[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

[[Page S2482]]

     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.''.
                                 ______