[Congressional Record Volume 165, Number 192 (Tuesday, December 3, 2019)]
[House]
[Pages H9194-H9197]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
END NEGLECTED TROPICAL DISEASES ACT
Mr. SIRES. Mr. Speaker, I move to suspend the rules and pass the bill
(H.R. 3460) to facilitate effective research on and treatment of
neglected tropical diseases through coordinated international efforts.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 3460
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.
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Statement of policy.
Sec. 4. Findings.
Sec. 5. Definition.
Sec. 6. Rule of construction.
Sec. 7. Expansion of United States Agency for International Development
Neglected Tropical Diseases Program.
Sec. 8. Actions by Department of State.
Sec. 9. Multilateral development and health institutions.
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 World Health Organization (WHO) has identified 17
neglected tropical diseases (NTDs). Approximately 2 billion
people, almost one-third of the world's population, are at
risk of contracting an NTD, and more than 1.4 billion people
are currently afflicted with 1 or more NTDs.
(2) In 2013, WHO adopted a comprehensive resolution on NTDs
recognizing that increased national and international
investments in prevention and control of neglected tropical
diseases have succeeded in improving health and social well-
being in many countries.
(3) NTDs have an enormous impact in terms of disease burden
and quality of life. NTDs cause the loss of up to 534,000
lives and 57 million 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, leading to
stigma, social discrimination, and societal marginalization.
(4) 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 one
NTD, hookworm, in children can result in a 43-percent
increase in future wage earnings.
(5) 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 6 or more endemic NTDs.
(6) NTDs are not confined to the developing world, however.
Several NTD outbreaks have been reported in the United States
and other developed countries, especially among the poor. In
the United States, NTDs disproportionately affect people
living in poverty, and especially minorities, including up to
2.8 million African Americans with toxocariasis and 300,000
or more people, mostly Hispanic Americans, with Chagas
disease.
(7) 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.
(8) Research and development efforts are immediately needed
for all NTDs, especially those for which limited or no
treatment currently exists.
(9) Critical to developing robust NTD control strategies
are epidemiological data that identify at-risk populations,
ensure appropriate treatment frequency, and inform decisions
about when treatment can be reduced or stopped.
(10) Of the 14 most common NTDs, roughly 80 percent of
infections are caused by soil-transmitted helminths (STH) and
schistosomiasis. STH are a group of 3 parasitic worms
(roundworms, whipworms, and hookworms) that afflict more than
1 billion people worldwide, including 600 million school-age
children, of whom more than 300 million suffer from severe
morbidity. Schistosomiasis is another helminth infection
affecting at least 200 million people in developing
countries, but some estimates indicate that the true number
of people affected may be double or even triple that number.
(11) The benefits of deworming are immediate and enduring.
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 half a year of schooling.
SEC. 5. DEFINITION.
In this Act, the term ``neglected tropical diseases'' or
``NTDs''--
(1) means infections caused by pathogens, including
viruses, bacteria, protozoa, and helminths that
disproportionately impact individuals living in extreme
poverty, especially in developing countries; and
(2) includes--
(A) Buruli ulcer (Mycobacterium Ulcerans infection);
(B) Chagas disease;
(C) dengue or severe dengue fever;
(D) dracunculiasis (Guinea worm disease);
(E) echinococcosis;
(F) foodborne trematodiases;
(G) human African trypanosomiasis (sleeping sickness);
(H) leishmaniasis;
(I) leprosy;
(J) lymphatic filariasis (elephantiasis);
(K) onchocerciasis (river blindness);
(L) scabies;
(M) schistosomiasis;
(N) soil-transmitted helminthiases (STH) (roundworm,
whipworm, and hookworm);
(O) taeniasis/cysticercosis;
(P) trachoma; and
(Q) yaws (endemic treponematoses).
SEC. 6. RULE OF CONSTRUCTION.
Nothing in this Act shall be construed to increase
authorizations of appropriations for the United States Agency
for International Development.
SEC. 7. EXPANSION OF UNITED STATES AGENCY FOR INTERNATIONAL
DEVELOPMENT NEGLECTED TROPICAL DISEASES
PROGRAM.
(a) Findings.--Congress finds the following:
(1) Since fiscal year 2006, the United States Government
has been an essential leader in global efforts to control
seven targeted neglected tropical diseases: lymphatic
filariasis (elephantiasis), onchocerciasis (river blindness),
schistosomiasis, soil-transmitted helminthiases (roundworm,
whipworm, and hookworm), and trachoma. Additional information
suggests that such efforts could also produce collateral
benefits for at least three other neglected tropical
diseases: foodborne trematodiases, scabies, and yaws (endemic
treponematoses).
(2) The United States Government is a partner in the London
Declaration on Neglected Tropical Diseases (2012), which
represents a new, coordinated international push to
accelerate progress toward eliminating or controlling 10 NTDs
by 2020.
[[Page H9195]]
(3) While many of the most common NTDs have safe, easy to
use, and effective treatments, treatment options for the NTDs
with the highest death rates, including human African
trypanosomiasis (sleeping sickness), visceral leishmaniasis,
and Chagas disease, are extremely limited.
(4) The United States Agency for International Development
(USAID) Neglected Tropical Diseases Program has made
important and substantial contributions to the global fight
to control and eliminate 5 of the most common NTDs.
Leveraging more than $15,700,000,000 in donated medicines,
USAID has supported the distribution of more than 1 billion
treatments in 31 countries across Africa, Asia, and Latin
America and the Caribbean.
(5) Since 2014, the USAID Neglected Tropical Diseases
Program has been investing in research and development for
the treatment of certain NTDs to ensure that promising new
breakthrough medicines can be rapidly evaluated, registered,
and made available to patients.
(6) The USAID Neglected Tropical Diseases Program is a
clear example of a successful public-private partnership
between the Government and the private sector and should be
judiciously expanded, as practicable and appropriate.
(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, should--
(1) provide integrated drug treatment packages to as many
individuals suffering from NTDs or at risk of acquiring NTDs,
including individuals displaced by manmade and natural
disasters, as logistically feasible;
(2) better integrate NTD control and treatment tools and
approaches into complementary development and global health
programs by coordinating, to the extent practicable and
appropriate, across multiple sectors, including those
relating to HIV/AIDS, malaria, tuberculosis, education,
nutrition, other infectious diseases, maternal and child
health, and water, sanitation, and hygiene;
(3) establish 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;
(4) as opportunities emerge and resources allow, engage in
research and development of new tools and approaches to reach
the goals relating to the elimination of NTDs as set forth by
the 2012 World Health Organization publication ``Accelerating
Work to Overcome the Global Impact of Neglected Tropical
Diseases: A Roadmap for Implementation'', including for
Chagas disease, Guinea worm, human African trypanosomiasis
(sleeping sickness), leprosy, and visceral leishmaniasis; and
(5) 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 the USAID 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 education (both primary and
secondary), in order to advance the goals of the London
Declaration on Neglected Tropical Diseases (2012).
(3) Including morbidity management in treatment plans for
high-burden NTDs.
(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 complement existing research
investments and ensure that new discoveries make it through
the pipeline and become available to individuals who need
them most.
SEC. 8. ACTIONS BY DEPARTMENT OF STATE.
(a) Office of the Global AIDS Coordinator.--It is the sense
of Congress that the Coordinator of United States Government
Activities to Combat HIV/AIDS Globally should fully consider
evolving research on the impact of NTDs on efforts to control
HIV/AIDS when making future programming decisions, as
necessary and appropriate.
(b) Global Programming.--
(1) In general.--The Secretary of State should encourage
the Global Fund to take into consideration evolving research
on the impact of NTDs on efforts to control HIV/AIDS when
making programming decisions, particularly with regard to
female genital schistosomiasis, which studies suggest may be
one of the most significant cofactors in the AIDS epidemic in
Africa, as necessary and appropriate.
(2) Global fund.--In this subsection, 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.
(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. 9. MULTILATERAL DEVELOPMENT AND HEALTH INSTITUTIONS.
(a) Congressional Finding.--Congress finds that the
treatment of NTDs, including community- and school-based
deworming programs, can be a highly cost-effective
intervention, and schools can serve as an effective delivery
mechanism for reaching large numbers of children with safe
treatment for soil-transmitted helminthiases (roundworm,
whipworm, and hookworm) in particular.
(b) United Nations.--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 to--
(1) 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) highlight impacts of community- and school-based
deworming programs on children's health and education,
emphasizing the cost-effectiveness of such programs;
(3) encourage governments to implement deworming campaigns
at the national level;
(4) consider the designation of 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) encourage accurate monitoring and evaluation of NTD
programs, including deworming programs; and
(6) 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.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New
Jersey (Mr. Sires) and the gentleman from New Jersey (Mr. Smith) each
will control 20 minutes.
The Chair recognizes the gentleman from New Jersey (Mr. Sires).
{time} 1630
General Leave
Mr. SIRES. Mr. Speaker, I ask unanimous consent that all Members have
5 legislative days in which to revise and extend their remarks and
include extraneous material on H.R. 3460.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New Jersey?
There was no objection.
Mr. SIRES. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, let me start by thanking Mr. Smith from New Jersey, a
senior member of the Foreign Affairs Committee, for his hard work on
this bill, which seeks to make progress on this pressing global health
challenge.
There is a category of diseases--what we call neglected tropical
diseases--that pack a particularly nasty punch on populations living in
poverty without adequate sanitation. These are precisely the kinds of
diseases that hold entire communities back. They drive up health costs,
lead to lost wages, undercut productivity, and deprive children of the
shot at a better future.
What is especially wrenching about these diseases is that they cause
all this harm, despite the fact that we have the tools to combat them.
Very elementary public health efforts can stop these diseases in their
tracks: research, drug distribution, and basic public health
intervention. Yet these diseases affect more than 1 billion people
around the world, according to the World Health Organization.
To its credit, USAID is already focusing on these diseases. The
Agency's Neglected Tropical Disease Program has worked to distribute
nearly $16 billion worth of donated medicines in more than 30
countries. It is a good start, but these efforts aren't yet equal to
the challenge.
This legislation underscores the serious challenge posed by neglected
tropical diseases and encourages USAID to expand its work to grapple
with this problem. It also sets up a stronger diplomatic approach for
dealing with these diseases by requiring the State Department to push
for broader action through the U.N., the Global Fund, and the G-20.
In short, this measure pushes for a smart, broad-based effort for
getting at these preventable diseases.
Mr. Speaker, I am pleased to support it, and I reserve the balance of
my time.
Mr. SMITH of New Jersey. Mr. Speaker, I yield myself such time as I
may consume.
[[Page H9196]]
Mr. Speaker, I thank Mr. Sires for his strong support for this
legislation and for his leadership on neglected tropical diseases. I
thank my other colleagues, Mr. McCaul and, of course, Ms. Bass, who has
also been a great supporter of this legislation.
Mr. Speaker, neglected tropical diseases, or NTDs, are a group of
parasitic and bacterial diseases, including worms, which blind,
disfigure, and sometimes kill victims from among the world's poorest
people, trapping the most marginalized communities in cycles of
poverty. There are numerous examples of them, including Chagas, dengue,
and leprosy.
Can you believe, Mr. Speaker, that there are over 200,000 cases of
leprosy in the world today? And there is an intervention. There are
drugs that can treat, mitigate, and even cure it, but sometimes people
do not get access to them, and that causes serious, serious problems.
The worms--and I will get into that in a minute--are absolutely
devastating, as well, and they need to be addressed very aggressively.
Mr. Speaker, approximately 2 billion people--almost one-third of the
world's population--are at risk of contracting an NTD, and over 1.4
billion people are currently afflicted with one or more NTDs.
Over the years, Mr. Speaker, I have chaired numerous hearings on
this: one in 2013; one in 2016, the global Zika epidemic; and many
others, always focusing on the fact that we need to do more.
These are preventable, but they are certainly treatable. But if you
don't get the drugs and you don't get the intervention, that person is
made--and those who are like that person--to suffer horrifically.
I introduced the End Neglected Tropical Diseases Act in four separate
Congresses--2014, 2015, 2017, and again this year--so I deeply
appreciate Chairman Engel and Ranking Member McCaul's strong support
for this legislation and the leadership for bringing it up today.
NTDs have an enormous impact in terms of disease burden and quality
of life. It causes the loss of life to about 534,000 people. NTDs
surpass both malaria and tuberculosis in causing greater loss of life-
years to disability and premature death. They cause disfigurement and
disability, often leading to stigma, social discrimination, and
societal marginalization.
NTDs create an economic burden of billions of dollars through the
loss of productivity and the high costs of healthcare required for
treatment when it gets, especially, to a critical stage.
People afflicted by NTDs are less productive than their healthy
counterparts. They jeopardize the ability of people to attend work and
school or to produce at full capacity.
The social, economic, and health burden of NTDs falls primarily on
low- and middle-income countries, where access to safe water,
sanitation, and healthcare is limited.
At least 100 countries face two endemic NTD burdens, and 30 countries
carry six or more endemic neglected tropical diseases.
As I said, they can be controlled. They can be prevented and even
eliminated, using low-cost, effective, and feasible solutions,
especially when treated early.
Research and development efforts are immediately needed for all NTDs,
especially those for which no treatment currently exists.
Recent data published by the WHO confirm that, in 2018, more than 1
billion people were treated for at least one of five neglected tropical
diseases.
Not well understood, Mr. Speaker, is the fact that neglected tropical
diseases are infecting large numbers of vulnerable people--especially
children--in developed countries, including the United States. Of
course, these include West Nile virus, dengue fever, and, most
recently, Zika.
An article published in the medical journal The Lancet scrutinized
this emerging threat and was titled, ``Neglected Tropical Diseases: No
Longer Someone Else's Problem.'' The article references world-renowned
NTD expert Dr. Peter Hotez of Baylor College of Medicine, who, I note
parenthetically, twice testified at hearings that I chaired.
I read his book--and I read it not once, but twice. It is a wake-up
call to what these horrible diseases do. But he estimates that more
than half of the 20 million Americans living in extreme poverty are
infected with at least one neglected tropical disease. That is right
here in the United States of America.
The End Neglected Tropical Diseases Act supports the treatment,
control, and elimination of NTDs primarily by ensuring that USAID's NTD
Program effectively integrates treatment, control, and elimination
efforts with other development issues, such as HIV/AIDS, malaria, water
and sanitation, and education.
It also directs, as my good friend Mr. Sires pointed out a moment
ago, the U.S. Government to advocate for increased efforts to address
NTDs among international institutions such as the U.N., World Health
Organization, and World Bank.
Let's not forget that of the 14 most common NTDs, roughly 80 percent
of infections are caused by soil-transmitted helminths and
schistosomiasis.
Soil-transmitted helminths are a group of three parasitic worms--
roundworms, whipworms, and hookworms--that afflict more than 1 billion
people worldwide, including 600 million school-age children, of whom
more than 300 million suffer from severe morbidity.
Schistosomiasis is another helminth infection affecting at least 220
million people in developing countries, and the World Health
Organization estimates that 90 percent of those individuals are in sub-
Saharan Africa.
The benefits of deworming are immediate and enduring. A rigorous,
randomized controlled trial has shown that school-based deworming
treatment reduces 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 half a year of schooling.
Let me also point out to my colleagues that the treatment for worms
is simple and cost-effective. Treatment for hookworm, for example, in
Tanzania costs about 4 cents per treatment to knock this terrible
disease out of the intestinal tract. Yet one-off deworming treatment is
not enough, as, without sanitary and hygiene behavioral changes, people
will get reinfected.
What we need to do, and what this bill does, is to integrate our
USAID deworming programs with our WaSH programs--water, sanitation, and
health--coupled with our nutrition interventions.
Let me just also make a point that needs to be underscored with
exclamation points. There is a very, very robust public-private
partnership that USAID leads with pharmaceutical industry companies
such as GlaxoSmithKline, Johnson & Johnson, and Merck.
And, of course, my friend in the chair and my friend managing the
bill on the Democrat side know, because these companies hail from the
great State of New Jersey--Merck in Rahway, for example--every U.S.
taxpayer dollar invested is leveraged with $26 in donated medicines,
resulting in $22 billion worth of donated medicine, which is
extraordinary. I don't know of any other health program where the
pharmaceuticals have stepped up like this to say: We are not going to
sell you these drugs; we are going to donate them.
We also have helped train 6.5 million individuals in countries around
the world to fight NTDs, helping them build and strengthen health
systems. So we are, I think, making a difference. We need to do more.
Mr. Speaker, I reserve the balance of my time.
Mr. SIRES. Mr. Speaker, I reserve the balance of my time.
Mr. SMITH of New Jersey. Mr. Speaker, it is my privilege to yield
such time as he may consume to the gentleman from Texas (Mr. McCaul),
the distinguished ranking member of the Foreign Affairs Committee.
Mr. McCAUL. Mr. Speaker, I rise today in support of the End Neglected
Tropical Diseases Act, a bill sponsored by my good friend, Mr. Smith of
New Jersey. I want to commend him for his efforts as being a steadfast
leader on this very important issue that is going to save lives--and
has saved lives. He is really the conscience, I think, of this body
when it comes to this issue.
[[Page H9197]]
NTDs represent a group of parasitic and bacterial diseases that
currently afflict more than 1.4 billion people worldwide. They can
result in severe disabilities such as blindness, compounding existing
social and economic challenges in the areas where these diseases
thrive.
To be clear, the United States has taken a leadership role in the
fight against NTDs. As many of these diseases have approved treatments,
USAID's NTD program has supplied medicine to key impacted countries
using an innovative public-private partnership, as Congressman Smith
alluded to.
Since 2006, USAID has leveraged more than $22 billion in donated
medicines to provide about $2.6 billion in treatments. However, there
is much more to be done, especially to build global political support
to fight NTDs.
To that end, this bill directs our flagship global health program,
PEPFAR, to find opportunities to integrate NTD research and care into
their existing efforts to fight HIV/AIDS, where appropriate.
To lessen the U.S. burden in this fight, this bill also encourages
greater participation in the research, treatment, and care of NTDs from
the Global Fund, the United Nations, and other G-20 partners.
NTDs pose a significant threat to health outcomes and have a
detrimental effect on developing economies. I again thank Mr. Smith for
his great leadership on this issue. And, once again, to pass something
in this House that will save lives is truly one of the most gratifying
experiences that we, as Members of Congress, have.
Mr. SIRES. Mr. Speaker, I continue to reserve the balance of my time.
Mr. SMITH of New Jersey. Mr. Speaker, I have no further requests for
time, and I yield back the balance of my time.
Mr. SIRES. Mr. Speaker, I yield myself such time as I may consume for
the purpose of closing.
Mr. Speaker, let me again thank Mr. Smith for all his hard work on
this bill.
This legislation shows so clearly how we can use development and
diplomacy in tandem to help meet serious global challenges. It is why
diplomacy and development are so important in our foreign policy.
There is no doubt that neglected tropical diseases have a major
roadblock for impoverished communities around the world. There is also
no doubt that we have the tools to combat them if we can garner the
resources and the political will to get the job done. That is what this
bill aims to do.
Mr. Speaker, I urge all Members to vote ``yes'' on this measure, 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 Jersey (Mr. Sires) that the House suspend the rules
and pass the bill, H.R. 3460.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill was passed.
A motion to reconsider was laid on the table.
____________________