
     substance abuse, refugee status, and other factors;
       Whereas the rate of TB disease in African Americans is 
     eight times higher than the rate in White non-Hispanic 
     Americans, and significant disparities exist among other 
     minorities in the United States, including Native Americans 
     and Alaska Natives, Asian Americans, and Hispanic Americans, 
     with 86 percent of all reported TB cases in the United States 
     in 2016 occurring in racial or ethnic minorities;
       Whereas, globally in 2017, an estimated 1,000,000 children 
     developed TB and 230,000 children died of TB;
       Whereas smoking greatly increases the risks of contracting 
     TB and TB recurrence and impairs the response to treatment;
       Whereas diabetes is a major risk factor for TB, and people 
     with diabetes are more likely to develop TB and have a higher 
     risk of death due to TB;
       Whereas bedaquiline is an antibiotic that boosts an MDR-TB 
     patient's chance of survival from approximately 50 percent to 
     as much as 80 percent, and through a public-private 
     partnership, the United States Agency for International 
     Development (commonly referred to as ``USAID'') provided 
     approximately 30,000 treatments in 110 countries from 2015 
     through the end of February 2018;
       Whereas Bacillus Calmette-Guerin, a TB vaccine that is 
     known as ``BCG'', provides some protection to infants and 
     young children but has had little epidemiologic impact on TB 
     worldwide;
       Whereas there is a critical need for new drugs, 
     diagnostics, and vaccines for controlling the global TB 
     epidemic;
       Whereas, in September 2018, the United Nations held the 
     first high-level meeting on TB in which 120 countries, 
     including the United States, signed a political declaration 
     committing to accelerating the TB response, including by 
     increasing funding for TB control programs and research and 
     development efforts, with the goal of reaching all affected 
     people with TB prevention and care;

[[Page S1910]]

       Whereas the enactment of the Tom Lantos and Henry J. Hyde 
     United States Global Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Reauthorization Act of 2008 (Public 
     Law 110-293; 122 Stat. 2918), and the Comprehensive 
     Tuberculosis Elimination Act of 2008 (Public Law 110-392; 122 
     Stat. 4195) provided a historic United States commitment to 
     the global eradication of TB, including a commitment to treat 
     4,500,000 TB patients and 90,000 MDR-TB patients between 2009 
     and 2013 and to provide additional treatment through 
     coordinated multilateral efforts;
       Whereas USAID--
          (A) provides technical assistance to 22 countries highly 
     burdened by TB to build self-reliance and support the 
     adoption of state-of-the-art TB-related technologies;
          (B) supports the development of new diagnostic and 
     treatment tools; and
          (C) supports research to develop new vaccines and other 
     new methods to combat TB;
       Whereas, in 2018, USAID launched--
          (A) a new business model entitled ``Global Accelerator 
     to End Tuberculosis'' to accelerate progress and build self-
     reliance with respect to TB prevention and treatment; and
          (B) a new mechanism to directly support local 
     organizations in priority countries;
       Whereas TB incidence in the countries that receive 
     bilateral TB funding from the United States through USAID has 
     decreased by nearly \1/4\ since 2000;
       Whereas, according the Copenhagen Consensus Center, TB 
     prevention programs return $56 for each dollar invested, 
     which is one of the highest returns on investment of any 
     health intervention;
       Whereas the Centers for Disease Control and Prevention, 
     partnering with other entities of the United States and 
     individual States and territories, directs the national TB 
     elimination program, coordinates TB surveillance, technical 
     assistance, and prevention activities, and helps to support 
     the development of new diagnostic, treatment, and prevention 
     tools to combat TB;
       Whereas the National Institutes of Health, through its many 
     institutes and centers, plays the leading role in basic and 
     clinical research on the identification, treatment, and 
     prevention of TB;
       Whereas the Global Fund to Fight AIDS, Tuberculosis, and 
     Malaria (commonly referred to as the ``Global Fund''), to 
     which the United States is a top financial donor, provides 
     more than 65 percent of all international financing for TB 
     programs;
       Whereas, to date, Global Fund-supported programs have 
     detected and treated more than 17,400,000 cases of TB; and
       Whereas March 24, 2019, is World Tuberculosis Day, a day 
     that commemorates the date in 1882 on which Dr. Robert Koch 
     announced his discovery of Mycobacterium tuberculosis, the 
     bacteria that causes TB: Now, therefore, be it
       Resolved, That the Senate--
       (1) supports the goals of World Tuberculosis Day to raise 
     awareness about tuberculosis;
       (2) commends the progress of tuberculosis elimination 
     efforts by entities that include the United States Agency for 
     International Development, the Centers for Disease Control 
     and Prevention, the National Institutes of Health, the World 
     Health Organization, and the Global Fund to Fight AIDS, 
     Tuberculosis, and Malaria; and
       (3) reaffirms the commitment to strengthen the United 
     States leadership and effectiveness of the global response to 
     tuberculosis with the goal of ending the tuberculosis 
     epidemic.

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