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25–842PDF 2017

END NEGLECTED TROPICAL DISEASES ACT

MARKUP

BEFORE THE

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, 

GLOBAL HUMAN RIGHTS, AND 

INTERNATIONAL ORGANIZATIONS

OF THE

COMMITTEE ON FOREIGN AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED FIFTEENTH CONGRESS

FIRST SESSION

ON

H.R. 1415

JUNE 15, 2017

Serial No. 115–37

Printed for the use of the Committee on Foreign Affairs

(

Available via the World Wide Web: http://www.foreignaffairs.house.gov/ or

http://www.gpo.gov/fdsys/

(II)

COMMITTEE ON FOREIGN AFFAIRS 

EDWARD R. ROYCE, California, Chairman 

CHRISTOPHER H. SMITH, New Jersey 

ILEANA ROS-LEHTINEN, Florida 

DANA ROHRABACHER, California 

STEVE CHABOT, Ohio 

JOE WILSON, South Carolina 

MICHAEL T. MCCAUL, Texas 

TED POE, Texas 

DARRELL E. ISSA, California 

TOM MARINO, Pennsylvania 

JEFF DUNCAN, South Carolina 

MO BROOKS, Alabama 

PAUL COOK, California 

SCOTT PERRY, Pennsylvania 

RON DESANTIS, Florida 

MARK MEADOWS, North Carolina 

TED S. YOHO, Florida 

ADAM KINZINGER, Illinois 

LEE M. ZELDIN, New York 

DANIEL M. DONOVAN, JR., New York 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

ANN WAGNER, Missouri 

BRIAN J. MAST, Florida 

FRANCIS ROONEY, Florida 

BRIAN K. FITZPATRICK, Pennsylvania 

THOMAS A. GARRETT, JR., Virginia 

ELIOT L. ENGEL, New York 

BRAD SHERMAN, California 

GREGORY W. MEEKS, New York 

ALBIO SIRES, New Jersey 

GERALD E. CONNOLLY, Virginia 

THEODORE E. DEUTCH, Florida 

KAREN BASS, California 

WILLIAM R. KEATING, Massachusetts 

DAVID N. CICILLINE, Rhode Island 

AMI BERA, California 

LOIS FRANKEL, Florida 

TULSI GABBARD, Hawaii 

JOAQUIN CASTRO, Texas 

ROBIN L. KELLY, Illinois 

BRENDAN F. BOYLE, Pennsylvania 

DINA TITUS, Nevada 

NORMA J. TORRES, California 

BRADLEY SCOTT SCHNEIDER, Illinois 

THOMAS R. SUOZZI, New York 

ADRIANO ESPAILLAT, New York 

TED LIEU, California

AMY PORTER, Chief of Staff THOMAS SHEEHY, Staff Director

JASON STEINBAUM, Democratic Staff Director 

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS, AND

INTERNATIONAL ORGANIZATIONS

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MARK MEADOWS, North Carolina 

DANIEL M. DONOVAN, JR., New York 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

THOMAS A. GARRETT, JR., Virginia 

KAREN BASS, California 

AMI BERA, California 

JOAQUIN CASTRO, Texas 

THOMAS R. SUOZZI, New York 

(III)

C O N T E N T S 

Page

MARKUP ON 

H.R. 1415, End Neglected Tropical Diseases Act .................................................. 2

APPENDIX 

Markup notice .......................................................................................................... 22

Markup minutes ...................................................................................................... 23

Markup summary .................................................................................................... 24

(1)

END NEGLECTED TROPICAL DISEASES ACT 

THURSDAY, JUNE 15 , 2017

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,

GLOBAL HUMAN RIGHTS, AND INTERNATIONAL ORGANIZATIONS,

COMMITTEE ON FOREIGN AFFAIRS,

Washington, DC. 

The subcommittee met, pursuant to notice, at 11:30 a.m., in room 

2255 Rayburn House Office Building, Hon. Christopher H. Smith 

(chairman of the subcommittee) presiding. 

Mr. SMITH. The subcommittee will come to order and good morning to everyone. 

Pursuant to notice, we are here this morning to work up Title I 

of H.R. 1415, the End Tropical Diseases Act. 

[The information referred to follows:]

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lli'i'l'H CONGRESS H R 1415 ls•r SBsSIOJ\ fll fll 

To f:wilitate effeetive resear<·h on and treatment of neghwted tropi(·.al disea;;es, 

inchtdiug Ebola, through coordinated domestic and international efforts. 

11\ THE HOUSE CW REPlUJSE.:.J'l'ATlVES 

!VIAR.CH 7, 2017 

}Ir. SMITH of X ew .T ersey (for himself and :Mr. MEEKS) introduet'd the follo>,~ng bill; wl1icl1 was referred to the Committee on l~m:rgy and Comm<>ree. and in ad<lition to the Committees on Foreign Affair~. and Financial Services, for a period to be subsequeHUy determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdirtiOJ1 of tl1c connnittee concerned 

A BILL 

To facilitate effective research on and treatment of neglected 

tropi<'.al diseases, induding Ehola, through eoonlinated 

domestic and international efforts. 

1 Be d enacted by the Senate and House of Representa3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the "End Neglected Trop5 ical Diseases Act''. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of eontents of this Ad is as follows: 

See. 1. Short title. 
3


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See. 

Sec. 

Sec. 

Sec. 

Sec. 

See. 

See. 

See. 

2 

2. Table of contents. 

" •J. Statement of policy. 

4. Findings. 

G. Definition. 

6. Rule of coustruetion. 

TITLE I-FOREIGN AFFAIRS 

101. Expansion of United States Agency for Inten1ational Development's 

Neglected Tropical Diseases Program. 

102. Actions by Department of State 

10:::. Multilateral development and health institutions. 

TITLI£ ll-Dl'JPAKl'l\:!E='JT 011' HEALTH A'lD H\.TJYL'Lf\ SIDRVICES 

Eke. 201. 

:::ke. 202. 

80c:. 2o:cl. 

:::ke. 204. 

Prmnoting 0ffortR through interagency v;orking· groups and ]ntKTnational fon1111R. 

Report on nog·ket~d tropical cliscases in tho U nit0d Stat0s. 

Centers of 0xedknee. 

Pmwl on worm infection solutions. 

1 SEC. 3. STATEMENT OF POLICY. 

2 It is the policy of the United States to support a 

3 broad range of implementation and research and develop4 ment activities that vvork toward the achievement of cost5 effeetive aml sustainable treatment, eontrol aml, vvhere 

6 possible, elimination of neglected tropieal diseases, includ7 ing Ehola, for the eeonomi(~ and soeial well-heing for all 

8 people. 

9 SEC. 4. FINDINGS. 

10 Congress finds the followiug: 

11 (1) The World Health Organization (\,1{0) has 

12 identified 17 negleded tropi("al diseases (NTDs). 

13 Approximately two billion people-almost one-third 

14 of the world's population-are at risk of contracting 

15 au NTD, and more than 1.4 billion people are cur16 rently afflicted \v:ith one or more NTDs. 
4


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:1 

(2) In 201:'3, \,\;riO ~Hloptell a eomprehensive 

2 resolution on NTDs recognizing that increased na3 tional and international investrnentN in prevention 

4 aud control of neglected tropical diseases have suc5 ceeded in improving health and social well-being in 

6 many countries. 

7 (3) NTDs have an enormous impact in terms of 

8 disease burden aml quality of life. NTDs eause the 

9 loss of up to s:H,OOO lives and 57 million disability-

] 0 adjusted life years each year. :.JTDs surpass both 

11 malaria and tuberculosis in causing greater loss of 

12 life-years to disability and premature death. Many 

13 NTDN (~amw llisfigurement and disahility, leading- to 

14 stigma, social diserimination, and soeietal marginali15 zation. 

16 ( 4) NTDs create an eeonomic burdeu of billions 

17 of dollars through the loss of productivity and high 

18 costs of health care required for treatment. People 

19 afflicted by KTDs are less productive than their 

20 healthy emmterparts. NTDs jeopardi~e the ability of 

21 people to attend work and sehool, or to produee at 

22 full eapaeity. For example, eontrolling one NTD, 

23 hookworm, in childrcu can result in a 43-pcrceut in24 crease in future wage earnings. 
5


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4 

( 5) The ~meiaL e(·ononne, and health burden of 

2 NTDs falls priinarily on low- and middle-income 

3 eountries, where H('.(~ess to safe water, sanitation, 

4 and health care is limited. At least 100 countries 

5 face two endemic NTD burdens, and 30 countries 

6 earry six or more endemie N'l'Ds. 

7 (6) NTDs are not confined to the developing 

8 ·world, however. Several NTD outbreaks have been 

9 reported in the United States and other developed 

l 0 countries, especially among the poor. In the rnited 

11 States, NTDs disproportiouately affect people living 

12 in poverty, and espeeially minorities, ineluding np to 

13 2.8 million Airiean-Arnerieans >vith toxo(~ariasis and 

14 :300,000 or more people, mostly Hispanie-A.merieans, 

15 >vith Chagas disease. 

16 (7) ln 2014, an outbreak of Ebola Virus Dis17 eases (Ebola) eaused a pandemic that infected more 

18 than 20,000 people, including more than 8,000 

19 deaths. Although not listed as an NTD by the World 

20 Health Organization, Ehola :-;hares the same eharae21 teristics as other NTDs by affecting people living 

22 "under conditions of poverty'' and is "concentrated 

23 almost exclusively in impoverished populations iu the 

24 developing world". Even \vhen the disease had 

25 spread to the United States and other developed 
6


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eountries, it vvas eontainea and (~ontrolled by the 

2 >veil-equipped health systems in those areas. 

3 ( M) Many KTDs ean he eontrolle!l, preventea, 

4 ancl even eliminated using low-cost, effective, aud 

5 feasible solutions. Understanding the economic bur6 deu of )J'l'Ds on productivity aud health care costs 

7 can help to assure governments and donors that the 

8 resourees aireetea toward )JTDs represent a good 

9 investment. 

l 0 ( 9) Research and development efforts are imme11 diatcly needed for all N'l'Ds, especially those for 

12 which limited or no treatment currently exists. 

13 (10) Critieal to developing robust NTD l'ontrol 

14 strategies are epidemiological data that identify at15 risk populations, ensure appropriate treatment fre16 queney, and inform decisious about wheu treatmeut 

17 can be reduced or stopped. 

18 (11) Of the 14 most common N'l'Ds, roughl.Y 

19 80 percent of infections are caused by soil-trans20 mitted helminths (STTT) and schistosomiasis. STTT 

21 are a group of three parasitic worms (roundworms, 

22 >vhipworms, and hookworms) that afflict more than 

23 one billion people worldwide, iuelmling 600 million 

24 school-age children, of whom more than :300 million 

25 suffer from severe morbidity. Schistosomiasis is an-
7


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6 

other helminth infedion e~ffeeting at least 200 rnil2 lion people in developing countries, but some esti3 me~tes indieate that the true number of people af4 fected may be double or even triple that number. 

5 (12) The main health problems caused by STTT 

6 arc related to thei1· negative effect ou childhood nu7 tritional status, which can cause stunting and wast8 ing. For example, STH infedion may lead to ane9 mia, malabsoqJtion of nutrients, loss of appetite, 

l 0 nan sea, abdominal pain, diarrhea, and reduced food 

11 intake. \Vhcu such health problems arc experienced 

12 in early childhood, a peak gTmvth and development 

13 period, the mental and physi(~al damage-and loss of 

14 future productivity and ~wage-earning potential-~will 

15 likely be irreversible. Sdristosorniasis eauses end16 organ damage to the urinary traet, female genital 

17 tract, liver and intestines. It also results in chronic 

18 health conditions in children. 

19 ( 1:3) STH and schistosomiasis are also particu20 larly detrimental to the health of women of repro21 ductive age and pregnant women. Their underly-ing 

22 poor iron status makes these women most suscep23 tiblc to developing anemia. Iron dcfieicncy anerrua 

24 resulting from hookworm infection during pregnancy 

25 has been linked to poor preg11aney outcomes such as 
8


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7 

prematurity. low hi1i,h weight, and impaired lad.a2 tion. Female genital schistosmiasis may be one of 

3 the most (~ommon gyneeologi(~ (~omlitions in A.:friea 

4 leading· to genital pain, itching, and bleeding aud 

5 markedly increased susceptibility to TITV/ AIDS. 

6 (14) Portunately, there is a simple, cost-effec7 tive solution to STH and schistosomiasis infections: 

8 single-dose rleworming pilh.;; that ean be safely ad9 ministered once or tTvice annually to those at risk. 

l 0 Pharmaceutical eompanies have committed to donate 

11 the drugs needed to treat all at-risk, school-age cllil12 dren in developing emmtries. Reg11lar administration 

13 of deworrning pills reduees morbidity assoeiated with 

14 STH and schistosomiasis infections reducing 

15 prevalenee and transmission rates. 

16 (15) Improved access to water, sanitation, and 

17 hygiene (WASH) can also reduce the transmission of 

18 NTDs, particularly intestinal worms. 

19 (16) The benefits of deworming are immediate 

20 :md enduring. A rigorous randomized controlled trial 

21 has shcnvn school-based deworming treatment to re22 duce school absenteeism by 25 pereent. School-based 

23 deworming also bcucfits young siblings and other 

24 children who live nearby but are too young to be 
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R 

treated, leading to large eognitive improvernento-; 

2 equivalent to half a year of schooling. 

3 SEC. 5. DEFINITION. 

4 ln this Act, the term "neglected tropical diseases" or 

5 "NTDs"-

6 (l) means iufections caused by pathogens, in7 eluding viruses, bacteria, protozoa, and helminths 

8 that disproportionately impaet individuals living in 

9 extreme poverty, especially in developing countries; 

10 and 

11 iucludes12 (A) Buruli ulcer (Mycobacterium lncerans 

13 infeetion): 

14 (B) Chagas disease; 

15 dengue or o-;evere dengue fever; 

16 (D) dracunculiasis (Guinea worm disease); 

17 (E) echinococcosis; 

18 (B') foodbornc trematodiases; 

19 (G) human African tl"}1Janosomiasis (sleep20 ing sickness); 

21 (H) leishmaniasis; 

22 (I) leprosy; 

23 (J) lymphatic filariasis (elephantiasis); 

24 (K) onchocerciasis (river blindness); 

25 (TJ) rabies; 
10


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9 

CVI) sehistosomiasis; 

2 

3 

4 

5 

(N) soil-transmitted helminthiases (STH) 

(round worm, whip worm, and hook worm): 

( 0) taeniasis/cysticercosis; 

(P) trachoma; and 

6 (Q) yaws (endemic trepoucmatoses). 

7 SEC. 6. RULE OF CONSTRUCTION. 

8 Nothing in this Ad shall be emu.;trned to inerease an9 thorizations of appropriations for the United States Agenl 0 cy for International Development or authori:T.ations of ap11 propriatious for the Department of Health and Human 

12 Services. 

13 TITLE I-FOREIGN AFFAIRS 

14 SEC. 101. EXPANSION OF UNITED STATES AGENCY FOR 

15 INTERNATIONAL DEVELOPMENT'S NE· 

16 GLECTED TROPICAL DISEASES PROGRAM. 

17 (a) FIKDINGS.-Congress finds the follmving: 

18 (1) Since fiscal year 200(-J, the United States 

19 Govenunent has been an essential leading partner in 

20 advaneing control and elimination efforts for seven 

21 targeted neglected tropical diseases: lymphatic fila22 r1as1s (elephantiasis), onchocerciasis (river blind23 ness), schistosomiasis, soil-transmitted helminthiases 

24 (STH) (round worm, whip worm, and hook vvorm), 

25 and trachoma. Additional information suggests that 
11


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10 

sueh efforts eonld also produce (•ollateral benefits for 

2 at least three other NTDs: foodborne trematodiases, 

3 S(~ahies, and yaws (endernie treponematoses). 

4 (2) The United States Ageney for International 

5 Development's (rSATD) Neglected Tropical Dis6 cases Program has made importaut and substantial 

7 contributions to the global fight to control and elimi8 nate the seven most eommon ~TDs. lJeveraging 

9 more than $6.7 billion in donated medicines, US~UD 

l 0 has supported the distribution of more than one bil11 lion treatments in 25 countries aeross Africa, -"""sia, 

12 and TJatin America and the Caribbean. 

13 (0) United States Government leadership ha,; 

14 been instrumental in maintaining the g·lobal fight 

15 against ~TDs and i,; a partner in the London De(~-

16 laration on Kegleeted 'l'ropieal Diseases (2012), 

17 which represents a new, coordinated international 

18 push to accelerate progress toward elimiuating or 

19 controlling 10 neglected tropical diseases by 2020. 

20 (4) USATD's Neglected Tropical Diseases Pro21 gram is a clear example of a successful public.-pr:i22 vate partnership between the Government and the 

23 private sector and should be judiciously expanded, as 

24 practic.able and appropriate. 
12


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11 

( 5) \\l1ile many of the mo~t ('ommon KTD~ 

2 have treatments that are safe, easy to use, and effec3 tive, treatment option~ for NTD~ with the highe~t 

4 death rates, inc.luding· human African trypanosomia5 sis, visceral leishmaniasis, and Chagas disease, are 

6 extremely limited. 

7 (6) Since 2014, rSAID's :\feglected Tropical 

8 Di~ea~es Program has heen inve~ting in gathering 

9 research on treatment for ce1tain NTDs to ensure 

l 0 that promising new breakthrough medicines can be 

11 rapidly evaluated, registered, and made available to 

12 patients. 

13 (h) 8E~8E OF CONCJ.RE88.-It i~ the ~en~e of Con14 gress that USAID's :\feglected Tropical Diseases Program 

15 ~honld16 ( 1) provide integrated drug treatment packages 

17 to as many individuals suffering from NTDs or at 

18 risk of acquiring K'l'Ds as logistically feasible; 

19 ( 2) better integrate control and treatment tools 

20 and approaehes for KTDs into complementary devel21 opment and global health programs by eoordinating 

22 aeross multiple sectors, including sectors relating to 

23 HIV/AIDS, malaria, and other infectious diseases 

24 and development seetors relating to education (in25 eluding primary and pre-primary edueation), food 
13


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12 

and nutrition seenrity, maternal and ehilll health, 

2 and water, sanitation, and hygiene CWASH), as 

3 praetieahle and appropriate; 

4 (3) establish low-cost, high-impact community 

5 and sehool-based "\!"TD programs to reach large at6 risk populations, including school-age children who 

7 require treatments for KTDs, w-ith integrated drug 

8 treatment paekages as feasible; 

9 ( '1) for other "\!"TDs, such as human African 

10 tl'}1)anosomiasis (sleeping sickness), Chagas disease, 

11 leishmaniasis, aud dcugue fever, eugagc iu resetu·eh 

12 and development of new tools and approaches to 

13 reaeh the goals relating to the elimination of KTDs 

14 as set forth in the vVorld Health Organization's "Ac15 eelerating \Vork to Overeorne the Global Impad of 

16 Neglected Tropical Diseases: A Roadmap for lmplc17 mentation" (2012), as opportunities emerge andre18 sources allow; and 

19 ( 5) monitor the research on and developments 

20 m the prevention and treatment of other NTDs so 

21 they can be incorporated into the program, as prac22 ticable and appropriate. 

23 (e) PROGl\.AlVl PRI0Rl'l'l1£S.-The Administrator of 

24 USAID should incorporate the follcnving priorities into 

25 USATD's Neglected Tropic.al DiseasPs Program: 
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1:1 

( 1) Planning for and eombwting robust monJ2 toring and evaluation of program investments in 

3 onler to ae<mrately measure irnpaet, illenti(y and 

4 share lessons learued, and inform future N'l'D con5 trol and elimination strategies. 

6 (2) Coordinating program activities with 

7 US~UD development sectors, including development 

8 sedors relating to e!lueation (im~luding primaiy and 

9 pre-primmy educ·ation), food and nutrition security, 

l 0 am1 water, sanitation, and hygiene CWASTT), in 

11 order to advance the goals of the Londou Declara12 tion on Neglected Tropical Diseases (201 

13 (8) Indnding morbidity management 111 treat14 ment plans for high-burden NTDs. 

15 ( 4) Ineorporat.ing :\fTDs that are re('.ognized as 

16 high-burden diseases in the Global Burden of Dis17 ease Study 2010 into the program as opportunities 

18 emerge, to the exteut praetieable and approp1·iate. 

19 ( 5) Continuing investments in research and de20 velopment for new tools, including diag11osties. 

21 drugs, and vaccmes. for KTDs to ensure that new 

22 diseoveries make it through the pipeline and become 

23 available to individuals who need them most. 
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14 

1 SEC. 102. ACTIONS BY DEPARTMENT OF STATE. 

2 (a) OFFICE OF THE GLOB~\L AIDS COORDINATOR.-

3 lt is the sense of Congress that the Coordinator of Cnited 

4 States Government Acth~ties to Combat HIV/ATDS Gloh5 ally should fully consider evolving research 011 the impact 

6 of neglected tropical diseases on efforts to control HIV/ 

7 AIDS when making future prognunrning· deeisions, as ne(~-

8 essary and appropriate. 

9 (b) GLOBAL PROGRAJ\ilVIING.-

10 (1) l~ GEJ\ERAL.-'l'he Secretary of State 

11 should encourage the Global Fund to take into con12 sideration evolv-ing research on the impact of KTDs 

13 on efforts to control HIV/AlDS when making pro14 gramming decisions, particularly ·fvith regard to fe15 male genital schistosomiasis, which has been re16 vealed as one of the rnost significant eo-factors in 

17 the AIDS epiaemie in "'"'liriea, as neeessary and ap18 propr:iate. 

19 (2) GumAT, FTTND.-Tn this subsection, the 

20 term "Global 11\md" means the public-private part21 nership lmovv11 as the Global Fund to Fight ,c\.IDS, 

22 Tnherenlosis and :Yialaria established pursuant to 

23 Aliiele 80 of the Svviss Civil Code. 

24 G-20 COTT~TRTES.-The Secretary of State, aet25 ing through the Office of Global Health Diplomacy, should 

26 encourage G-20 countries, particularly Argentina, Tirazil, 
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15 

China. Imlia, Indonesia. Mexieo, the Republi(~ of Korea. 

2 Saudi Arabia, and South Africa, to significantly increase 

3 their role in the eontrol and elimination of NTDo-L 

4 SEC. 103. MULTILATERAL DEVELOPMENT AND HEALTH IN5 STITUTIONS. 

6 (a) CONGRESSIOl\AL J1'I.'!DlNG.-Congress finds that 

7 the treatment of high burden neglected tropical diseases, 

8 ineluding (~omrnm1ity and sehool-hasea deworming pro9 grams, can be a highly cost-effective education intervenl 0 tion and schools can serve as an effective delivery mecha11 uism for reaching large numbers of children with safe 

12 treatment for soil-transmitted helminthiases (STH) 

13 (ronnd worm. whip worm, and hook worm) in partieular. 

14 (b) UmTED NATIONS.-The President should direct 

15 the rnited StateN permanent representative to the rnited 

16 Nations to usc the voice, vote, and influence of the C uited 

17 States to urge the "World Health Organization and the 

18 United Natious Developmcut Programme to take the ac19 tions described in subsection (d). 

20 (e) WcmT,D DA~K TNSTTTUTE.-The President shall 

21 direct the United States Exeeutive Direetor at the Inter22 national Bank for Reeonstruction and Development to use 

23 the voiee, vote, and influence of the L"nitecl States to urge 

24 the "World Bank Institute to take the actions described 

25 in subsection (d). 
17


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16 

(d) ACTIONS DESCRIBED.-The aetions des(~ribed in 

2 this subsection are the following: 

3 ( 1) Ensure the dissemination of best praetiees 

4 and programming on 1\'l'Ds to governments and 

5 make data accessible to practitioners in an open and 

6 timely fashion. 

7 (2) Highlight impacts of community and schoolS hao-;ed deworrning programs on l'hililren' s health and 

9 education, emphasizing the cost-effectiveness of such 

10 progTams. 

11 Encourage governments to implement 

12 deworming campaig11s at the national level. 

13 ( 4) Designate a portion of gnJ.nt funds of the 

14 institutions to deworming initiatives and cross-sec15 toral (~ollaboration with water and sanitation and hy16 gwne efforts aml nutrition or educatiou program17 ming. 

18 ( 5) Encourage accurate monitoring and cvalua19 tion of NTD programs, including deworming pro20 grams. 

21 ( 6) Engage governments in cross-border initia22 tives for the treatment, control, prevention, and 

23 climiuatiou of :'-JTDs, and assist in developing 

24 transnational agreements, when necessary. 
18

Mr. SMITH. Title I is in jurisdiction of the Committee on Foreign 

Affairs; whereas, Title II is in the Energy and Commerce Committee, so that will have to be done by them and we are pushing 

hard for that to happen. 

I know that the measure is unopposed and no amendments have 

been put forward. 

I also note that the subcommittee will reconvene following this 

markup for a hearing. With other events that have been scheduled 

and upon consultation with Ranking Member Bass and pursuant to 

yesterday’s notice, we intend to consider this bill in an expedited 

manner. 

All members have a copy of H.R. 1415 before them. After we 

have concluded our expedited consideration, I would be glad to recognize any member, including myself and the ranking member, or 

Dr. Bera, since he is serving in that position right now, for any 

statements they might have on the issue. 

All members are given leave to assert written remarks into the 

record, if they so choose. 

Seeing again that we have a reporting quorum present, without 

objection, H.R. 1415, the End Tropical Diseases Act, Title I only, 

is considered as read. 

The Chair moves that it be adopted. 

All those in favor, say aye. 

All those opposed, say no. 

The ayes have it, in the opinion of the Chair. The item is adopted. 

Without objection, the measure is reported favorably to the full 

committee and the staff is directed to make any technical and conforming changes. 

I will just say a few opening comments on this legislation. 

Neglected tropical diseases—and let me just say, too, this is the 

second Congress that we were trying to get this legislation passed. 

We got it out of our full committee last year. Regrettably, it stalled 

in the Energy and Commerce Committee but my hope is that that 

will not be the case this year. 

Neglected tropical diseases are a group of 17 parasitic and bacterial diseases which blind, disable, disfigure, and sometimes kill 

victims from among the more than 1 billion of the world’s poorest 

people, trapping the most marginalized communities into a cycle of 

poverty. These diseases can keep children from attending school 

and their parents from working, and cause excessive bleeding by 

mothers during birth and results often in low birth weight babies. 

NTDs, therefore, constitute a significant hurdle to achieving economic growth and dilute the impact of foreign assistance programs. 

While tropical diseases primarily affect communities in developing countries, outbreaks have been reported in the United States 

and developing countries in recent years, such as the West Nile 

virus, Dengue fever, and most recently Zika. 

The most common NTDs can be controlled and eliminated; however, there is still much work to be done to prepare for currently 

unknown diseases that may appear on the international scene and 

to reach the World Health Organization’s control and elimination 

goals by 2020. 

19

To achieve these goals, heightened support is needed now from 

both new and longstanding partners. H.R. 1415 supports the control and elimination of NTDs in the United States by, among other 

things, supporting USAID’s NTD program to better integrate NTD 

control and elimination efforts with other development issues such 

as HIV/AIDS, malaria, water and sanitation, and education; conduct research and development for improved drugs, diagnostics, 

and vaccines to control or to eliminate NTDs; directing the U.S. 

Government to advocate for increased efforts to address NTDs 

among international institutions, such as the U.N., WHO, and the 

World Bank; calling for the Department of Health and Human 

Services to submit a report on NTDs in the U.S. to better understand the epidemiology, impact, and appropriate funding needed to 

address NTDs domestically; encouraging the creation of one or 

more NTD Centers of Excellence. 

I would note parenthetically that in the year 2000, I authored 

legislation on the issue of autism and the mainstay of the legislation was a series of those Centers of Excellence. And those Centers 

of Excellence and the work that now CDC and NIH do on autism 

has resulted in a major push to try to help those with autism, discover root causes, and to promote early childhood intervention and 

it came out of those Centers of Excellence. So this could be a game 

changer, we think, in a game that has to be changed for the sake 

of the poor and marginalized communities. 

It also would establish a panel on intestinal worm infections to 

evaluate and make recommendations regarding potential solutions 

to worm infections, which impact more than 1 billion people worldwide, including 600 million school-aged children. 

Secretary of State Rex Tillerson told the Foreign Affairs Committee, full committee, yesterday that the administration was committed to remaining a leader in areas including global health. They 

can demonstrate that commitment by continuing to support the 

work done by CDC and the National Institutes of Health, and the 

U.S. Agency for International Development. And I do believe that 

as we move forward on this budget, those gaping cuts will not materialize. And I know I and others will work hard to ensure that 

we do more, in some cases, rather than less. 

It is long past time for Congress to affirm this work, particularly 

in the area of NTDs. And I want to thank Ranking Member Bass, 

Congressmen Dan Donovan, Gregory Meeks, Sanford Bishop, and 

Eleanor Holmes Norton for joining us as early cosponsors of this 

legislation. 

And I would like to yield to Dr. Bera, if he has any comments 

he would like to make. 

Mr. BERA. Great. Thank you, Mr. Chairman. I will keep my comments brief but I think this is an important piece of legislation. I 

look at this as a physician who has worked overseas. 

And you know we don’t always think about neglected tropical 

diseases. The folks sitting around the table at home may not be 

talking about schistosomiasis or trachoma but the truth is, these 

are diseases that affect millions around the world. And the reason 

why investing in this research and looking for cures are so important, it is a reflection of not only our values, as a nation, to engage 

with our allies and other like-valued countries around the world to 

20

relieve suffering, we also know that the world is much more interconnected today. 

You know diseases that emerge much like Ebola a few years ago 

or Zika in one part of the world certainly move and spread. So, we 

can’t just think about how we address health and disease here in 

the United States. We have also got to go where those diseases are 

and look for those discoveries. 

So you know it is my hope that this moves quickly through the 

full committee and to the floor of the House. And, again, it is a reflection of who we are as a nation, our values to be concerned and 

focus on that suffering around the world. 

So, thank you, Mr. Chairman. I will yield back. 

Mr. SMITH. Thank you, Dr. Bera. 

Mr. Donovan. 

Mr. DONOVAN. Thank you, Mr. Chairman. I just want to take a 

moment to thank you for your leadership in this area. I mean global health has become a great interest of mine since I got here 2 

years ago. We deal daily with the preventable diseases throughout 

the world. 

As Dr. Bera says, we are a compassionate, leading Nation. We 

outsource our abilities to help others. As he also mentioned, because of the ability for people to travel, many diseases that may 

not affect our Nation now because people traveling to our country 

affect us as well but, through our compassion and leadership, this 

Nation should do everything it can to relieve other countries of diseases that are preventable and nonexistent in our own country. 

You have been a leader in this area for so many, many years, I 

just wanted to thank you, Mr. Chairman, and I thank my colleague 

for supporting this legislation. 

Mr. SMITH. Thank you very much. Mr. Suozzi. 

Mr. SUOZZI. I will associate my remarks with everything that has 

been said already and thank you for your leadership. Thank you. 

Mr. SMITH. Well, thank you. Mr. Garrett. 

Mr. GARRETT. Thank you, Mr. Chairman. Very briefly, I think 

budget hawks might look at this and wonder what the purview was 

of this organization as it relates to this action. I would answer 

them by saying it is difficult, if not impossible, to separate global 

health from American health; that in a world with intercontinental 

travel, in a world that shrinks by the day conceptually, the idea to 

combat these NTDs abroad, rather than at home, might parallel 

the hawkish line that some take on the War on Terror. 

I would associate myself with the gamut of individuals on this 

committee and submit that, while it is not just being a good neighbor, it is also being a good tenant in our home and this is good policy at every level. Thank you. 

Mr. SMITH. Mr. Garrett, thank you so very much. 

Thanks to all the members of the subcommittee for their support 

and their excellent remarks. Without further ado, the markup is 

concluded. 

[Whereupon, at 11:53 a.m., the subcommittee was adjourned.] 

(21)

A P P E N D I X 

MATERIAL SUBMITTED FOR THE RECORD

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SUBCOMMITTEE MARKlJP NOTICE 

COMMITTEE ON FOREIGN AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

WASHINGTON, DC 20515-6128 

Subcommittee on Africa, Global Health, Global Human Rights, and International 

Organizations 

Christopher H. Smith (R-NJ), Chairman 

June 15, 2017 

TO: MEMBERS Oil THE COMMITTEE ON FOREIGN AFFAIRS 

You are respectfully requested to attend an OPEN meeting of the Subcommittee on 

Atfica, Global Health, Global Human Rights, and International Organizations, to be held in 

Room 2255 of the Rayburn House Office Building (and available live on the Committee website 

at http://www.ForeignA±Tairs.house.gov) 

DATE: Thursday, June 15,2017 

TIME: 11:30 a.m. 

MARKUP OF: HR. 1415, End Neglected Tropical Diseases Act 

By Direction of the Chairman 
23

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25842m.eps

COMMITTEE ON FOREIGN AFFAIRS 

MINUTES OF SUBCOMMIHEE MARKUP 

MINUTES OF SUBCOMMIHEE ON Afi'ica, Global Ilea/tit, G/ob'tl Human Rights, and lnte MARKUP 

Day Thur.l'day _Date. ·-"-J."'m"'te"-""-15,,'-'2"'0"'1"'-7-_Room 2255 Ravbm·n HOB 

Starting Time. 11:_43 a.m. Ending Time 11:53 a.m. 

Recesses ~~( __ to __ ) ( __ to __ )( __ to __ ) L__to __ )(~to __ ) L_to __ ) 

Pr·e,•iding Member(•) 

Rep. Chds Smith 

Chec!< all of tile following that app{J•: 

Open Session [2] 

Executive (closed) Session D 

Televised [2] 

F-lec!r'ollically Recorded (taped) [2] 

Stenographic Record [l] 

RILLS FOR MARKUP: (fnc/ude bill mmtber(\) and fit/e('J of legis/a/ion.) 

H.R. 1415, End Neglected Tropical Diseases Act 

COMMI1TJ£J<; MBMllERS PRESENT: 

Rep. F. James Seuseubt·emzer, Jr., Rep. Daniel Donovan, Rep. Ami Eel'((, Rep. Thomas Suozzi 

NON-COMMITTEE MEMBERS PRESENT: 

STATEMENTS FOR THE RECORD: (List any statements submitled for the record) 

ACTIONS TAKEN DURING THE MARKUP: (AIIaclt copies u(le)?is/ation wtd amendmeuls.) 

H.R. 1415 pit.l'.,etl by voice vote fVas referred to the full committee ovitlumt mnendmet1l. 

UJ<:COUUIW VOTicS TAKEN (FOR MARKUP): (Aitac!tfina! vote tally sheet listing each member.) 

TIME SCHEDULED TO RECONVENE----

01' 

TIME AD.TOURNED II· B a m 
24

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25842s.eps

6/15/17 Subcommittee ou Africa, Global Health, Global Human Rights, aud Iuteruatioual 

Organizations Markup Summary 

1) H.R. 1415 (Smith NJ), "End Neglected Tropical Diseases Act" 

H.R. 1415 was agreed to by voice vote and the Chairman ordered the measure favorably reported 

to the Full Committee by unanimous consent 

The subcommittee adjourned.