[Congressional Record (Bound Edition), Volume 154 (2008), Part 15]
[House]
[Pages 20285-20288]
[From the U.S. Government Publishing Office, www.gpo.gov]




           COMPREHENSIVE TUBERCULOSIS ELIMINATION ACT OF 2008

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1532) to amend the Public Health Service Act with respect to 
making progress toward the goal of eliminating tuberculosis, and for 
other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 1532

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the 
     ``Comprehensive Tuberculosis Elimination Act of 2008''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

[[Page 20286]]

 TITLE I--DEPARTMENT OF HEALTH AND HUMAN SERVICES IN COORDINATION WITH 
 THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND OTHER APPROPRIATE 
                                AGENCIES

      Subtitle A--National Strategy for Combating and Eliminating 
                              Tuberculosis

Sec. 101. National strategy.

                 Subtitle B--Interagency Collaboration

Sec. 111. Advisory Council for Elimination of Tuberculosis and the 
              Federal Tuberculosis Task Force .

          Subtitle C--Evaluation of Public Health Authorities

Sec. 121. Evaluation of public health authorities.

              Subtitle D--Authorization of Appropriations

Sec. 131. Authorizations of appropriations.

                TITLE II--NATIONAL INSTITUTES OF HEALTH

Sec. 201. Research and development concerning tuberculosis.

 TITLE I--DEPARTMENT OF HEALTH AND HUMAN SERVICES IN COORDINATION WITH 
 THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND OTHER APPROPRIATE 
                                AGENCIES

      Subtitle A--National Strategy for Combating and Eliminating 
                              Tuberculosis

     SEC. 101. NATIONAL STRATEGY.

       Section 317E of the Public Health Service Act (42 U.S.C. 
     247b-6) is amended--
       (1) by striking the heading for the section and inserting 
     the following: ``national strategy for combating and 
     eliminating tuberculosis'';
       (2) by amending subsection (b) to read as follows:
       ``(b) Research and Development; Demonstration Projects; 
     Education and Training.--With respect to the prevention, 
     treatment, control, and elimination of tuberculosis, the 
     Secretary may, directly or through grants to public or 
     nonprofit private entities, carry out the following:
       ``(1) Research, with priority given to research and 
     development concerning latent tuberculosis infection, strains 
     of tuberculosis resistant to drugs, and research concerning 
     cases of tuberculosis that affect certain populations at risk 
     for tuberculosis.
       ``(2) Research and development and related activities to 
     develop new tools for the elimination of tuberculosis, 
     including drugs, diagnostics, vaccines, and public health 
     interventions, such as directly observed therapy and non-
     pharmaceutical intervention, and methods to enhance detection 
     and response to outbreaks of tuberculosis, including 
     multidrug resistant tuberculosis. The Secretary is encouraged 
     to give priority to programmatically relevant research so 
     that new tools can be utilized in public health practice.
       ``(3) Demonstration projects for--
       ``(A) the development of regional capabilities to prevent, 
     control, and eliminate tuberculosis and prevent multidrug 
     resistant and extensively drug resistant strains of 
     tuberculosis;
       ``(B) the intensification of efforts to reduce health 
     disparities in the incidence of tuberculosis;
       ``(C) the intensification of efforts to control 
     tuberculosis along the United States-Mexico border and among 
     United States-Mexico binational populations, including 
     through expansion of the scope and number of programs that--
       ``(i) detect and treat binational cases of tuberculosis; 
     and
       ``(ii) treat high-risk cases of tuberculosis referred from 
     Mexican health departments;
       ``(D) the intensification of efforts to prevent, detect, 
     and treat tuberculosis among foreign-born persons who are in 
     the United States;
       ``(E) the intensification of efforts to prevent, detect, 
     and treat tuberculosis among populations and settings 
     documented as having a high risk for tuberculosis; and
       ``(F) tuberculosis detection, control, and prevention.
       ``(4) Public information and education activities.
       ``(5) Education, training, clinical skills improvement 
     activities, and workplace exposure prevention for health 
     professionals, including allied health personnel and 
     emergency response employees.
       ``(6) Support of Centers to carry out activities under 
     paragraphs (1) through (4).
       ``(7) Collaboration with international organizations and 
     foreign countries in carrying out such activities.
       ``(8) Develop, enhance, and expand information technologies 
     that support tuberculosis control including surveillance and 
     database management systems with cross-jurisdictional 
     capabilities, which shall conform to the standards and 
     implementation specifications for such information 
     technologies as recommended by the Secretary.''; and
       (3) in subsection (d), by adding at the end the following:
       ``(3) Determination of amount of nonfederal 
     contributions.--
       ``(A) Priority.--In awarding grants under subsection (a) or 
     (b), the Secretary shall give highest priority to an 
     applicant that provides assurances that the applicant will 
     contribute non-Federal funds to carry out activities under 
     this section, which may be provided directly or through 
     donations from public or private entities and may be in cash 
     or in kind, including equipment or services.
       ``(B) Federal amounts not to be included as 
     contributions.--Amounts provided by the Federal Government, 
     or services assisted or subsidized to any significant extent 
     by the Federal Government, may not be included in determining 
     the amount of non-Federal contributions as described in 
     subparagraph (A).''.

                 Subtitle B--Interagency Collaboration

     SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF TUBERCULOSIS 
                   AND THE FEDERAL TUBERCULOSIS TASK FORCE.

       (a) In General.--Section 317E(f) of the Public Health 
     Service Act (42 U.S.C. 247b-6(f)) is amended--
       (1) by redesignating paragraph (5) as paragraph (6); and
       (2) by striking paragraphs (2) through (4), and inserting 
     the following:
       ``(2) Duties.--The Council shall provide advice and 
     recommendations regarding the elimination of tuberculosis to 
     the Secretary. In addition, the Council shall, with respect 
     to eliminating such disease, provide to the Secretary and 
     other appropriate Federal officials advice on--
       ``(A) coordinating the activities of the Department of 
     Health and Human Services and other Federal agencies that 
     relate to the disease, including activities under subsection 
     (b);
       ``(B) responding rapidly and effectively to emerging issues 
     in tuberculosis; and
       ``(C) efficiently utilizing the Federal resources involved.
       ``(3) Comprehensive plan.--
       ``(A) In general.--In carrying out paragraph (2), the 
     Council shall make or update recommendations on the 
     development, revision, and implementation of a comprehensive 
     plan to eliminate tuberculosis in the United States.
       ``(B) Consultation.--In carrying out subparagraph (A), the 
     Council may consult with appropriate public and private 
     entities, which may, subject to the direction or discretion 
     of the Secretary, include--
       ``(i) individuals who are scientists, physicians, 
     laboratorians, and other health professionals, who are not 
     officers or employees of the Federal Government and who 
     represent the disciplines relevant to tuberculosis 
     elimination;
       ``(ii) members of public-private partnerships or private 
     entities established to address the elimination of 
     tuberculosis;
       ``(iii) members of national and international 
     nongovernmental organizations whose purpose is to eliminate 
     tuberculosis;
       ``(iv) members from the general public who are 
     knowledgeable with respect to tuberculosis elimination 
     including individuals who have or have had tuberculosis; and
       ``(v) scientists, physicians, laboratorians, and other 
     health professionals who reside in a foreign country with a 
     substantial incidence or prevalence of tuberculosis, and who 
     represent the specialties and disciplines relevant to the 
     research under consideration.
       ``(C) Certain components of plan.--In carrying out 
     subparagraph (A), the Council shall, subject to the direction 
     or discretion of the Secretary--
       ``(i) consider recommendations for the involvement of the 
     United States in continuing global and cross-border 
     tuberculosis control activities in countries where a high 
     incidence of tuberculosis directly affects the United States; 
     and
       ``(ii) review the extent to which progress has been made 
     toward eliminating tuberculosis.
       ``(4) Biennial report.--
       ``(A) In general.--The Council shall submit a biennial 
     report to the Secretary, as determined necessary by the 
     Secretary, on the activities carried under this section. Each 
     such report shall include the opinion of the Council on the 
     extent to which its recommendations regarding the elimination 
     of tuberculosis have been implemented, including with respect 
     to--
       ``(i) activities under subsection (b); and
       ``(ii) the national plan referred to in paragraph (3).
       ``(B) Public.--The Secretary shall make a report submitted 
     under subparagraph (A) public.
       ``(5) Composition.--The Council shall be composed of--
       ``(A) ex officio representatives from the Centers for 
     Disease Control and Prevention, the National Institutes of 
     Health, the United States Agency for International 
     Development, the Agency for Healthcare Research and Quality, 
     the Health Resources and Services Administration, the United 
     States-Mexico Border Health Commission, and other Federal 
     departments and agencies that carry out significant 
     activities related to tuberculosis;
       ``(B) State and local tuberculosis control and public 
     health officials;
       ``(C) individuals who are scientists, physicians, 
     laboratorians, and other health professionals who represent 
     disciplines relevant to tuberculosis elimination; and
       ``(D) members of national and international nongovernmental 
     organizations established to address the elimination of 
     tuberculosis.''.

[[Page 20287]]

       (b) Rule of Construction Regarding Current Membership.--
     With respect to the advisory council under section 317E(f) of 
     the Public Health Service Act, the amendments made by 
     subsection (a) may not be construed as terminating the 
     membership on such council of any individual serving as such 
     a member as of the day before the date of the enactment of 
     this Act.
       (c) Federal Tuberculosis Task Force.--Section 317E of the 
     Public Health Service Act (42 U.S.C. 247b-6) is amended--
       (1) by redesignating subsection (g) as subsection (h); and
       (2) by inserting after subsection (f) the following 
     subsection:
       ``(g) Federal Tuberculosis Task Force.--
       ``(1) Duties.--The Federal Tuberculosis Task Force (in this 
     subsection referred to as the `Task Force') shall provide to 
     the Secretary and other appropriate Federal officials advice 
     on research into new tools under subsection (b)(2), including 
     advice regarding the efficient utilization of the Federal 
     resources involved.
       ``(2) Comprehensive plan for new tools development.--In 
     carrying out paragraph (1), the Task Force shall make 
     recommendations on the development of a comprehensive plan 
     for the creation of new tools for the elimination of 
     tuberculosis, including drugs, diagnostics, and vaccines.
       ``(3) Consultation.--In developing the comprehensive plan 
     under paragraph (1), the Task Force shall consult with 
     external parties including representatives from groups such 
     as--
       ``(A) scientists, physicians, laboratorians, and other 
     health professionals who represent the specialties and 
     disciplines relevant to the research under consideration;
       ``(B) members from public-private partnerships, private 
     entities, or foundations (or both) engaged in activities 
     relevant to research under consideration;
       ``(C) members of national and international nongovernmental 
     organizations established to address tuberculosis 
     elimination;
       ``(D) members from the general public who are knowledgeable 
     with respect to tuberculosis including individuals who have 
     or have had tuberculosis; and
       ``(E) scientists, physicians, laboratorians, and other 
     health professionals who reside in a foreign country with a 
     substantial incidence or prevalence of tuberculosis, and who 
     represent the specialties and disciplines relevant to the 
     research under consideration.''.

          Subtitle C--Evaluation of Public Health Authorities

     SEC. 121. EVALUATION OF PUBLIC HEALTH AUTHORITIES.

       (a) In General.--Not later than 180 days after the date of 
     enactment of the Comprehensive Tuberculosis Elimination Act 
     of 2008, the Secretary of Health and Human Services shall 
     prepare and submit to the appropriate committees of Congress 
     a report that evaluates and provides recommendations on 
     changes needed to Federal and State public health authorities 
     to address current disease containment challenges such as 
     isolation and quarantine.
       (b) Contents of Evaluation.--The report described in 
     subsection (a) shall include--
       (1) an evaluation of the effectiveness of current policies 
     to detain patients with active tuberculosis;
       (2) an evaluation of whether Federal laws should be 
     strengthened to expressly address the movement of individuals 
     with active tuberculosis; and
       (3) specific legislative recommendations for changes to 
     Federal laws, if any.
       (c) Update of Quarantine Regulations.--Not later than 240 
     days after the date of enactment of this Act, the Secretary 
     of Health and Human Services shall promulgate regulations to 
     update the current interstate and foreign quarantine 
     regulations found in parts 70 and 71 of title 42, Code of 
     Federal Regulations.

              Subtitle D--Authorization of Appropriations

     SEC. 131. AUTHORIZATIONS OF APPROPRIATIONS.

       Section 317E of the Public Health Service Act, as amended 
     by section 111(c) of this Act, is amended by striking 
     subsection (h) and inserting the following:
       ``(h) Authorization of Appropriations.--
       ``(1) General program.--
       ``(A) In general.--For the purpose of carrying out this 
     section, there are authorized to be appropriated $200,000,000 
     for fiscal year 2009, $210,000,000 for fiscal year 2010, 
     $220,500,000 for fiscal year 2011, $231,525,000 for fiscal 
     year 2012, and $243,101,250 for fiscal year 2013.
       ``(B) Reservation for emergency grants.--Of the amounts 
     appropriated under subparagraph (A) for a fiscal year, the 
     Secretary may reserve not more than 25 percent for emergency 
     grants under subsection (a) for any geographic area, State, 
     political subdivision of a State, or other public entity in 
     which there is, relative to other areas, a substantial number 
     of cases of tuberculosis, multidrug resistant tuberculosis, 
     or extensively drug resistant tuberculosis or a substantial 
     rate of increase in such cases.
       ``(C) Priority.--In allocating amounts appropriated under 
     subparagraph (A), the Secretary shall give priority to 
     allocating such amounts for grants under subsection (a).
       ``(D) Allocation of funds.--
       ``(i) Requirement of formula.--Of the amounts appropriated 
     under subparagraph (A), not reserved under subparagraph (B), 
     and allocated by the Secretary for grants under subsection 
     (a), the Secretary shall distribute a portion of such amounts 
     to grantees under subsection (a) on the basis of a formula.
       ``(ii) Relevant factors.--The formula developed by the 
     Secretary under clause (i) shall take into account the level 
     of tuberculosis morbidity and case complexity in the 
     respective geographic area and may consider other factors 
     relevant to tuberculosis in such area.
       ``(iii) No change to formula required.--This subparagraph 
     does not require the Secretary to modify the formula that was 
     used by the Secretary to distribute funds to grantees under 
     subsection (a) for fiscal year 2009.
       ``(2) Limitation.--The authorization of appropriations 
     established in paragraph (1) for a fiscal year is effective 
     only if the amount appropriated under such paragraph for such 
     year equals or exceeds the amount appropriated to carry out 
     this section for fiscal year 2009.''.

                TITLE II--NATIONAL INSTITUTES OF HEALTH

     SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING TUBERCULOSIS.

       Subpart 2 of part C of title IV of the Public Health 
     Service Act (42 U.S.C. 285b et seq.) is amended by inserting 
     after section 424B the following section:

     ``SEC. 424C. TUBERCULOSIS.

       ``(a) In General.--The Director of the National Institutes 
     of Health may expand, intensify, and coordinate research and 
     development and related activities of the Institutes with 
     respect to tuberculosis including activities toward the goal 
     of eliminating such disease.
       ``(b) Certain Activities.--Activities under subsection (a) 
     may include--
       ``(1) enhancing basic and clinical research on 
     tuberculosis, including drug resistant tuberculosis;
       ``(2) expanding research on the relationship between such 
     disease and the human immunodeficiency virus; and
       ``(3) developing new tools for the elimination of 
     tuberculosis, including public health interventions and 
     methods to enhance detection and response to outbreaks of 
     tuberculosis, including multidrug resistant tuberculosis.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Burgess) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and to 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  I rise in support of H.R. 1532, the Comprehensive Tuberculosis 
Elimination Act--a bill to amend and reauthorize the preventative 
health services regarding tuberculosis.
  Tuberculosis causes more deaths than any other infectious disease 
caused by a single microorganism with approximately 1.6 million people 
worldwide succumbing to the disease each year. While the U.S. has done 
well in combating the disease in the past, the global burden continues 
to be high, and the emergence of drug-resistant tuberculosis has added 
a new level of difficulty to the problem.
  The bill before us recognizes these issues by creating a Federal 
tuberculosis task force, by modifying the structure and duties of the 
Advisory Council for the Elimination of Tuberculosis and by encouraging 
the director of the National Institutes of Health to expand, intensify 
and coordinate research and development activities with respect to 
tuberculosis.

                              {time}  2015

  All of these efforts will steer us closer to the final goal of the 
elimination of tuberculosis.
  I want to acknowledge my colleague on the Energy and Commerce 
Committee, Congressman Gene Green of Texas, for his leadership on this 
issue. This bill was negotiated in a bipartisan and bicameral fashion. 
I am proud to support it. I urge my colleagues to do the same.
  Mr. Speaker, I reserve the balance of my time.

[[Page 20288]]


  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  I rise in support of H.R. 1532, the Comprehensive Tuberculosis 
Elimination Act of 2008.
  I certainly want to join in commending Congressman Gene Green, 
Congresswoman Tammy Baldwin, and Congresswoman Heather Wilson for their 
work on this bill.
  This bill revises the national strategy to combat tuberculosis at the 
Centers for Disease Control. The Centers for Disease Control provides 
leadership and assistance to domestic and international efforts to 
prevent, control and eliminate tuberculosis.
  Despite the lower incidence rate of tuberculosis in 2007, according 
to the Centers for Disease Control, the average annual percentage 
decline in the tuberculosis rate slowed from just over 7 percent per 
year in the 1993 to 2000 range to under 4 percent from 2000 to 2007.
  The high global burden of this disease, coupled with continued 
problems of drug-resistant strains and lack of better tools for 
tuberculosis control, threatens our ability to eliminate tuberculosis 
in the United States. The Centers for Disease Control's national TB 
program provides grants to States and other entities for prevention and 
control services, researches the prevention and control of 
tuberculosis, funds demonstration projects, sponsors public information 
and education programs and supports education training and clinical 
skills improvement activities to address tuberculosis.
  This bill will help in the noble goal of continuing to try to 
eradicate this disease. I do urge Members to support this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I have no further requests for time. I 
would urge support of this tuberculosis act and yield back the balance 
of my time.
  Mr. GREEN of Texas. Mr. Speaker, I rise today in support of H.R. 
1532, the Comprehensive Tuberculosis Elimination Act of 2008.
  If you think that TB is a disease that occurs in impoverished nations 
you are wrong. In 2007, more than 13,000 individuals were diagnosed 
with TB in the U.S.
  This year alone my district had several TB outbreaks and in May, 150 
people were exposed to TB in an outbreak and 19 individuals were 
diagnosed with TB.
  Each year approximately 9 million people develop active TB and 1.7 
million die of the disease, making it the second deadliest in the 
world. Right now one third of the world's population is infected with 
TB and TB will claim 30 million lives over the next decade.
  With time, the TB germ has changed. It is now airborne and drug 
resistant strains have been found in 46 countries, including the U.S.
  In 2006, 91 cases of multi drug-resistant TB were reported in the 
United States and MDR-TB has been reported in 49 states. From 1993 to 
2007, there were 88 cases of extensively drug resistant TB in the U.S., 
which is resistant to almost all drugs used to treat TB.
  Unfortunately, we have allowed the treatment and diagnostic tools to 
treat TB go without updating for far too long. In fact, the most common 
test to diagnose TB is more than 100 years old.
  The drugs commonly used to treat TB are more than 40 years old, the 
TB vaccine we currently have is more than 85 years old and only 
provides some protections against severe TB in children, but is 
unreliable in protecting against the most common form of adult TB.
  The Comprehensive Tuberculosis Elimination Act addresses the issue of 
domestic TB by improving and increasing efforts to prevent, detect, and 
treat individuals in our country with TB.
  It would authorize grants within the CDC for research, development, 
and education. These grants include clinical trials to evaluate new 
drugs, diagnostics and vaccines; studies of at-risk populations; and 
projects to control TB along the U.S.-Mexico border.
  H.R. 1532 will reauthorize the Advisory Council on the Elimination of 
TB so the council may coordinate federal TB control and develop a new 
national plan to eliminate TB in the U.S.
  H.R. 1532 also provides for new tools in the fight against domestic 
TB by providing for CDC research and development for new drugs, 
diagnostics, and vaccines.
  The bill also directs the NIH to expand basic and clinical TB 
research and develop a TB vaccine.
  The Comprehensive Tuberculosis Elimination Act provides the means 
necessary to wage war against TB in the U.S. and hopefully in the 
future the eradication of TB in this country.
  Mr. BURGESS. I also have no further requests for time, and I will 
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. Pallone) that the House suspend the 
rules and pass the bill, H.R. 1532, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BURGESS. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.
  The point of no quorum is considered withdrawn.

                          ____________________