[Congressional Record Volume 167, Number 56 (Thursday, March 25, 2021)]
[Senate]
[Pages S1832-S1833]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 SENATE RESOLUTION 137--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 Foreign Relations:

                              S. Res. 137

       Whereas, in 2019, nearly \1/4\ of the global population was 
     infected with the tuberculosis bacterium (referred to in this 
     preamble as ``TB'');
       Whereas the World Health Organization (referred to in this 
     preamble as the ``WHO'') estimates that 10,000,000 people 
     developed TB in 2019, 8.2 percent of whom were also infected 
     with the human immunodeficiency virus (referred to in this 
     preamble as ``HIV'');
       Whereas, in 2019, TB killed an estimated 1,408,000 people, 
     causing more deaths worldwide than any other single 
     infectious agent;
       Whereas, globally in 2019, an estimated 1,200,000 children 
     developed TB, and in 2017, 230,000 children died of TB;
       Whereas \2/3\ of new TB infections in 2019 occurred in 8 
     countries: India, Indonesia, China, the Philippines, 
     Pakistan, Nigeria, Bangladesh, and South Africa;
       Whereas TB is a leading killer of people infected with HIV, 
     and 208,000 people with HIV died of TB in 2019;
       Whereas vulnerable populations also at high risk for 
     developing TB include individuals who are pregnant and 
     newborns;
       Whereas, in 2018, TB was one of the 6 leading causes of 
     death among adult women between the ages of 15 and 49 in low-
     income countries;
       Whereas, in some settings, women with TB can face stigma, 
     discrimination, and 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 mismanaged or not made 
     consistently accessible;
       Whereas studies have demonstrated direct person-to-person 
     transmission of drug-resistant TB;
       Whereas multi-drug resistant TB (referred to in this 
     preamble as ``MDR-TB'') is caused by bacteria with resistance 
     to rifampin and isoniazid, the 2 most potent treatments for 
     TB infection;
       Whereas, in 2019, according to the 2020 WHO Global 
     Tuberculosis Report, an estimated 3.3 percent of all new TB 
     cases and 18 percent of previously treated cases were MDR-TB 
     or rifampin-resistant TB;
       Whereas, in 2019, an estimated 465,000 people around the 
     world developed MDR-TB or rifampin-resistant TB, yet only 
     approximately 38 percent of those individuals were identified 
     and treated;
       Whereas extensively drug-resistant TB (referred to in this 
     preamble 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;
       Whereas, in 2019, every WHO region reported XDR-TB cases;
       Whereas, in 2019, the Centers for Disease Control and 
     Prevention (referred to in this preamble as ``CDC'') 
     estimated that the average cost of treating a single patient 
     with MDR-TB in the United States was $178,000, and the 
     average cost of treating a patient with XDR-TB was even 
     higher at $553,000, compared with $20,000 to treat a patient 
     with drug-susceptible TB;
       Whereas, between 2005 and 2007, according to an analysis by 
     CDC, MDR-TB and XDR-TB cases in the United States 
     collectively cost the health care system an estimated 
     $53,000,000;
       Whereas CDC estimates that costs resulting from all forms 
     of TB in the United States totaled more than $608,000,000 in 
     2019;
       Whereas, in a 2000 report, the Institute of Medicine found 
     that a decrease in TB control funding and the spread of HIV 
     and acquired immune deficiency syndrome (commonly referred to 
     as ``AIDS'') caused a resurgence of TB in the late 1980s and 
     early 1990s;
       Whereas a total of 8,916 TB cases were reported in the 
     United States in 2019, 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 8 
     times higher than the rate of disease in White, non-Hispanic 
     Americans, and significant disparities exist among other 
     minorities in the United States, including Asian Americans, 
     Hispanic Americans, and Native Americans and Alaska Natives, 
     with approximately 88 percent of all reported TB cases in the 
     United States in 2019 occurring in racial or ethnic 
     minorities;
       Whereas smoking--
       (1) greatly increases the risks of contracting TB and 
     infection recurrence; and
       (2) impairs therapeutic efficacy;
       Whereas diabetes is a major risk factor for TB, and people 
     with diabetes are more likely to develop and succumb 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 (referred to in this preamble as ``USAID'') 
     provided approximately 105,000 treatments in 110 eligible 
     countries from 2015 through 2019;
       Whereas Bacillus Calmette-Guerin, a TB vaccine that is 
     known as ``BCG'', provides some protection to infants and 
     young children against serious forms of childhood TB but has 
     had little epidemiologic impact on controlling 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;
       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

[[Page S1833]]

     Comprehensive Tuberculosis Elimination Act of 2008 (Public 
     Law 110-392; 122 Stat. 4195) led to a historic United States 
     commitment to support 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--
       (1) provides technical assistance to 55 countries and 
     implements bilateral programs in 23 high-burden TB countries 
     that--
          (A) build capacity; and
          (B) support the adoption of state-of-the-art TB-related 
     technologies;
       (2) supports the development of new diagnostic and 
     treatment tools; and
       (3) supports research to develop new vaccines and other new 
     methods to combat TB;
       Whereas, in 2018, USAID launched--
       (1) a new business model entitled ``Global Accelerator to 
     End Tuberculosis'' to accelerate progress and build capacity 
     with respect to TB prevention and treatment; and
       (2) 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 more than 29 percent since 2000;
       Whereas, according to 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 CDC, in partnership with other entities of the 
     United States and individual States and territories--
       (1) directs the national TB elimination program;
       (2) coordinates TB surveillance, technical assistance, and 
     prevention activities; and
       (3) 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 (referred to in this preamble as the ``Global 
     Fund''), to which the United States is a top financial donor, 
     provides more than 73 percent of all international financing 
     for TB programs;
       Whereas, in 2019, Global Fund-supported programs detected 
     and treated more than 5,700,000 cases of TB;
       Whereas the coronavirus disease 2019 (COVID-19) pandemic 
     and mitigation efforts put in place as a result of the 
     pandemic have taken a devastating toll on countries with the 
     highest burden of TB disease and on the global TB response, 
     threatening to reverse up to 8 years of progress fighting the 
     disease;
       Whereas, in 2020, in the 23 high-burden TB countries in 
     which USAID implements bilateral programs, 1,000,000 fewer 
     people with TB had access to diagnosis and treatment, a 23 
     percent decline from 2019;
       Whereas, between 2020 and 2025, global projections estimate 
     that the impact of the COVID-19 pandemic will lead to an 
     additional 6,300,000 cases of TB and an additional 1,400,000 
     TB deaths; and
       Whereas March 24, 2021, is World Tuberculosis Day, a day 
     that commemorates the date in 1882 on which Dr. Robert Koch 
     announced his discovery of Mycobacterium tuberculosis, the 
     bacterium 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 leadership 
     role of the United States in, and the effectiveness of the 
     global response to, the fight to end the tuberculosis 
     epidemic.

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