[Congressional Record Volume 169, Number 120 (Thursday, July 13, 2023)]
[Senate]
[Pages S2479-S2482]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 286. Mr. MENENDEZ submitted an amendment intended to be proposed
by him to the bill S. 2226, to authorize appropriations for fiscal year
2024 for military activities of the Department of Defense, for military
construction, and for defense activities of the Department of Energy,
to prescribe military personnel strengths for such fiscal year, and for
other purposes; which was ordered to lie on the table; as follows:
At the appropriate place in title XII, insert the
following:
[[Page S2480]]
SECTION 12__. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Short Title.--This section may be cited as the ``End
Tuberculosis Now Act of 2023''.
(b) Findings.--Congress makes the following findings:
(1) Tuberculosis (referred to in the Act as ``TB'') is a
preventable, treatable, and curable disease, yet more than 25
years after the World Health Organization declared it to be a
public health emergency and called on countries to make
scaling up TB control a priority, TB remains a deadly health
threat.
(2) In 2021 alone, an estimated 10,600,000 people became
ill with TB, 11 percent of whom were children, and an
estimated 1,600,000 of these people died from the illness. In
order to achieve by 2035 the goals of the Political
Declaration of the High-Level Meeting of the General Assembly
on the Fight Against Tuberculosis, adopted by the United
Nations General Assembly October 10, 2018, and of the World
Health Organization End TB Strategy, adopted by the World
Health Assembly in 2014, new and existing tools must be
developed and scaled-up.
(3) More than \1/3\ of people who become ill with TB may be
undiagnosed or misdiagnosed, resulting in unnecessary
illness, communicable infections, and increased mortality.
(4) Since March 2020, the COVID-19 pandemic has severely
disrupted TB responses in low- and middle-income countries,
stalling and reversing years of progress made against TB.
According to the World Health Organization, from 2019 to
2020--
(A) global detection of TB dropped by 18 percent;
(B) an estimated 1,300,000 fewer people were diagnosed and
enrolled on TB treatment; and
(C) in some countries, TB case notifications dropped by up
to 41 percent, setting progress back by up to 12 years.
(5) Failure to properly diagnose and treat TB can lead to
death, can exacerbate antimicrobial resistance (a key
contributor to rising cases of multi-drug-resistant TB and
extensively drug-resistant TB), and can increase the
probability of the introduction of resistant TB into new
geographic areas.
(6) TB programs have played a central role in responding to
COVID-19, including through leveraging the expertise of
medical staff with expertise in TB and lung diseases, the
repurposing of TB hospitals, and the use of the TB rapid
molecular testing platforms and x-ray equipment for multiple
purposes, including the treatment of COVID-19.
(7) With sufficient resourcing, TB program expertise,
infection control, laboratory capacity, active case finding,
and contact investigation can serve as platforms for
respiratory pandemic response against existing and new
infectious respiratory disease without disrupting ongoing TB
programs and activities.
(8) Globally, only about \1/2\ of the $13,000,000,000
required annually, as outlined in the Stop TB Partnership's
Global Plan to End TB, is currently available.
(9) According to estimates by the Global Fund for AIDS,
Tuberculosis, and Malaria, an additional $3,500,000,000 was
needed during 2021 for TB programs in eligible countries in
order to recover from the negative impacts of COVID-19.
(10) On September 26, 2018, the United Nations convened the
first High-Level Meeting of the General Assembly on the Fight
Against Tuberculosis, during which 120 countries--
(A) signed a Political Declaration to accelerate progress
against TB, including through commitments to increase funding
for TB prevention, diagnosis, treatment, and research and
development programs, and to set ambitious goals to
successfully treat 40,000,000 people with active TB and
prevent at least 30,000,000 from becoming ill with TB between
2018 and 2022; and
(B) committed to ``ending the epidemic in all countries,
and pledge[d] to provide leadership and to work together to
accelerate our national and global collective actions,
investments and innovations urgently to fight this
preventable and treatable disease'', as reflected in United
Nations General Assembly Resolution 73/3.
(11) The United States Government continues to be a lead
funder of global TB research and development, contributing 44
percent of the total $915,000,000 in global funding in 2020,
and can catalyze more investments from other countries.
(12) Working with governments and partners around the
world, USAID's TB programming has saved an estimated
74,000,000 lives, demonstrating the effectiveness of United
States programs and activities against the illness.
(13) On September 26, 2018, the USAID Administrator
announced a new performance-based Global Accelerator to End
TB, aimed at catalyzing investments to meet the treatment
target set by the United Nations High-Level Meeting, further
demonstrating the critical role that United States leadership
and assistance plays in the fight to eliminate TB.
(14) It is essential to ensure that efforts among United
States Government agencies, partner nations, international
organizations, nongovernmental organizations, the private
sector, and other actors are complementary and not
duplicative in order to achieve the goal of ending the TB
epidemic in all countries.
(c) United States Government Assistance to Combat
Tuberculosis.--Section 104B of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b-3) is amended to read as follows:
``SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.
``(a) Findings.--Congress makes the following findings:
``(1) The international spread of tuberculosis (referred to
in this section as `TB') and the deadly impact of TB's
continued existence constitutes a continuing challenge.
``(2) Additional tools and resources are required to
effectively diagnose, prevent, and treat TB.
``(3) Effectively resourced TB programs can serve as a
critical platform for preventing and responding to future
infectious respiratory disease pandemics.
``(b) Policy.--
``(1) In general.--It is a major objective of the foreign
assistance program of the United States to help end the TB
public health emergency through accelerated actions--
``(A) to support the diagnosis and treatment of all adults
and children with all forms of TB; and
``(B) to prevent new TB infections from occurring.
``(2) Support for global plans and objectives.--In
countries in which the United States Government has
established foreign assistance programs under this Act,
particularly in countries with the highest burden of TB and
other countries with high rates of infection and transmission
of TB, it is the policy of the United States--
``(A) to support the objectives of the World Health
Organization End TB Strategy, including its goals--
``(i) to reduce TB deaths by 95 percent by 2035;
``(ii) to reduce the TB incidence rate by 90 percent by
2035; and
``(iii) to reduce the number of families facing
catastrophic health costs due to TB by 100 percent by 2035;
``(B) to support the Stop TB Partnership's Global Plan to
End TB 2023-2030, including by providing support for--
``(i) developing and using innovative new technologies and
therapies to increase active case finding and rapidly
diagnose and treat children and adults with all forms of TB,
alleviate suffering, and ensure TB treatment completion;
``(ii) expanding diagnosis and treatment in line with the
goals established by the Political Declaration of the High-
Level Meeting of the General Assembly on the Fight Against
Tuberculosis, including--
``(I) successfully treating 40,000,000 people with active
TB by 2023, including 3,500,000 children, and 1,500,000
people with drug-resistant TB; and
``(II) diagnosing and treating latent tuberculosis
infection, in support of the global goal of providing
preventive therapy to at least 30,000,000 people by 2023,
including 4,000,000 children younger than 5 years of age,
20,000,000 household contacts of people affected by TB, and
6,000,000 people living with HIV;
``(iii) ensuring high-quality TB care by closing gaps in
care cascades, implementing continuous quality improvement at
all levels of care, and providing related patient support;
and
``(iv) sustainable procurements of TB commodities to avoid
interruptions in supply, the procurement of commodities of
unknown quality, or payment of excessive commodity costs in
countries impacted by TB; and
``(C) to ensure, to the greatest extent practicable, that
United States funding supports activities that simultaneously
emphasize--
``(i) the development of comprehensive person-centered
programs, including diagnosis, treatment, and prevention
strategies to ensure that--
``(I) all people sick with TB receive quality diagnosis and
treatment through active case finding; and
``(II) people at high risk for TB infection are found and
treated with preventive therapies in a timely manner;
``(ii) robust TB infection control practices are
implemented in all congregate settings, including hospitals
and prisons;
``(iii) the deployment of diagnostic and treatment
capacity--
``(I) in areas with the highest TB burdens; and
``(II) for highly at-risk and impoverished populations,
including patient support services;
``(iv) program monitoring and evaluation based on critical
TB indicators, including indicators relating to infection
control, the numbers of patients accessing TB treatment and
patient support services, and preventative therapy for those
at risk, including all close contacts, and treatment outcomes
for all forms of TB;
``(v) training and engagement of health care workers on the
use of new diagnostic tools and therapies as they become
available, and increased support for training frontline
health care workers to support expanded TB active case
finding, contact tracing, and patient support services;
``(vi) coordination with domestic agencies and
organizations to support an aggressive research agenda to
develop vaccines as well as new tools to diagnose, treat, and
prevent TB globally;
``(vii) linkages with the private sector on--
``(I) research and development of a vaccine, and on new
tools for diagnosis and treatment of TB;
``(II) improving current tools for diagnosis and treatment
of TB, including telehealth solutions for prevention and
treatment; and
[[Page S2481]]
``(III) training healthcare professionals on use of the
newest and most effective diagnostic and therapeutic tools;
``(viii) the reduction of barriers to care, including
stigma and treatment and diagnosis costs, including through--
``(I) training health workers;
``(II) sensitizing policy makers;
``(III) requiring that all relevant grants and funding
agreements include access and affordability provisions;
``(IV) supporting education and empowerment campaigns for
TB patients regarding local TB services;
``(V) monitoring barriers to accessing TB services; and
``(VI) increasing support for patient-led and community-led
TB outreach efforts;
``(ix) support for country-level, sustainable
accountability mechanisms and capacity to measure progress
and ensure that commitments made by governments and relevant
stakeholders are met; and
``(x) support for the integration of TB diagnosis,
treatment, and prevention activities into primary health
care, as appropriate.
``(c) Definitions.--In this section:
``(1) Appropriate congressional committees.--The term
`appropriate congressional committees' means the Committee on
Foreign Relations of the Senate and the Committee on Foreign
Affairs of the House of Representatives.
``(2) End tb strategy.--The term `End TB Strategy' means
the strategy to eliminate TB that was approved by the World
Health Assembly in May 2014, and is described in `The End TB
Strategy: Global Strategy and Targets for Tuberculosis
Prevention, Care and Control After 2015'.
``(3) Global alliance for tuberculosis drug development.--
The term `Global Alliance for Tuberculosis Drug Development'
means the public-private partnership that bring together
leaders in health, science, philanthropy, and private
industry to devise new approaches to TB.
``(4) Global tuberculosis drug facility.--The term `Global
Tuberculosis Drug Facility' means the initiative of the Stop
Tuberculosis Partnership to increase access to the most
advanced, affordable, quality-assured TB drugs and
diagnostics.
``(5) MDR-TB.--The term `MDR-TB' means multi-drug-resistant
TB.
``(6) Stop tuberculosis partnership.--The term `Stop
Tuberculosis Partnership' means the partnership of 1,600
organizations (including international and technical
organizations, government programs, research and funding
agencies, foundations, nongovernmental organizations, civil
society and community groups, and the private sector),
donors, including the United States, high TB burden
countries, multilateral agencies, and nongovernmental and
technical agencies, which is governed by the Stop TB
Partnership Coordinating Board and hosted by a United Nations
entity, committed to short- and long-term measures required
to control and eventually eliminate TB as a public health
problem in the world.
``(7) XDR-TB.--The term `XDR-TB' means extensively drug-
resistant TB.
``(d) Authorization.--To carry out this section, the
President is authorized, consistent with section 104(c), to
furnish assistance, on such terms and conditions as the
President may determine, for the prevention, treatment,
control, and elimination of TB.
``(e) Goals.--In consultation with the appropriate
congressional committees, the President shall establish
goals, based on the policy and indicators described in
subsection (b), for--
``(1) United States TB programs to detect, cure, and
prevent all forms of TB globally for the period between 2023
and 2030 that are aligned with the End TB Strategy's 2030
targets and the USAID's Global Tuberculosis (TB) Strategy
2023-2030; and
``(2) updating the National Action Plan for Combating
Multidrug-Resistant Tuberculosis.
``(f) Coordination.--
``(1) In general.--In carrying out this section, the
President shall coordinate with the World Health
Organization, the Stop TB Partnership, the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, and other
organizations with respect to the development and
implementation of a comprehensive global TB response program.
``(2) Bilateral assistance.--In providing bilateral
assistance under this section, the President, acting through
the Administrator of the United States Agency for
International Development, shall--
``(A) catalyze support for research and development of new
tools to prevent, diagnose, treat, and control TB worldwide,
particularly to reduce the incidence of, and mortality from,
all forms of drug-resistant TB;
``(B) ensure United States programs and activities focus on
finding individuals with active TB disease and provide
quality diagnosis and treatment, including through digital
health solutions, and reaching those at high risk with
preventive therapy; and
``(C) ensure coordination among relevant United States
Government agencies, including the Department of State, the
Centers for Disease Control and Prevention, the National
Institutes of Health, the Biomedical Advanced Research and
Development Authority, the Food and Drug Administration, the
National Science Foundation, the Department of Defense
(through its Congressionally Directed Medical Research
Programs), and other relevant Federal departments and
agencies that engage in international TB activities--
``(i) to ensure accountability and transparency;
``(ii) to reduce duplication of efforts; and
``(iii) to ensure appropriate integration and coordination
of TB services into other United States-supported health
programs.
``(g) Priority To End TB Strategy.--In furnishing
assistance under subsection (d), the President shall
prioritize--
``(1) building and strengthening TB programs--
``(A) to increase the diagnosis and treatment of everyone
who is sick with TB; and
``(B) to ensure that such individuals have access to
quality diagnosis and treatment;
``(2) direct, high-quality integrated services for all
forms of TB, as described by the World Health Organization,
which call for the coordination of active case finding,
treatment of all forms of TB disease and infection, patient
support, and TB prevention;
``(3) treating individuals co-infected with HIV and other
co-morbidities, and other individuals with TB who may be at
risk of stigma;
``(4) strengthening the capacity of health systems to
detect, prevent, and treat TB, including MDR-TB and XDR-TB,
as described in the latest international guidance related to
TB;
``(5) researching and developing innovative diagnostics,
drug therapies, and vaccines, and program-based research;
``(6) support for the Stop Tuberculosis Partnership's
Global Drug Facility, the Global Alliance for Tuberculosis
Drug Development, and other organizations promoting the
development of new products and drugs for TB; and
``(7) ensuring that TB programs can serve as key platforms
for supporting national respiratory pandemic response against
existing and new infectious respiratory disease.
``(h) Assistance for the World Health Organization 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--
``(1) to provide resources to the World Health Organization
and the Stop Tuberculosis Partnership to improve the capacity
of countries with high burdens or rates of TB and other
affected countries to implement the End TB Strategy, the Stop
TB Global Plan to End TB, their own national strategies and
plans, other global efforts to control MDR-TB and XDR-TB; and
``(2) to leverage the contributions of other donors for the
activities described in paragraph (1).
``(i) Annual Report on TB Activities.--Not later than
December 15 of each year until the earlier of the date on
which the goals specified in subsection (b)(2)(A) are met or
the last day of 2030, the President shall submit an annual
report to the appropriate congressional committees that
describes United States foreign assistance to control TB and
the impact of such efforts, including--
``(1) the number of individuals with active TB disease that
were diagnosed and treated, including the rate of treatment
completion and the number receiving patient support;
``(2) the number of persons with MDR-TB and XDR-TB that
were diagnosed and treated, including the rate of completion,
in countries receiving United States bilateral foreign
assistance for TB control programs;
``(3) the number of people trained by the United States
Government in TB surveillance and control;
``(4) the number of individuals with active TB disease
identified as a result of engagement with the private sector
and other nongovernmental partners in countries receiving
United States bilateral foreign assistance for TB control
programs;
``(5) a description of the collaboration and coordination
of United States anti-TB efforts with the World Health
Organization, the Stop TB Partnership, the Global Fund to
Fight AIDS, Tuberculosis and Malaria, and other major public
and private entities;
``(6) a description of the collaboration and coordination
among the United States Agency for International Development
and other United States departments and agencies, including
the Centers for Disease Control and Prevention and the Office
of the Global AIDS Coordinator, for the purposes of combating
TB and, as appropriate, its integration into primary care;
``(7) the constraints on implementation of programs posed
by health workforce shortages, health system limitations,
barriers to digital health implementation, other challenges
to successful implementation, and strategies to address such
constraints;
``(8) a breakdown of expenditures for patient services
supporting TB diagnosis, treatment, and prevention, including
procurement of drugs and other commodities, drug management,
training in diagnosis and treatment, health systems
strengthening that directly impacts the provision of TB
services, and research; and
``(9) for each country, and when practicable, each project
site receiving bilateral United States assistance for the
purpose of TB prevention, treatment, and control--
``(A) a description of progress toward the adoption and
implementation of the most recent World Health Organization
guidelines to improve diagnosis, treatment, and prevention of
TB for adults and children, disaggregated by sex, including
the proportion of health facilities that have adopted the
latest World Health Organization guidelines on strengthening
monitoring systems
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and preventative, diagnostic, and therapeutic methods,
including the use of rapid diagnostic tests and orally
administered TB treatment regimens;
``(B) the number of individuals screened for TB disease and
the number evaluated for TB infection using active case
finding outside of health facilities;
``(C) the number of individuals with active TB disease that
were diagnosed and treated, including the rate of treatment
completion and the number receiving patient support;
``(D) the number of adults and children, including people
with HIV and close contacts, who are evaluated for TB
infection, the number of adults and children started on
treatment for TB infection, and the number of adults and
children completing such treatment, disaggregated by sex and,
as possible, income or wealth quintile;
``(E) the establishment of effective TB infection control
in all relevant congregant settings, including hospitals,
clinics, and prisons;
``(F) a description of progress in implementing measures to
reduce TB incidence, including actions--
``(i) to expand active case finding and contact tracing to
reach vulnerable groups; and
``(ii) to expand TB preventive therapy, engagement of the
private sector, and diagnostic capacity;
``(G) a description of progress to expand diagnosis,
prevention, and treatment for all forms of TB, including in
pregnant women, children, and individuals and groups at
greater risk of TB, including migrants, prisoners, miners,
people exposed to silica, and people living with HIV/AIDS,
disaggregated by sex;
``(H) the rate of successful completion of TB treatment for
adults and children, disaggregated by sex, and the number of
individuals receiving support for treatment completion;
``(I) the number of people, disaggregated by sex, receiving
treatment for MDR-TB, the proportion of those treated with
the latest regimens endorsed by the World Health
Organization, factors impeding scale up of such treatment,
and a description of progress to expand community-based MDR-
TB care;
``(J) a description of TB commodity procurement challenges,
including shortages, stockouts, or failed tenders for TB
drugs or other commodities;
``(K) the proportion of health facilities with specimen
referral linkages to quality diagnostic networks, including
established testing sites and reference labs, to ensure
maximum access and referral for second line drug resistance
testing, and a description of the turnaround time for test
results;
``(L) the number of people trained by the United States
Government to deliver high-quality TB diagnostic,
preventative, monitoring, treatment, and care services;
``(M) a description of how supported activities are
coordinated with--
``(i) country national TB plans and strategies; and
``(ii) TB control efforts supported by the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, and other
international assistance programs and funds, including in the
areas of program development and implementation; and
``(N) for the first 3 years of the report required under
this subsection, a description of the progress in recovering
from the negative impact of COVID-19 on TB, including--
``(i) whether there has been the development and
implementation of a comprehensive plan to recover TB
activities from diversion of resources;
``(ii) the continued use of bidirectional TB-COVID testing;
and
``(iii) progress on increased diagnosis and treatment of
active TB.
``(j) Annual Report on TB Research and Development.--The
President, acting through the Administrator of the United
States Agency for International Development, and in
coordination with the National Institutes of Health, the
Centers for Disease Control and Prevention, the Biomedical
Advanced Research and Development Authority, the Food and
Drug Administration, the National Science Foundation, and the
Office of the Global AIDS Coordinator, shall submit to the
appropriate congressional committees until 2030 an annual
report that--
``(1) describes the current progress and challenges to the
development of new tools for the purpose of TB prevention,
treatment, and control;
``(2) identifies critical gaps and emerging priorities for
research and development, including for rapid and point-of-
care diagnostics, shortened treatments and prevention
methods, telehealth solutions for prevention and treatment,
and vaccines; and
``(3) describes research investments by type, funded
entities, and level of investment.
``(k) Evaluation Report.--Not later than 3 years after the
date of the enactment of the End Tuberculosis Now Act of
2023, and 5 years thereafter, the Comptroller General of the
United States shall submit a report to the appropriate
congressional committees that evaluates the performance and
impact on TB prevention, diagnosis, treatment, and care
efforts that are supported by United States bilateral
assistance funding, including recommendations for improving
such programs.''.
______